Worldwide Connections - A UCSC Tradition

The iGEM Competition challenges teams to improve quality of life using synthetic biology. Creating change requires an understanding of what the world is asking for, and as the 6th UCSC iGEM team, we uphold the reputation of UCSC investing heavily in worldwide outreach to not only spread the word about our project, but to understand the impact of our project on a personal level. Through these personal connections, we evaluated and continue to evaluate potential issues related to our project, including stigma, price, ethics, safety, security, and sustainability. We created a brochure as a means to address common rumors and expand current knowledge about contraception.

Our map below details all countries we've contacted for input. Our questionnaire we used to gather information was approved by the Institutional Review Board and we changed names to assure anonymity of participants.

Inspiration

Before choosing a project, our team emailed over 50 World Health Organization representatives around the globe to determine the most pressing issues. The recent resurgence of the women’s rights movement in the United States prompted our team to open the discussion of women’s health at this year’s competition. We determined that many resource-constrained countries struggle with access to contraception because of stigma, location, and cost. Our goal was to focus on those countries to determine if they’d be interested in our new contraception method and willing to speak with us about their personal experiences.

Execution

Our outreach team contacted several organizations, associations, and foundations for help finding locals willing to speak to us. Not many of them got back to us, so we went an alternative route. We searched GoFundMe and found a group of women in Uganda called the Joy Women’s Group asking for money to help buy condoms for their community. They were funded through the Brighter Brains Institute (BBI), and we contacted the BBI who put us into contact with three local women’s groups in Uganda. Read More >> Through word of mouth, we reached 7 additional women’s groups. We created a questionnaire for locals to fill out to have a consistent question format. Their response to our efforts prompted us to reach out to other groups in 15 more countries to further spread our word and evaluate the need for cheaper, more accessible birth control. We also spoke to family members and friends who have lived or traveled abroad to gain additional perspective outside of women's groups.

Outcome

Through our survey and close conversations with people from several countries, we gained a better understanding of the situations and challenges of women around the world. We received over 56 responses to our survey as well as personal testimonies from people regarding their perspective on birth control in their communities. In the stories below, names have been exchanged with popular names from individuals’ respective countries for privacy reasons. Check out our map and the stories below to learn more!

Our Connections

Our Connections

Australia

Jamie, Pediatric Doctor

Jamie is an Australian pediatric doctor. We asked Jamie about her and her patients' experiences with birth control. According to Jamie, "one of [her] patients would soak a sponge in lemon juice and place it in her vaginal tract to avoid pregnancy because her husband believed condoms were too socially stigmatized with prostitution”. Though prostitution is legal in some parts of Australia, it is still heavily stigmatized along with condom use. We hope to provide women a safe birth control method not associated with prostitution.

Brazil

Gisele, Mother and Community Leader

Gisele, a mother of seven, knows many women who had to perform their own at-home abortions if an unwanted pregnancy arose, since abortions are illegal in Brazil. These abortions often resulted in medical complications, and women were sent to hospitals to receive treatment for the aftermath of these dangerous abortion attempts. Read More >> Government officials rarely speak out about family planning issues in Brazil, and Gisele believes that women are too afraid to speak out. She supports our new birth control method, especially because she’s only familiar with post-impregnation birth controls (like abortions) rather than preventive measures. We believe that if our method is approved by the Brazilian government for distribution, we could not only reduce the rate of dangerous at-home abortions, but potentially lower the rate of associated health complications and death in fertile women.

China

Zhi, Former Chinese Citizen

We spoke with a former Chinese Citizen named Zhi. When Zhi lived in China, they witnessed first-hand the one-child-per-couple policy where women were often felt forced to have abortions or be sterilized; babies were often abandoned or given up for adoption, especially if the child was female ^[1]. Read More >> The regime change in 2016 allowed women to have up to two children; however, the number of children a woman can have is still determined by the government rather than by the parents, and with the government’s desire to increase the Chinese population, birth control is becoming more difficult to access. According to Zhi, many people in China are unfamiliar with contraceptives and Chinese officials are working to increase information using social media. We hope that our brochure can help the Chinese officials’ efforts to provide better knowledge and understanding of modern contraception methods.

