Contraception is often discussed as though the question is simply whether people can access a method. But access begins much earlier than the point at which someone walks into a clinic or pharmacy. It begins with a much more fundamental question: What options are actually being developed in the first place?
A recent webinar we attended titled Why Contraceptive Innovation is so Hard, and What Keeps Developers Committed, and hosted by the Contraceptive Technology Innovation (CTI) Exchange and Impact Global Health, brought this question into sharp focus.
The webinar was moderated by Emily Hoppes, and the session opened with Cécile Ventola of Impact Global Health taking participants through current trends in contraceptive research and development (R&D), before moving into a panel discussion featuring three voices from very different corners of the field: Dr. Lanita Dorflinger, a contraceptive R&D expert with over 35 years of experience, most recently at FHI 360; Dr. Leo Hahn, an OBGYN and translational researcher at Oregon Health and Science University; and Dr. Laura Hertel, founder and CEO of a biotech startup developing non-hormonal male contraception.
Together, their conversation offered an opportunity to look beyond the contraceptive methods currently available and examine the forces shaping what may become available in the future.
One of the clearest messages, echoed across both the data presentation and the panel, was that innovation is not simply about creating more contraceptives. It is about creating better choices.
Cécile opened with a number worth sitting with: 138 contraceptive products are currently under active development globally. Of these, 43% remain in pre-clinical stages, 32% are in some phase of clinical development (split across Phase I at 30%, Phase II at 43%, and Phase III at just 23% of that clinical share), 21% are still at the discovery stage, and only 4% have reached post-approval. By intended duration, short-acting methods dominate the pipeline with 57 active products, followed by long-acting methods at 33, with permanent methods trailing far behind at just 7.
She framed the current moment around five key trends: improving existing methods, expanding non-hormonal options, advancing on-demand contraception, diversifying contraceptive R&D more broadly, and planning earlier for introduction and scale rather than treating that as an afterthought once a product is already approved.
For many years, contraceptive development has largely revolved around improving existing hormonal and long-acting methods. However, the R&D landscape is beginning to show greater interest in alternatives that respond to different preferences and experiences.
Non-hormonal contraception is one example. According to Impact Global Health's G-FINDER analysis, which has tracked global health R&D investment since 2007 through a low- and middle-income country lens, funding for non-hormonal contraceptive methods rose from roughly 17% of contraceptive R&D funding in 2018 to 48% in 2024. Funding for user-controlled methods showed a similar climb, and in a live poll during the session, 71% of attendees correctly identified that user-controlled funding had been increasing over that period, while 70% correctly identified the same upward trend for non-hormonal methods. The room, in other words, had a good read on the direction of travel.
What they were less accurate about was where the money actually concentrates today. When Cécile polled attendees on which method duration received the majority of 2024 funding, 67% guessed long-acting reversible contraception (LARC). The actual answer was short-acting methods, at 42% of funding, most of it directed toward drug R&D. LARC funding has in fact been declining over time, and permanent and on-demand methods continue to receive very little investment of any kind. It was a small moment in the session, but a telling one: even people closely following this field can carry assumptions about where resources go that don't quite match reality.
But Who is Paying for this Innovation?
This is where the conversation becomes more complicated.
Despite encouraging developments in the types of products being explored, the overall funding picture is concerning. To put the scale of underinvestment in perspective, Cécile shared a comparison I haven't been able to stop thinking about: in 2024, malaria R&D received $736 million, compared to just $124 million for contraception. For every $1 invested in malaria research, only $0.19 goes toward contraception and multipurpose prevention technologies (MPTs) combined. Contraception funding also sat well below funding for sexually transmitted infections ($279 million) and comparably to other "non-issue-specific" sexual and reproductive health funding ($280 million).
Funding for MPTs specifically has fared even worse, falling to around $15-16 million in 2024, a decline of nearly 80% from 2018 levels.
The issue is not merely how much money exists, but where that money comes from and how dependent the field is on a small number of funders. Nearly 90% of contraceptive R&D funding between 2018 and 2024 came from three sources: the Gates Foundation, the US National Institutes of Health (NIH), and the pharmaceutical and biotech industry. Industry funding alone declined by 63% over that period, the single largest driver of the overall funding drop.
