Hands up if you’ve ever felt personally victimised by the false promise of a pill for men.
For years, we’ve been teased by whispers of a new male contraceptive on the horizon and yet, here we are, well into the 21st century where male birth control in the form of a pill is still nonexistent.
Unfortunately, while permanent sterilisation is available for both genders, temporary contraception remains almost exclusively accessible for women. From a million and one different variations of the pill to IUDs, vaginal rings, three-monthly depo contraceptive injections, an internal condom, contraceptive implants and the diaphragm, women have a plethora of contraceptive options to choose from.
There have also been recent additions to this ever-growing list, according to Family Planning NSW Associate Medical Director dr. Clare Boerma.
“Newer contraceptive options for women include a lower-dose and smaller hormonal IUD called ‘Kyleena’, which became available in March 2020, and most recently, a progestogen-only pill labelled ‘Slinda’ became available in August this year.”
On the other hand, men are limited to one option: condoms. (Well, really two, with the second being withdrawal or ‘pulling out’ — but we all know this can’t be deemed reliable nor effective.)
Sure, the development of the female pill in the 1960s was, and remains, a key milestone for women’s rights. It has helped liberate many women, allowing them to take control of their fertility without their sexual partner’s involvement or knowledge. But the imbalance of options – and so, perceived ‘responsibility’ – is significant here.
Though the status quo may be challenged in other areas of gender inequality, this particular duty still largely remains a ‘women’s role’. And in this situation, greater responsibility in heterosexual relationships can equate to a burden, not a privilege.
The weight of contraceptive imbalance
For women, there are three key considerations to make when deciding whether or not to take a contraceptive drug: 1) the risks of the drug itself, 2) the risk of getting pregnant and 3) the risks of going through with said pregnancy. Conversely, healthy men don’t theoretically suffer any risks if they get someone pregnant.
“There’s an imbalance in outcomes for the consequences,” explains Dr. Mikayla Couch, an obstetric and gynaecology registrar at NSW Health.
“For example, if not wanting to continue the pregnancy, a woman would then have to arrange a termination, which is a significant procedure financially, emotionally and physically.”
So, why has it been extremely difficult to create birth control options for men when scientists have been able to create Covid vaccines in months? There are a few reasons to answer this million-dollar question.
“The process required for developing and testing a new contraceptive is onerous and male contraceptives have been in and out of development for decades,” Boerma explains.
In fact, what’s most startling is knowing the first trials of the male pill date all the way back to the 1970s but the female variety only took a short decade to be made widely available after it was invented. The biggest inhibitors for this gender imbalance have been a lack of funding and general fear.
“Development of a male contraceptive has been slowed due to funding challenges, patchy interest and investment by industry…” Boerma continues.
“In the past, there has been some uncertainty by research funders about whether there’s a market for these options, given the range of effective and safe female contraceptives available.”
Drugs with antispermatogenic agents (i.e. those that suppress sperm production and maturation) have been created in the past, however, the side effects have far outweighed the benefits, according to science.
“There has also been concern regarding what side effects men will tolerate – particularly when they aren’t the ones getting pregnant – and research has been haltered for this reason,” Boerma says.
This fear was famously illustrated in a two-hormone injection trial commissioned by the World Health Organization, which was designed to lower sperm count.
While the initial results looked promising with a 96 per cent success rate in preventing pregnancy, the trial was placed on hold after an independent review panel found too many side effects including acne, mood swings, depression and raised libido. It’s ironic since the female pill is still available despite having more numerous and severe side effects like migraines, weight gain, nausea and decreased libido.
Tighter ordinances have also been road blockers, Boerma explains.
“Regulatory hurdles are much higher than they were in the late 50s and early 60s when the first iterations of the female contraceptive pill were being made and approved.”
It makes you question — would today’s female pill have met the same fate had it been invented recently?
For a method to meet somewhat of a consensus today, it needs to meet five crucial factors: high efficacy, reversibility, speed of action, ease of use and safety. Let’s be honest, achieving all is a pretty challenging feat. Alas, the hope of a male pill being readily available in say, the next five years, is still a far cry.
“We know there is ongoing research into the male hormonal contraceptives. However, it takes a lot of time and money for a drug to be tested for safety and efficacy, and then to be approved for sale,” Boerma notes.
Couch adds that it isn’t a priority, either: “With the world currently fighting Covid, priorities are elsewhere. Similarly, contraceptive options for women are highly effective so there’s no urgency in finding a male option.”
The question of enthusiasm
Then there’s also another problem — if a pill or any other form of male contraception did become available, it doesn’t ensure its usage. Just take the male vasectomy as an example — this method was invented almost 200 years ago but female sterilisation is currently 10 times more common worldwide despite being less effective, more costly and susceptible to greater complications.
According to a UN study, just over a third of reproductive-aged couples worldwide don’t use any contraception at all but when it is used, only eight per cent of men rely on condoms while a mere two per cent on vasectomy. So, will new reversible male hormonal contraceptives even be met with a rally of support?
Surprisingly, the cultural expectations surrounding contraception suggest many men would actually embrace a pill if it was available. In fact, even an old 2002 study found 75.4 per cent of Australian men were welcoming of male hormonal contraception. On a global scale, a US-based study found 77 per cent of sexually active males aged 18-44 are “very or somewhat” interested in trying methods other than condoms or a vasectomy.
Boerma agrees: “In recent years, there has been a shift in the presumption that contraception should primarily be a woman’s responsibility and there is evidence showing a high proportion of men find the idea of male contraceptive acceptable.”
It highlights the fact that maybe a more persistent and louder push for wider cultural acceptance and relaxation of gender roles, especially with respect to contraception and pregnancy, is the prime answer to making this long-awaited male pill come to fruition in the imminent future.
It’s not all doom and gloom
As Boerma mentioned earlier, there are more contraceptive options for women now available, which may help eliminate some of the physical discomfort and stress, so it’s worthwhile running through all your options with your GP to find one that suits you best.
“If you’re feeling like your contraception is a burden, I’d recommend you talk to your GP or clinician at your local Family Planning clinic. There are many contraceptive options available and it’s a key part of our role to support patients to make informed choices about their reproductive health,” Boerma explains.
“If continually buying and remembering to take a pill is a hassle, or you’re worried about the risk of unintended pregnancy, it may be worth considering a long-acting reversible contraceptive such as an IUD or contraceptive implant, which requires no daily action by the user and can last several years.”
Aside from speaking to a healthcare professional, it’s important to remember conversations with your sexual partner should most likely be had, too.
“I would recommend that if you’re engaging in sexual activity where there may be a risk of pregnancy, have an open discussion with your partner and be aware of what contraceptive is being used,” Boerma emphasises.
“Ideally, avoiding unintended pregnancy should be a shared responsibility. If it’s your partner using the contraceptive and they’re not entirely happy with the method, support them to consider other options that may be available.”
As for any financial stress, we’re fortunate here in Australia to have the Pharmaceutical Benefits Scheme (PBS), which subsidises several contraceptives to make them more affordable and accessible. Or, you could also chat to your sexual partner about considering splitting the cost as a way to neutralise the responsibility.
Whatever you decide to do to help alleviate some of this emotional, mental and physical stress, remember Couch’s advice:
“You have all the decision-making power and don’t have to do something you don’t want to.”
No contraception is, or will be, perfect and almost any medication or irreversible surgery has some sort of side effect. So, while we can (justifiably) sit here blaming science and lack of funding for this gender imbalance, keep in mind that you do have choices available to you. Here’s hoping those options only grow from here – and not just for uterus owners.