Colombia

Yeraldin, Colombian Citizen

Yeraldin, a Colombian-born citizen, believes that our birth control method research is a meaningful pursuit. According to Yeraldin, “there are many unwanted pregnancies in Colombia, but it is a problem because there is no money to buy [contraceptives]”. Yeraldin believes that an easy, affordable birth control option could minimize the large amount of unplanned pregnancies currently in Colombia. She does not know of any specific rumors on birth control in Colombia because birth control is rarely discussed. We hope to prompt the discussion of birth control by contacting Colombian officials in charge of regulating contraception and ask them if/how they plan to combat the lack of discussion around birth control.

Maria, Universidad de los Andes

A few members of our iGEM team attended the 2018 BMES Coulter Conference. At the conference, they met a student named Maria from Universidad de los Andes. She helped us gain insight on birth control in Colombia. Read More >> According to Maria, there are three primary healthcare plans in Colombia: “the public service, in which every working adult must pay an amount of their income for health coverage, the private service in which, additional to the amount they are already paying, the person must pay extra for a wider coverage of specialists and medicine, and the SISBEN which is the health plan for people in low income areas that do not have a job or cannot contribute to the healthcare system economically”. There are other healthcare plans such as the compulsory health plan (Plan Obligatorio de Salud) which covers a variety of birth control methods. Maria uses this healthcare plan but didn’t realize that it covered birth control methods until she researched for this project. She also believes that not many people would know this either unless they researched like she did. According to Maria, birth control is generally supported in the more developed areas of Colombia, but in rural areas there is still stigma surrounding birth control methods. As a result, many women in the rural areas get pregnant in their early teens. Maria has experience taking birth control herself; she used birth control pills and states that “it is the most popular method around the community”. A recent report given to us by Maria relays that birth control pills in Colombia were reduced in price by 50% so that more people can buy them. We are happy to see that Colombia is taking action to make birth control more accessible, but the issue of stigma still exists. We hope that our brochure may be of use to the rural communities in Colombia.

Guatemala

Zuleyka, Guatemalan Citizen

Zuleyka is a mother of eight from Mixco, Guatemala. She had her first child at the age of fourteen and faced several labor complications because she lacked the proper medical assistance to deliver her baby. Zuleyka birthed her baby on a dirt floor and relays that this is common among women in her area. Guatemala has one of the highest rates of pregnancy in South America due to their lack of access to contraceptives and prevalence of sexual violence ^[2]. In her community, many people believe that their religious deity blessed every woman with their particular number of children, which makes many women question their use of birth control methods if it "interferes with God's plan". Zuleyka went through a similar internal conflict, as she wished she spaced our her children out to provide better financial support to her growing family. Hearing Zuleyka’s story further inspired us to create our brochure for distribution and work to create a safe, alternative birth control method for women in need.

India

Foundation for Mother and Child Health

Through a connection with our PI, David Bernick, we met Piyasree Mukherjee, CEO of the Foundation for Mother and Child Health in India. According Ms. Mukherjee, her community possesses differing views on birth control. Some deem birth control a “money trap” because it requires device replacement or multiple rounds of a prescription. Others are skeptical and/or not knowledgeable about birth control because of the lack of information. Our team knows that birth control is expensive, but this was the first time that we heard that women felt gouged by necessary recurrent purchases of birth control methods. We will continue to update this information when their questionnaire responses arrive.

Italy

Aurora, Previous Resident & Student

During her time in Italy, Aurora found it difficult to use her preferred form of birth control and was instead pushed to use an IUD. IUDs, although common, are accompanied by potential painful side effects; Aurora described her first IUD experience as “super painful”. Read More >> IUDs typically last 3-6 years, and when Aurora eventually needed to get her IUD replaced, doctors informed her that her cervix was too small for the second IUD, so she received medicine to soften her cervix. She withstood torturous cramps during the process and relayed to us, “if it hurt that [much] putting it in, I’m worried about getting it out”. We asked Aurora about religious implications of birth control in Italy, and she described Italy is a heavily Catholic country where in most cases, religious leaders discourage use of birth control methods because they view it as sin. Regardless of the fact that Italy has easier access to contraceptives compared to most other countries we’ve heard from, the country’s religious overtones halt many from pursuing birth control for fear of harassment and ostracism. Aurora is yet another individual who proves that a more discrete birth control method like ours would greatly benefit women in countries where stigma on birth control still exists.

