Research and fertility regulation.

Research into family planning becomes all the more important when evidence indicates that demographic profiles have changed over time in populations using contraceptive methods. For example, in some countries that have successfully introduced large-scale fertility-regulating methods, the population is still expected to double in less than 30 years. Such is the case of Bangladesh, where most of the population growth is due to what is termed ``the population momentum'', in which the wider population base will soon become of reproductive age. There is no doubt that such populations will require larger investments and the introduction of more effective fertility-regulating programmes than in the past. Continued progress in research into family-planning methods and in programme implementation will therefore continue to be of paramount importance. At the same time, studies on the quality of services, and the safety and efficacy of fertility-regulating methods are crucial given that these activities will, to a great extent, determine ultimate programme success. In this context, research on both the safety and the efficacy of fertilityregulating methods Ð particularly on the safety of long-term hormonal methods Ð is highly relevant. The Special Programme of Research, Development and Research Training in Human Reproduction, co-sponsored by the United Nations Development Programme, the United Nations Population Fund, the World Bank and WHO, formed in 1984 a Task Force on the Safety and Efficacy of Fertility Regulating Methods. Published in this issue of the Bulletin (pp. 713±721), the article by David Skegg ``Safety and efficacy of fertility-regulating methods: a decade of research'' comprehensively reviews the studies on the safety and potential adverse effects of contraceptive methods endorsed by the Task Force. For policy-makers, the article provides useful information on various aspects of administration, side-effect management, and safety of available contraceptives. Managers of population programmes in developing countries will find this background material particularly useful as an aid in making decisions on the design and implementation of future programmes. One issue that should be considered further is the practice of carrying out studies in developing countries in a post-marketing fashion. In the article, Skegg points out that most of the previous research on the safety and efficacy of fertility-regulating methods was conducted in Western Europe or the USA. However, it is clearly important for developing countries to carry out their own safety studies, given their considerable use of and requirement for contraceptives. Nevertheless, the following aspects need to be rationalized.