Such concentration creates vulnerability. When a small number of institutions determine a large proportion of the resources available for research, changes in their priorities can have consequences across the entire development pipeline. And those consequences are not theoretical. They are already visible in 2025.
If the 2018–2024 data painted a concerning picture, Cécile's look toward 2025 was more alarming still. Combined funding from Gates, NIH, and USAID is trending further downward, and some of it has stopped entirely. Gates Foundation and NIH funding combined fell 17% in 2025, down to $82 million from $100 million in 2024. USAID funding, meanwhile, has dropped to zero.
That detail landed heavily in the room. USAID has historically been one of the funders supporting later-stage clinical development, the expensive, high-risk phase where promising candidates either advance toward real products or quietly stall for lack of resources. Its absence doesn't just shrink the funding pool; it removes a specific kind of support at a specific, critical point in the pipeline.
Cécile's own conclusion drew four threads together plainly: funding trends are moving downward, especially for MPTs; the pool of funders is dangerously limited, leaving the field vulnerable, with the impact of USAID's withdrawal already significant; R&D is genuinely becoming more responsive to unmet needs and user preferences; and all of this still depends on sustained, diversified funding actually materializing to carry products to completion.
One of the most important insights from Cécile's presentation is that developing a contraceptive is not simply about discovering an interesting scientific idea. A promising candidate must survive multiple stages of research, testing, and clinical development before it can become a product that people can actually use.
Yet much of the available funding remains concentrated in the earlier stages. Discovery and preclinical research has consistently absorbed between 32% and 43% of contraceptive R&D funding over the 2018–2024 period. There has been some encouraging late-stage movement in recent years, with Phase III funding reaching 12.5% in 2024 compared to almost none in 2021, but that movement has been supported specifically by US NIH, USAID, CIFF, and industry funders whose current trajectories, as the 2025 data show, are anything but secure.
This matters because the later stages are often among the most expensive and demanding parts of development. A promising method can therefore exist for years as a scientific possibility without becoming a practical contraceptive option. The implication is clear: Innovation needs continuity.
Funding a promising idea is not enough. There must also be sustained investment to help that idea move from discovery, through clinical trials, and ultimately toward scale.
This was precisely the challenge Dr. Lanita Dorflinger chose to illustrate when the panel turned to her.
When asked to describe a particularly challenging moment in her 43-year career, spent first at USAID and then 34 and a half years at FHI 360, Lanita didn't point to a single failed experiment. She pointed to formulation itself: the sheer difficulty of engineering a product to meet a Target Product Profile, or TPP, especially for longer-acting methods like injectables, microarray patches, or biodegradable implants.
She walked the panel through FHI 360's work on a biodegradable implant, a product designed to sit between current injectables and implants, lasting 18 to 24 months, biodegrading in place with no need for removal, and offering a short "tail" so that fertility returns quickly once the product's effective life ends. On paper, that's a reasonable set of specifications. In the lab, it's an extraordinarily complex engineering problem.
What struck me most was the timeline. Research on biodegradable implants began over 40 years ago, in the 1980s. FHI 360 itself started working on one specific version in the late 1990s and early 2000s, and the initial designs failed because both the duration and the "tail" ran longer than calculations had predicted. It took years to secure funding to explore alternatives. About a decade ago, Gates Foundation support finally allowed the team to pursue a redesigned version, built around a core-shell structure that let researchers control duration through the shell's thickness while using an inert biodegradable core to eliminate the long tail problem. That product, now in a Phase I trial, has since changed hands commercially, with the rights acquired by Dare Bioscience and Theramex.
Four decades, in other words, from concept to a product still only in early-stage trials, with success still not guaranteed. Lanita's closing observation on this point was blunt: the sheer duration required to study long-acting products can itself discourage investment, because it simply takes too long for pharmaceutical companies or biotechs to see a return.
If Lanita's challenge was formulation, Dr. Leo Hahn's was something more conceptual, and arguably more fundamental: how do you even know if something is working before you can test it in humans?
Leo's research sits in two arms. One looks at improving existing hormonal methods, particularly around side effects like unscheduled bleeding. The other, the one he focused on for the panel, is non-hormonal contraceptive drug discovery, specifically, how cervical mucus might be engineered to block sperm throughout the entire menstrual cycle, not just during the portions of it where mucus is naturally thick.
