The START Center researched both the existing landscape and future potential of contraceptive co-administration products in low and middle-income countries as part of an update to the Bill & Melinda Gates Foundation on current perspectives in this field. Using peer-reviewed and grey literature, online tools and databases, and key informant interviews, the START team identified 43 existing products and 24 novel opportunities. The START center conducted a ranking of these opportunities based on health impact, appeal to women, technical feasibility, and implementation feasibility. Within three user groups—adolescents, young adults and older adults—each identified product was ranked as high, medium, or low on the basis of the four ranking factors. Each factor was given a weight—health impact (40%), appeal to women (30%), technical feasibility (20%), implementation feasibility (10%)—to reflect their relative importance and a weighted average was used to obtain an aggregate score for each product within each user group.
The START team produced an interactive Excel workbook that contains various product information for all the existing products, in addition to a scorecard that aggregates the various product rankings within each user group, based on the ranking factors. Users can alter both the weights and individual product rankings, with automatic updating of the scorecard’s aggregate scores. Results show that the top products differ greatly by user group, but generally speaking, the most promising opportunities included several micronutrients and non-communicable disease treatments. If further feasibility investigation were to be conducted, the next steps for investigating the feasibility of contraceptive co-administration would be a systematic survey of users to assess potential uptake, interest, and demand; laboratory testing of co-formulated products to determine stability and shelf-life of products, and implementation research to determine supply chain and distribution requirements. This investigation does not represent any ongoing strategy within the Bill & Melinda Gates Foundation.