Why is there no male birth control pill? A piece by Lisa Campo-Engelstein in this month’s Science Progress argues that we could have solved this problem decades ago, if not for “social factors” that have effectively made contraception a “woman’s problem” while simultaneously denying men the same option to control their fertility without their partner’s participation or consent. To borrow a metaphor, this screws us all: Women take on a greater burden for preventing pregnancy, while men can only hope their partner did so.
Let’s pretend you are a straight couple, in a monogamous long-term relationship, and you don’t want a kid. Consider your options: A woman can choose from 11 forms of contraception — including barrier methods like the diaphragm, permanent sterilization, and that holy grail of the sexual revolution, the pill, and its more recent and even more foolproof sisters in hormonal birth control, the ring and injectibles. A man can choose two: condoms or a vasectomy.
When comes to effectiveness, there’s no competition between hormonal and barrier methods: Condoms fail at a rate of about 16 percent, while the pill and other forms of hormonal contraceptives hover at about 3 percent. But to get the pill, a woman has to pay for regular gynecology appointments, where she will put her legs in stirrups and let her doctor root around in her vagina, then be prescribed a monthly dose of hormones. It’s also not cheap: According to Campo-Engelstein, women pay 68 percent more out of pocket for birth control than men of the same age. Not all insurance plans cover birth control. And uninsured women — who make up one in five women — are 30 percent less likely to use prescription birth control. What’s more, women sign on for a host of possible side effects: cardiovascular complications, depression, hepatic adenomas, pathologic weight gain, and possible bone loss. If you’re over 35, you have to quit smoking, or risk an even higher chance of blood clots that could lead to a stroke. Most women prefer these risks to those that accompany unplanned pregnancy, or a life of celibacy. But they are not trivial.
Guys? The shy ones might squirm a bit at the druggist (or dispense with the whole mess and order from Condomania). But women often take responsibility for male contraception, too: According to the piece, women are responsible for contraception about 67.3 percent of the time; when one includes condoms bought by women, the rate rises to 91 percent. But what men gain in convenience, they lose in control: They have to trust their partners to take their contraceptives correctly (while considering that even the most conscientious woman can miss a pill or two). If their partner gets knocked up, they have no say in whether or not she aborts. And if she keeps the child, they will be thrust into legal and financial fatherhood, like it or not. Writes Campo-Engelstein: “In some ways it seems unfair to hold men responsible for children they did not want when they are ill equipped to prevent pregnancy.”
What would solve this problem is a long-acting reversible contraceptive, or LARC, for men. But, infuriatingly for all of us, science isn't the only thing standing in the way. Scientists didn’t even start researching male LARCs until the ‘70s — 50 years after research began on female contraception. During the ‘90s, 60 percent of research dollars went to high-tech female contraception, while only 7 percent went to male contraception (3 percent went to female barrier methods, spermicides and natural fertility; 30 percent to multiple methods, mostly female).
The reasons behind this inequality, writes Campo-Engelstein, are based on outmoded “gender ideologies, not fact.” One such ideology is that men can not be trusted to be honest about birth control — although surveys show only 2 percent of women worldwide agree with this, while 55 percent of men say they would be willing to take a male pill. But some scientists believe men wouldn’t put up with the kind of unpleasant side effects that women take for granted: Some working on hormonal birth control for men, for example, are afraid that men might believe the common side effects of testosterone — including acne, mood swings and temporary shrinking of the testes — would “ ‘minimize’ their masculinity.” Others working on a pill that would prevent ejaculation worried that men would freak out — even though ejaculation has no effect on a man’s orgasm. The author has great hope in a new study of a protein that might inhibit male fertility with fewer side effects. But even if we catch the elusive male LARC, there’s still reason to wonder if we will see equal use of contraceptives between men and women: As Campo-Engelstein points out, the final solution — vasectomies and tubal ligations — are equally available to men and women. But although vasectomies are “quicker, easier, safer and cheaper,” than tubal ligations — and sometimes, reversible — American women are three times as likely to use permanent contraception than men.
For now, we’re at a stalemate: Men and women have separate and unequal access to birth control and thus unequal control over their sexual autonomy. We need more funding for research, untainted by outmoded gender assumptions. No form of birth control is perfectly accurate, perfectly safe, or without a few side effects. But as we develop more options, we also need to believe — and expect — that men and women will both be willing to compromise if their greater goal is participating in the joys of nonreproductive sex.