The challenge he raised was about surrogate outcomes in preclinical work. In cancer research, you can grow cancer cells in a dish and see if a compound kills them. In some areas of contraception, ovulation inhibition offers a reasonably clean marker you can test for. But if your question is whether sperm can travel from one point in the reproductive tract to another, there is no dish for that. The system is too anatomically and physiologically complex to simulate outside a living organism, which is why Leo's research increasingly relies on non-human primate models, the closest biological analogue to humans available.
The problem, as he put it plainly, is that these studies are expensive and necessarily small in sample size. Getting together a large primate study to simply answer “does this work at all” becomes a significant financial and logistical burden, long before a product is anywhere near ready for commercial development. It's a kind of bottleneck that fields like oncology simply don't face in the same way.
Dr. Laura Hertel brought a third, very different vantage point: the view from inside an early-stage biotech startup. Having left a career as a virologist at UCSF, she founded her company in January 2024 to develop a non-hormonal, fast-acting, reversible contraceptive pill for men, one designed to work within roughly 10 days (the duration of sperm maturation) rather than the 74 days required for full spermatogenesis, with a safety profile she describes as extremely strong.
On the science, she said, things have gone well, arguably better than expected. The challenge, as with the others, has been funding, and her description of the investment landscape was some of the most candid material in the entire session.
Investor interest, she said, genuinely exists. Venture capitalists are intrigued by male contraception; it is novel, and that novelty draws attention. But two forces are actively working against that interest translating into capital.
The first is the AI boom, which is pulling early-stage investment away from biotech entirely, because AI companies currently promise faster, larger returns with comparatively lower risk. The second is a broader shift toward conservative portfolio management among larger VCs, who are increasingly reinvesting in companies they already hold rather than spreading capital into new, higher-risk categories, particularly in a field like male contraception where very few products have ever completed the FDA pathway.
The result, in her words, is that funding for early-stage companies like hers has been “basically not existing,” leaving her, by her own description, “squarely in the family and friends” stage of financing.
And yet, she offered a reason for hope that reframes the entire conversation: more than half of all pregnancies globally are unplanned, an estimated 121 million people. Surveys from the WHO and others show that men are genuinely interested in taking on more responsibility for contraception, for reasons ranging from supporting a partner to simply not wanting to be caught in a situation they didn't plan for. The market, in other words, already exists. What's missing is capital willing to meet it.
The panel's conversation about user needs built directly on a theme already visible in the funding data: the increasing share of R&D funding directed toward user-controlled methods. But the discussion pushed further than the numbers, asking a sharper question, one the moderator posed directly: how do we actually incorporate user perspectives into R&D, especially for users in African countries and other regions outside the US and Europe, where so much of this research and funding originates?
Leo's answer was disarmingly simple: you don't need to be an OBGYN to understand why this work matters. Everyone knows someone who doesn't want to be pregnant and is dissatisfied with their current options. But he then turned the question back toward something more structural: funding itself shapes who ends up doing this research in the first place. Industry R&D funding has shrunk considerably, but NIH and Gates Foundation support for early, preclinical drug discovery still exists, and that funding actively pulls in researchers from completely unrelated fields, immunologists, neurobiologists, people who simply see a grant call and pivot their expertise toward contraception. That inflow of unconventional ideas, he argued, even if most of them won't pan out, is part of what keeps the field's foundation alive. As he put it, somewhat wryly, he would rather see more money flow toward contraception than cancer, when in reality the ratio runs roughly 100 to 1 in the opposite direction. “But at least it is on the list.”
Another issue deserving greater attention is who gets represented in contraceptive development.
The funding data show that women continue to receive the overwhelming majority of contraceptive R&D investment, accounting for 74% of funding in 2024, compared to just 12% directed toward men and 14% toward multiple or unspecified users. The imbalance is even starker for MPTs, where funding has remained almost entirely focused on women across the full 2018–2024 period, rarely dipping below roughly 90% in any given year.
Expanding contraceptive choice therefore also means asking whose reproductive agency is being prioritised. If contraception is understood as a shared responsibility, innovation cannot permanently position women as the primary users and men as peripheral participants. The goal should not be to replace women's options with men's. It should be to expand the range of choices available to everyone involved in reproductive decision-making.
