Contraception should be an egalitarian decision, so where’s the male pill?

contraception should be an egalitarian decision

So where's the male pill?

Sexual liberation comes with a price: contraception. There are plenty of options, designed to provide the right fit for each woman’s lifestyle and routine, but this begs the question: why should it solely be the woman’s responsibility?

It takes two to tango, isn’t that the saying?

Currently, the onus of contraception is shouldered primarily by women. Women feel the burden of being responsible for all precautions and suffer the consequences of both failing to prepare and preparing to succeed. Is this because there are scant options for men to control their fertility or because it’s a woman’s problem? After all, women have a reason to be concerned about unwanted pregnancy when the impact on their bodies and lives is far greater than that on their male partner. But all this assumes only single women and men are concerned about contraception; there are plenty of couples—married or not—looking to delay or prevent pregnancy altogether. Most investigations into men’s perceptions about their responsibility in contraception have targeted young, unmarried males; hardly a representative cohort.

There’s evidence to suggest a man is less likely to take responsibility for effective contraception if he lacks a sense of obligation for the children that may result. Married men who hold more egalitarian attitudes are more likely to think men and women have a shared responsibility for contraception. Furthermore, research shows men’s involvement in decisions about sex, contraception and childrearing strongly influences sexual and contraceptive behaviour, significantly strengthens and reduces discord in relationships, and reinforces a man’s responsibility for the children he fathers. Interestingly however, the same research indicates men with nonegalitarian beliefs think they have the dominant responsibility for contraception—so why hasn’t the medical and pharmaceutical industry caught up?

Photo by Jan Zhukov on Unsplash

Worryingly, when it comes to contraception, women’s health is a secondary priority to cost-effectiveness, with NHS guidelines noting cost-effectiveness as a reason for recommending implants, injections and IUDs. The pill is perhaps the most common but hormonal contraceptives bring a host of issues: and no-one knows exactly what issues they’ll get until they try them. Each method lists a litany of side effects—weight gain, acne, mood swings, headaches, vaginitis, breast pain, cystitis, abdominal pain, prolonged bleeding, etc.—and there’s no research into the long-term effects of spending your fertile years full of synthetic hormones.

And what of the fact these methods are never 100 percent effective? When used correctly, they get extremely close, but perfect use is a pipedream and not a reality for most women. Life gets in the way. Not only do you need to suffer the potential side effects, but it could all be for naught in the end anyway. Related to this is the assumption that contraceptive responsibility purely requires using contraception: what about the cost and time spent attending appointments?

The lack of advancement in male forms of reversible contraception has received significant academic attention and yet we still lack realistic developments. Of the current methods, one is permanent (vasectomy), two involve not having sex (abstinence and outercourse) and one should not be considered effective (withdrawal). Men need choices too.

In theory, a male contraceptive should be easily developed: it’s not like we don’t understand the biology of sperm production. In one 2016 study, men were injected with testosterone and progestogen—similar to the hormones in the female pill—and pregnancy rates were lower than typically seen for women on the pill. Promising stuff! But the study had to be cut short: the men were experiencing negative side effects including acne, mood disorders and raised libido. This seems the most jarring part of this discussion: why should men get a pass on the standard side effects experienced by women the world over? There’s more to it: 75 percent of the study participants wanted to continue. One of the independent committees overseeing the safety of the trial pulled the plug.

Photo by Toa Heftiba on Unsplash

As always, there’s a money aspect too. Globally, the female pill is the third most-used form of contraception, with a projected market value of nearly $23 billion by 2023. There’s little incentive for pharmaceutical companies to invest in a male pill. It’s not just the billions of dollars required to bring a new drug to market, medical regulators don’t view a male contraceptive as worth the risk: an unwanted pregnancy does not pose the same risks to men as it would to women, so investment in this area isn’t seen as viable. 

Given the socio-historical context in which female contraception emerged and the very real fact that contraception has empowered women by allowing greater control over family planning, it made sense for women to take responsibility for preventing pregnancy. But we’ve moved on from the sexual liberation early days. Research shows most men perceive a couple’s decision-making regarding sexual behaviour and contraception as an egalitarian process: 78 percent of men in a heterosexual relationship view decisions about contraception as a shared responsibility. Personal attitudes and perceptions shape contraceptive opinions and decisions, and communication between partners is key to ensuring effective contraception in each situation. That current methods tend to exclude men from the conversation is both unjust and unwise.