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How can we more effectively “begin with the end in mind” in contraceptive R&D?

Post written by Emily Hoppes, MA, MPH, FHI 360, and @em_hoppes on Twitter

“Beginning with the end in mind”—in the field of contraceptive research and development, we often use this phrase to highlight the importance of keeping the needs and perspectives of potential end users front-and-center as we design, test, evaluate, and introduce new products. It’s a concept that has been discussed on the CTI Exchange before, but a topic that warrants further exploration. The phrase can mean a lot of things, and perspectives will vary depending on who you talk to, their role in the development and introduction pathway, their positionality, and their past experiences, to name a few. Over the course of this year on the CTI Exchange, we plan to bring together as many of these perspectives as possible to explore the topic of “beginning with the end in mind.” Through this series, we hope to share ideas, debate and challenge one another, and collaborate and innovate around a topic that is essential to the work we are all aiming to advance daily.

At the heart of efforts to “begin with the end in mind” are considerations to ensure acceptability, affordability, accessibility, and equity of new and existing contraceptive products and services. Achieving these four goals requires taking proactive steps at all phases of the contraceptive development process, from the very early phases of research to introduction and scale-up of products. As we explore this topic, we will dive deeper into each of these key concepts.


Many of those working in contraceptive R&D associate “beginning with the end in mind” with integrating social-behavioral and user preferences research into product development. This approach highlights the importance of considering the needs and perspectives of potential end users—as well as partners, providers, and other key influencers on contraceptive use—throughout the R&D process. Identifying and incorporating user preferences is both essential and complicated. We need to reimagine how social-behavioral research is integrated into contraceptive R&D and think creatively to identify opportunities for integrating user input throughout the R&D process, and in ways that include the diversity and nuance of people’s preferences. For example, how do we take the broad spectrum of perspectives on contraceptive-induced menstrual changes and incorporate these considerations into the development of new contraceptive products?

Affordability and Accessibility

The issues of affordability and accessibility are intertwined and impact one another. There is a lot to be learned from past experiences developing and introducing contraceptive products, including injectables, implants, diaphragms, rings, and the hormonal IUS. This series will look to these and other examples for lessons learned about how to address barriers to access, including options for enhancing self-care—such as the potential for self-injection DMPA-SC—and increasing affordable pricing for quality-assured products. What these past experiences show us is that we must consider price and access at the very earliest stages of the contraceptive R&D process, long before we know if a product will reach the market. We must also engage a wide-range of stakeholders, including regulators, manufacturers, advocacy organizations, and policymakers, especially those involved in country-level health systems and health coverage.


Finally, as we consider this topic, we need to take a long, hard look at the systems and structures in which the processes of contraceptive R&D operate. A true understanding and acknowledgement of the historical foundation for these systems and structures, and how they continue to perpetuate global inequities in access to contraceptives, is a first key step. Decolonization is one lens we can use to challenge and dismantle the power structures that lead to these global health inequities. In contraceptive R&D, using a decolonizing lens includes broadening the people and perspectives involved in decision-making, centering the voices of groups who have been historically marginalized, and improving equity and inclusion throughout the entire process.

The Way Forward

So how can we more purposefully, realistically, and effectively integrate considerations to ensure that we achieve our goals of acceptability, accessibility, affordability, and equity in contraceptive R&D? Let’s dedicate the year on the CTI Exchange to answering this question together.

As part of this series on “beginning with the end in mind,” we want to hear from you. Please reach out if you have ideas for blog posts, video series, webinars, infographics, or any other contributions. And please help us amplify this important content on Twitter, LinkedIn, and YouTube. In the meantime, please take a moment to answer the poll question below to engage with this topic and provide feedback that we can use to create content that is most interesting and applicable to our audience.