Mexico

Rosa, Citizen & Research Team Lead

Through our connection with the ITESG team in Guanajuato, Mexico, we interviewed women to discuss their experiences with birth control. We sent questionnaires to these locals and interviewed one woman named Rosa. Rosa described her younger self as “uneducated” on the proper use of birth control. As a result of her being unaware and her continued lack of birth control, she became pregnant at a young age and had a child she couldn’t properly care for. Read More >> Another woman mentioned that when she attended a routine check-up with her male friend, the male received free condoms just for being a man while she was not given any condoms or additional information about birth control methods. This statement correlates with statements from the other women, which describe that culture plays a large part in birth control issues; Mexico is largely Catholic which discourages women from discussing their sex lives. Many women feel too embarrassed or ashamed to purchase contraception, feel unable to use protection during sex, and must take care of the child(ren) that may result. We hope that our new, discrete birth control method may help women feel more at ease, as it won’t require them to routinely purchase it in public.

New Zealand

Ava, New Zealand Citizen

Ava, an alum from the University of Otago, shared that she often struggles to obtain birth control. In New Zealand, 15-minute appointments with a local health care provider are available to all citizens but are too short to be personalized enough to the patient, and while longer appointments are available, they are more expensive. This lack of personalization and Ava’s lack of funds deterred her from pursuing birth control forms that require a prescription, so she instead pursued condom use. Read More >> One-use condoms, however, became expensive after a while, and Ava decided to spend her money on things she saw more important than her sexual health. Although many of her peers used oral contraceptives, her low-income background forced her to prioritize buying food and paying rent over sexual protection. Sexual health education is not emphasized in the rural areas around Ava and locals still use traditional forms of birth control, many of which are painful, unsafe, and/or ineffective. For example, in areas where poroporo leaves are found, people make a broth from these leaves that they believe acts as a contraceptive. The leaves have not been shown to suppress ovulation ^[3]. These misconceptions and alternatives prove to our team how much our cheap and safe contraceptive has potential to help.

Peru

Guillermo, Former Peru Citizen

Guillermo, father to three daughters, visits his family in Peru at least once a year. In the 70’s and 80’s, birth control was very expensive, and only people of higher economic status had access to it. Read More >> Now, since Peru is a predominantly Catholic society, many Peruvians don’t support the use of birth control in general. In most cases, those in need of birth control are the ones who can’t afford it. In addition to cost, access to birth control is an issue. According to Guillermo, Peruvians “have social services available to help, but no outreach programs since many women live in the mountains of Peru away from the capital”. Peru is also a male-dominated society, and many husbands/boyfriends “don’t believe in birth control and are against it out of ignorance”. Possibly because of this, Peru has an extremely high rate of illegal abortions. Guillermo explained that “women die all the time” from illegal abortions; in the year 2000, 35% of pregnancies ended in abortion ^[4]. Interestingly enough, he wonders if the design of our product would entice women to try it. The most common form of birth control in Peru is birth control pills, which are easy to identify given their recognizable packaging. Our product would grow as a yeast, and the user could press the dried yeast herself to form a pill. This process is less recognizable than normal birth control pills and may be appealing for women who face a male-dominated society that doesn’t approve of birth control use. This viewpoint hadn’t been considered by our team before, and we now hope to incorporate this angle into our development and advertisement of our new birth control method.

Russia

Misha, Former Russian Citizen

Misha is a woman who spent the first part of her life in Soviet Russia. She tried for many years to obtain any form of birth control but only received her first IUD after having her first child at age 19. She couldn’t afford to purchase condoms, and most couples opted not to use any forms of contraception. Russia’s government did not encourage or supply cheap contraceptives. For a time, inexpensive abortions were available at state hospitals. Most women were aware of this and expected to have one to three abortions in their lifetimes. Abortion clinics shut down after a few years, which led to many Russian women to obtain illegal abortions, most of which were ineffective or dangerous. We didn’t realize the prevalence of illegal abortions in Russia and we hope to legalize our birth control method in Russia to prevent the need for these abortions.

