The best birth control options for women today have qualities our grandmothers could only have dreamed of. They toggle the fertility switch to off until a woman wants it on, making pregnancy “opt in” rather than “opt out.” They are easily reversed when a woman wants a baby and have bonus health benefits like lighter periods and protection against some cancers. They last from three to 12 years, depending on the method and can simply be forgotten once in place, yet have an annual failure rate below 1 in 500. By contrast, the only easily reversible method for men — the condom – lasts for exactly one orgasm, requires action during every sexual encounter, has a shocking annual pregnancy rate of 1 in 6, and is anything but forgettable. Men who want to manage their lives and fertility are stuck relying on technology that is almost 100 years old.
Wait till your father gets home
Four generations have passed since the rubber was invented, and in the intervening decades the role of men as fathers has changed dramatically. When Young’s Rubber Co. first took the Trojan rubber condom to market in the 1920s, most men married shortly after adolescence. They smoked cigars in bars while their babies were born. As kids grew up, fathers stereotypically left nurturing to mothers, stepping in with the belt when children got out of line. If a man seeded a child outside of marriage, he could often simply deny his involvement. In most communities and cultures, quantity of offspring was still a measure of a manhood; a man gained stature by seeding more children rather than by raising children who were happier and healthier.
Today, many fathers are intimately involved with their children from the moment of birth, and they delight in sharing in the playful and tender nurturing that once was the province of women. As men become more involved in raising children, most prefer fewer, deeper parenting relationships rather than offspring who are “cheaper by the dozen.” With the economic and educational landscape shifting, most also prefer to start having children later than our ancestors did.
But as traditional family structures have declined, fatherhood has also become more precarious. Single young men are getting drawn into parenthood by default rather than by design. When pregnancy comes early or unexpectedly, a man’s life plans may be derailed—either because of the responsibility he personally feels or because modern paternity tests mean he is on the hook to help support his offspring even when the timing is bad and circumstances make it hard to be a part of his child’s life in the way he might desire.
In other words, the social, emotional and financial costs to men of surprise pregnancy have gone up dramatically, while the options men have to manage their fertility are stuck in the 1920s. Condoms may be the best technology available for preventing sexually transmitted infections, but from the standpoint of fertility management they are almost a century out of date! If cars had advanced as much as condoms in the same time period, we’d all still be driving the Model T—or the once thrilling Model A.
Men, women, and children all pay the price for this ridiculous state of affairs. The difference between an annual failure rate of 1 in 6 (male condoms) vs. 1 in 2000 (female implant) is outrageous.
Here are eight reasons why it’s long past time we all demanded better.
1. Mutual consent and intent. If one thing belongs to each of us as individuals, it is our own body, and that includes our body’s ability to make babies. In an ideal world, each person owns his or her own genetic code, and whenever a child gets created through the recombination of DNA from two people, that requires the active consent of both parties. This is true whether the fertilized egg was formed through sex or some kind of assisted reproductive technology.
If our ancestors wanted sex, they had to accept the risk of pregnancy as part of the package. To ensure that children were born into secure families, cultures evolved strict rules about who could have sex when and claimed these rules were from gods. Sexual intimacy, family formation and childbearing were intimately bound together.
Now, thanks to contraceptive technologies, which have been described as the most disruptive technology of the 20th century, people are increasingly able to make independent choices about having sex, getting married and having babies. Whether inside or outside of marriage, sexual consent and baby-making consent are two different things. But at this point, because of imperfect contraceptives and imperfect access, the two are only partially uncoupled; and many babies are the result of active intent on the part of only one partner—or neither. Investing in new technologies that allow men to manage their fertility and make intentional choices about parenthood is critical to mutual consent.
2. Double Dutch and intentional childbearing as the new normal. Today half of all pregnancies in the U.S. are unintended, and many young people drift into partnership and parenthood in response to a surprise pregnancy. A wide variety of measures suggest that this pattern stacks the odds against healthy babies and flourishing families, and it contributes to multigenerational poverty.
Part of the problem is that many family planning methods that women use have a high rate of method failure or human error or both, which is why the CDC and medical experts increasingly recommend long-acting IUDs and implants when appropriate, including for sexually active teens. But even without better birth control for females, more effective and appealing options for guys and a norm of “double Dutch” protection—with each partner managing his or her own fertility—would do much to help make surprise pregnancy genuinely surprising. Consider: If a female using the pill has an annual pregnancy rate of 1 in 11, and a male using a condom has an annual failure rate of 1 in 6, together they can drop their yearly pregnancy risk to about 1 in 60.
3. The power of whatever is trending. Cultural norms can create virtuous or vicious cycles. As a social species, humans tend to adapt to whatever is familiar, and we want to be like the people around us, whether we’re talking about social media or early unplanned pregnancy.
Recent research suggests that one of the best predictors of whether a young woman will get pregnant as a teenager is whether her older sister did. While a host of factors are likely at play here, patterns of teen pregnancy and unintended pregnancy suggest that cultural norms around childbearing may play a role in contraceptive diligence and perceived agency. Teen pregnancy drives more teen pregnancy, and the converse is true as well. A change in male options that helps to make intentional childbearing the new normal might be expected to create a virtuous cycle that further drives up contraceptive use for both females and males.
