Safety and efficacy of fertility-regulating methods: a decade of research

An international venture was launched in 1985 to fill a recognized gap in p ost-marketing surveillance of fertility-regulating methods. For this purpos e a new task force was set up by the Special Programme of Research, Develop ment, and Research Training in Human Reproduction, which is cosponsored by the United Nations Development Programme, the United Nations Population Fun d, the World Bank, and WHO. Research priorities were chosen and epidemiolog ical studies inaugurated, involving a total of 47 countries - mostly from t he developing world. Important progress has been made, especially in helpin g to define the beneficial and possible adverse effects of oral contracepti ves on the risk of neoplasia; in showing that the injectable contraceptive depot-medroxyprogesterone acetate protects against endometrial cancer and d oes not increase the overall risk of breast cancer; in clarifying which gro ups of women are susceptible to the rare cardiovascular complications of or al contraceptives (myocardial infarction, stroke, and venous thromboembolis m); and in establishing the long-term effectiveness a nd safety of intraute rine devices. The research has already made a significant impact on family planning policies and practice. Critical appraisal of this venture, which h as been modestly funded, confirms the value of mission-oriented research. I t also illustrates the potentia I of collaboration that bridges the global divide between developing and developed countries.