Trinidad and Tobago

Tatyana, Trinidad and Tobago Resident

Tatyana is a mother of one. When we spoke to Tatyana about our new contraceptive, she told us she had believed condoms were the only type of birth control. Tatyana isn’t a fan of condoms anymore, as she experienced a condom that broke and resulted in an unexpected pregnancy. She relayed that she didn't believe condoms are reliable. Luckily, she was financially stable enough to care for the child, which is an issue many mothers in Trinidad and Tobago face. Condoms are commonly found in local pharmacies, but information about how to use them is severely lacking. Tatyana explained that women in the area need and want to know more about birth control. Our team hopes that our brochure will inform women of available alternatives to condoms and how to use them safely.

Uganda

Basaliza Women Development Association (BAWODA)

BAWODA is group of women leaders spread all throughout Uganda. Our outreach team spoke with Joy Muhindo, the chairperson of BAWODA. She informed us that the stigma on birth control in Uganda arose because women began trying unsanctioned birth control methods with dangerous side effects. Many women heard of these side effects and assumed that all birth control methods had these potential dangerous side effects. Their group encourages condom use if women cannot access safer birth control methods. While the BAWODA women are willing to try our new method, they hope that we also encourage condom use on top of our contraception because of the prevalence of HIV/AIDS in their area. We hadn’t considered that condom use is still necessary on top of our birth control since ours cannot protect against AIDS, so this was an important reminder for us.

Buhanga Thuligahuma Women's Group

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Through the recommendation of Hank Pellissier of the Brighter Brains Institute, our team contacted a Buhangan villager named Masereka Sebastian. Buhanga is a rural village of 2,000 people, and all are members of the BaKonzo tribe. According to Masereka Sebastian, "you can't drive a car there - you have to walk 3 kilometers or take a dirt bike [to their village]". Since Masereka Sebastian owns a dirt bike and can access printing shops outside of the village, our iGEM team contacted him to print our questionnaires for distribution to the local Buhanga Women. Women later mailed us their responses. Read More >> From their questionnaire responses, we learned how expensive contraception methods are and how many women’s husbands don’t respond positively to them using birth control. As with other questionnaire responses, more of the same rumors were mentioned- specifically, that birth control can cause cancer or infertility. Uganda is a heavily Catholic country and the Catholic church doesn't support birth control use, so we need to consider this for the development and distribution of our product in stigmatized areas.

Joy Women's Group

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The Joy Women’s Group is located in Western Uganda in the Nyamwamba Division of the Kasese Municipality. One of their group’s objectives is to promote nutrition, health, and hygienic practices in the community. All 25 of their group members wanted to participate in our research. According to participants, their community generally supports the use of contraceptives. Their community has access to contraception through a government healthcare facility known as Naigobya HC III. Naigobya HC III provides family planning services, maternal care, prenatal care, and post-natal care. Read More >> Through this facility, locals may receive injections or pills as birth control. Similar to other Ugandan groups, however, treatment at this facility is expensive. The Joy Women’s Group also presented rumors similar to what we heard from other groups. Their information is invaluable, and our team is very thankful for their participation.

Kabwe Rural Women Development Association (KARWODA)

Through the recommendation of Kabugho Beatrace from KUWA, we met Masika Annet of the Kabwe Rural Women Development Association (KARWODA). Beatrace informed Annet that we were looking for more information about birth control methods and/or family planning programs already in practice, and she told us that “most birth control methods are sold in hospitals, drug shops, and clinics but are inaccessible”. She emphasized that even though options are available, most are far too expensive for the average woman to afford. Read More >> Many women also fear dangerous side effects such as blocked oviducts and bleeding. Instead, women revert to condom use which is often accompanied by public shaming if they are seen carrying condoms out of a shop. Shame plays a large part, it seems, in deterring these women from using birth control. As a result, women partake in unprotected sex which results in unwanted pregnancies and STDs. We hope that our discrete birth control method will allow women to practice safe family planning methods without shame.