4. Adaptive indifference. It is psychologically adaptive for people to be passive or at least to lack strong preferences about events over which they lack control. The much loved Serenity Prayer reminds us of this: Grant me the serenity to accept the things I cannot change; the courage to change the things I can; and the wisdom to know the difference.
Since our ancestors had little means to prevent childbearing other than by practicing sexual abstinence, traditional culture and religion promote the idea that, at least within marriage, every child is a blessing. For millennia, this was the best way to ensure that children were loved and wanted when they come into the world. In the words of the Serenity Prayer, unsought childbearing was to be accepted as one of “the things I cannot change.” For men, this is largely still the case.
As I said earlier, the only reversible prophylactic widely available to men, the condom, has a 1 in 6 annual failure rate, leaving couples who want to stack the odds in favor of a flourishing family with abortion as their last line of defense against an ill-conceived pregnancy. But a guy, for very good reasons, gets only so much say about terminating a pregnancy. Although most abortion decisions involve a joint agreement between a man and woman, if they disagree the decision ultimately falls to the person most affected—the female. Under these conditions, it remains adaptive for men not to be too invested in whether an act of sex produces a baby.
An unsought pregnancy can derail a young man’s life, but the rewards of sex being what they are—intense physical pleasure and intimate connection--a healthy young man may want to avoid thinking too much about the risks. Men who find condoms aversive may further engage in “motivated reasoning,” convincing themselves (or their female partners) that a pregnancy wouldn’t be a big deal. In the extreme, one way that some people deal with anxiety about events that are hard to predict is to actively bring them on. For some, the inability to prevent pregnancy with confidence may actually encourage some people to “lean into it.”
5. Gender Equality. One of the hard-wired differences between most male and female primates, including humans, is an orientation toward gender-associated dominance hierarchies. To the extent this is the case, it may be uncomfortable for females to have power that is denied to males. For literally millennia, male humans have sought to control female fertility and reproductive capacity, creating patriarchal hierarchies with men as the deciders.
Many modern men are more concerned with whether their family flourishes than who’s on top, and they appreciate the growing availability and excellence of female contraceptives that allow couples to delay, space or limit childbearing. But others may instinctively or even subconsciously dislike the fact that women have control that they themselves do not. Men with better tools to manage their own fertility are less likely to feel one-upped by a woman’s fertility management capability.
In much of the developing world, traditional gender roles remain strong, even to the point that women essentially remain chattel whose primary or highest function is to produce offspring that bring economic value and standing to a man. Women who have no ability to manage their fertility cannot reliably take on other roles. Even in prosperous Western democracies, they cannot fully participate in the economy or institutions of democracy. This makes the evolution of more egalitarian gender dynamics difficult. The paucity of real fertility management tools for men adds to an epidemic of surprise pregnancies that create cultural drag against full gender equality.
6. Shifting fatherhood norms and family/cultural violence. One of the most distressing aspects of ancient chattel culture is gender-based violence and sexual coercion. We now know that gender-based violence tends to increase during pregnancy, while marital satisfaction tends to decrease both after the first child and as the number of children born to a couple grows. This means that empowering men to manage their fertility may have positive effects on family dynamics.
At a societal level, as couples are able to delay, space and limit their childbearing, men tend to partner more fully in nurturing their children, which blurs rigid gender roles and strengthens family bonds, part of a virtuous cycle that fosters intentional parenthood, engaged parenting and more stable partnership even in the absence of traditional marriage. This change in norms may decrease not only gender-based violence and family violence but also violence in society as a whole. Young men born of later, intended pregnancies and who have fathering role models are less likely to end up in the criminal justice system, a benefit that ripples through not only their own lives but through whole communities.
7. Space for conversation, intentions and dreams. Medical practice standards encourage primary care doctors to ask women “one key question” when they seek routine care: Would you like to get pregnant in the next year? This simple question opens much more than a conversation about family planning options or preconception care; it also prompts a young woman to ask herself about her broader goals and dreams. It places her as the active agent in charge of creating her future. If she doesn’t want to get pregnant right away (most teens and young adults don’t), why not? What does she aspire to do or see or learn or accomplish before she has a baby?
By contrast, once young men are told about condoms in middle school and high school, the lack of additional contraceptive options means there is no reason for doctors to ask about their desires and intentions. Consequently young males don’t receive the additional, repeated prompt to ask themselves about their ideal future and to situate their parenting objectives within that future.
8. Justice. Around the planet, advocates for healthier families insist that reproductive rights are human rights. Are they? If so, why is little attention paid to reproductive empowerment of the half of humanity born male? An honest human rights framework would acknowledge that the difference between the top easily reversed family planning method available for women (1 in 2000 annual failure rate) and the top method available for men (1 in 6 annual failure rate) is unjust and unconscionable.
Adding insult to injury in the U.S. is the lack of insurance coverage for male birth control methods. For example, the contraceptive mandate of the American Affordable Care Act dictates that all FDA-approved contraceptives for women be covered with no co-pay as a part of preventive health services. But vasectomies—the only reliable options available to men—are excluded, as are condoms. What is the reasoning? Since men can’t get pregnant, being able to manage their fertility isn’t a health issue? Do male mental health and lifespan development and general flourishing count for nothing in the health equation?
Surely we can do better.