When the panel turned to closing reflections, Lanita offered a perspective shaped by four decades in the field: the seeds of many of the products now in development were planted years, sometimes decades, ago, and science has only recently advanced to a point where many of them could genuinely move forward, if funding existed to support that movement.
But all product development is risky and expensive, regardless of medical field. The real challenge, as she named it directly, is drawing investment into a space where the potential financial return is dramatically smaller than what the same money could earn elsewhere. She pointed to a recently approved pancreatic cancer drug priced at roughly $480,000 a year as the kind of return that quietly shapes where investor capital flows, and why fields like contraceptive R&D, which rarely offer anything close to that margin, struggle to compete.
Her challenge to the room was really a challenge to funders: how do we draw in people motivated by common good rather than thousand-fold returns? She pointed to FHI 360's own pipeline as evidence of what becomes possible when user input shapes design from the start: longer-acting injectables that reduce the burden of frequent clinic visits, a microarray patch delivering three to six months of contraception directly in a user's own hands, a biodegradable implant that could eliminate the complications some women face with removal. Each of these, she noted, has the potential to reduce real pressure on health systems, particularly in low- and middle-income settings where so many of these products are ultimately intended to serve.
She closed with a line from Melinda Gates's The Moment of Lift: that contraceptives are the greatest lifesaving, poverty-ending, women-empowering innovation ever created. Whatever else investors choose to fund, she argued, there has to be room for at least a portion of capital to be guided by public good rather than pure return, and she believes there are social investors out there who already believe exactly that.
Why This Conversation Matters to Shades of Us
Listening to this session, we found ourselves thinking about how much of this conversation sits upstream of the work we do every day. Our stories shape whether people ever hear about the ones that already exist, understand how to access them, and feel entitled to ask for better options when the ones available don't fit their lives.
The panel's repeated point that funding determines which researchers enter this field and which ideas get taken seriously has a quiet parallel in our own world: narrative and visibility determine which health realities get taken seriously by the public, by policymakers, and sometimes by funders themselves.
Laura's statistic stayed with us the most: 121 million unplanned pregnancies globally, and a market of interested men that the current funding landscape simply isn't built to serve. That is not only a funding gap. It is a storytelling gap. Few of the men she described, ones who want to take on contraceptive responsibility but feel they have no real options, have ever seen that desire reflected at them in media, in film, or in the everyday conversations happening in their own communities. If social and behaviour change communication is one of the tools capable of shifting what people believe is normal, available, or theirs to ask for, then we have a role to play that sits well before a product ever reaches a pharmacy shelf: normalising the idea that contraception is a shared responsibility, not a women's issue quietly delegated to half the population.
The USAID funding collapse Cécile described also deserves our attention for a more immediate reason. When a major funder disappears overnight, the gap left behind is not only financial. It is informational and narrative too; programs that once explained new methods to communities, trained providers, or supported user-education campaigns often disappear alongside the funding that sustained them. That is precisely the kind of gap storytelling organisations can help absorb, not by replacing clinical R&D, but by keeping public understanding and demand alive even when formal programming contracts.
The future of contraception should therefore not be reduced to the question of whether a new product can be invented. The more important question is whether the R&D ecosystem is capable of producing meaningful, affordable and diverse choices for different people and different reproductive needs.
There are reasons for optimism. Funding for non-hormonal methods is growing. User-controlled approaches are receiving greater attention. Researchers like Leo are exploring new non-hormonal mechanisms, entrepreneurs like Laura are building entirely new categories of product, and veterans like Lanita are still pushing decades-old ideas across the finish line as the science finally catches up to what was imagined long ago.
But optimism must be matched with investment, and the 2025 outlook is a sober reminder of how fragile that investment remains.
The current funding picture tells us that the contraceptive pipeline is being asked to deliver more while, in many respects, being supported by less. Without diversified and sustained investment, promising innovations may remain trapped in laboratories or early-stage trials rather than becoming products that can transform reproductive healthcare.
Perhaps, then, the most important lesson from this session is this:
Contraceptive choice does not begin with access to a product. It begins with the decision to invest in developing choices in the first place.
If reproductive autonomy is the destination, R&D funding is part of the road that gets us there. The challenge for funders, researchers, industry, and policymakers is to ensure that road does not narrow just when people need more options, not fewer.
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