Kinywankoko United Women Association (KUWA)

Our iGEM team contacted Kabugho Beatrace through Hank Pellissier of the Brighter Brains Institute. KUWA is a women’s group based in the Kasese Municipality of Uganda. They assist marginalized women in the surrounding villages by providing them condoms, sanitary products, feminine hygiene education, and economic empowerment. They reside in the Bukonzo county which is “rated among the poorest counties where women live below poverty line and one [Ugandan citizen] survives on less than one US dollar a day” (Kabugho Beatrace, chairperson of KUWA). Read More >> According to Beatrace, the population of Kasese increases every day due to high birth rates. At the same time, there is also a high infant mortality rate, as many mothers are too unhealthy to bear a child. The only contraception available in Bukonzo county are condoms sold in remote pharmacies. According to Beatrace, the condoms are placed near registers and customers are often too afraid to be seen purchasing condoms due to stigma. When we spoke with Beatrace, she was very supportive of our new contraceptive. She works closely with other women’s groups in Uganda and contacted them to discuss our new method and provide us their input on our project’s safety, maintainability, and cost. Our team is extremely grateful for Kabugho Beatrace and the connections she provided us.

Kyogha Women

Our conversation with the Kyogha women was informative. Their chairperson, Esther, told us that her group has been on the search for advanced, safe birth control methods for a while now. Her group recently visited Makerere University in Uganda to see if they can “make an advanced birth control method that is also accessible with less side effects”. She’s spent many years implementing family planning programs and trying to address the stigma on birth control. As with other groups, she mentioned that people fear purchasing birth control because they fear "being laughed at". We hope that our new birth control method will contribute to the new market of affordable and safe contraceptives. We also want to design our packaging to be more discreet so Esther and other women feel comfortable using it.

Nyakiyumbu Widows Association

We reached out to the Nyakiyumbu Widow’s Association, they were interested in our contraception method. Muhindo Nyesi, chairperson of the NWA, stopped replying to our emails soon after. Our team wondered if her group lost interest, but we soon learned the reason for her absence; Nyesi’s nephew was hit by a car and, during recovery, was also brutally attacked by a group of boys. He was in the ICU for several weeks and underwent brain surgery, but he finally recovered enough for Nyesi to go to the local library to email us back. She provided us responses to our questionnaire and apologized for her absence. We are so grateful for Nyesi’s efforts for our project, especially in these difficult times for her family. Read More >> The responses we received through Nyesi were different than the others we’ve collected; one woman argued that having more accessible contraception encourages youth to become sexually active at earlier ages. Her viewpoint was similar to that of a woman from India, and our team realized that this was something we must consider if we want to encourage more contraception use. We also discovered another method of contraception in Africa: uterus removal. We weren’t aware that women used uterus removal as a means of birth control, and this news encouraged us to pursue our birth control method since it would be safer for women to use.

Promote Africa Foundation

We discovered the Promote Africa Foundation (PAF) through the Joy Women’s Group. The PAF is a united women’s group that runs programs related to female reproductive health and women’s rights. According to Evelyn Lewsley, the leader of the PAF, they “encourage women to space their children because most children are abandoned by families who fail to provide for their children”. The PAF encourages birth control methods throughout the Kasese District, and are currently encouraging birth control injections; however, they struggle to find users since injections sometimes cause bleeding and therefore deter women from use. The PAF hopes our birth control method will be safer for the women in Africa.

Rita Women Development Association

The Rita Women Development Association resides in the Rwenzori region of Western Uganda. This group empowers women in their community and promotes contraceptives to prevent the spread of sexually-transmitted diseases. Through the recommendation of Kabugho Beatrace of KUWA, we met the Rita women. Masika Vicky, the chairperson of Rita, informed us of the stigma on birth control (primarily condoms because they are the only contraception available). Read More >> Currently, their group is working on an anti HIV/AIDS campaign due to the high percentage of people affected by the virus in the Rwenzori region. The spread of HIV/AIDS stems from the stigma on contraception use; according to Masika Vicky's statistics, an estimated 98% of people fear to buy condoms in public and therefore have unprotected sex despite the outbreak of HIV/AIDS. This stigma also correlates with the high birth rates, similar to those seen in the Kasese Municipality where KUWA resides. Masika Vicky relayed that “Uganda is now highly populated, so we are encouraging family planning.” We spoke to five Rita women about their opinions on our progesterone-producing yeast and they liked the idea of a contraception method containing naturally-produced progesterone. One Rita member informed us that they’ve initiated “related programmes to teach women about reproductive health and child spacing”. We are grateful to work with a group with similar goals to ours, and we appreciate the insight.

United Kingdom

Dr. Pam Lowe, Aston University

Our team spoke to Dr. Pam Lowe from Aston University in the United Kingdom. Dr. Lowe is the Senior Lecturer for the Department of Sociology and Policy at Aston University. Dr. Lowe is well known for her strong opinions on the unspoken ‘two-child policy’ in the United Kingdom. According to Dr. Lowe, the only stigma on birth control is not on those who use it, but rather on those who don't. Read More >> Fortunately for the UK, birth control is free with the National Health Service, even for teenagers. Even migrants make use of sexual health clinics in the UK since the NHS does not require a valid ID. In Dr. Lowe’s opinion, the UK most likely doesn't need our new method. Dr. Lowe’s information was valuable, even if it didn't favor our projects.

United States of America

Family Planning 2020

Family Planning 2020 (FP2020) is a global partnership that supports women’s rights related to sexual and reproductive health. They are a subsection of the United Nations Foundation and partner with the Bill and Melinda Gates Foundation to spread birth control information and awareness. By 2020, they want to expand access to family planning “information, services, and supplies to women in 69 of the world’s poorest countries”. Read More >>FP2020 has contacts all around the world working to increase access to birth control, and our team felt they would be a perfect partner to help us expand our outreach. We met with Martyn Smith, whose primary role in FP2020 is to establish contacts in “civil society, government, donor agencies, and private sectors” worldwide. Martyn offered to connect us with local agents in several countries to better understand what steps are needed to get out product to market. Most medications require rigorous testing, but the requirements vary country to country. We hope that this relationship will allow us to plan for future testing and determine the likelihood of our product making it to market.

Population Council

The Population Council conducts research and works to address critical worldwide health and development issues. Through our connection with FP2020, we met John Townsend, the Director of Country Strategy for Pop Council. Specifically, he works in the women's health division to find new promising birth control methods. John was inspired by our project and offered to connect us with several colleagues in different countries, including other members of Pop Council. We discussed potential issues with manufacturing as well as which countries may be ideal to start product development. John helped give our project a route to development, and we are extremely grateful for our ongoing relations with his organization.

We created the brochure shown below as a way to educate others regarding birth control and address popular rumors about contraception. This brochure has not been reviewed or approved by professionals and therefore is not ready for distribution. Below is strictly a working draft of our brochure.

Silver Medal Requirements

We contacted family members, friends, and representatives of the World Health Organization to discuss current issues with birth control. We sent out questionnaires to several grassroot organizations and advocacy groups around the world to gauge their interest in our product and learn about stigma, cost, and access issues. We also presented to local classes and partook in a TEDx talk to teach people about iGEM and discuss potential ethical issues with our project.

Gold Medal Requirements

We took what we learned from our questionnaire and other outreach efforts to create a product tailored to our potential users. The women who returned questionnaires encouraged us to consider cost, location, and accessibility. We localized contraceptive production because we were informed that drugstores and hospitals are far away for women in rural areas. We will use discreet packaging for our product because several women are worried about being seen using birth control in stigmatized areas. We are also researching ways to get our product to market in several countries by collaborating with Family Planning 2020 and Population Council. Given that our yeast needs a food source, we collaborated with the ITESG research team and engineered our yeast to survive off upcycled dairy waste. Through our conversations, we determined that women even in rural areas have high accessibility to milk-producing animals, which makes our milk-surviving yeast plausible for most areas worldwide.

The PoPPY team would like to thank everyone who made this project possible, especially those described above. Thank you to every individual who participated in our human practices research by answering our questionnaire as well as those who allowed our team members to interview them on such personal matters. Without you, this project wouldn't be what it is today. Thank you!