Editor’s Note: Unfortunately, in order to have a conversation around the ways that society polices what kind of birth control is on the market, we have to get into the mind of society – and society is cissexist. Thus, this article at times echoes those sentiments – not because we at Everyday Feminism believe that vaginas can only belong to women or that penises can only belong to men, but rather, because in order to deconstruct the stereotypes, we need to operate under the assumptions of those stereotypes.
I first became sexually active in high school, and I accepted pretty early on that if I was having the kind of sex that could lead to pregnancy (and was in the kind of situation where I wasn’t worried about STI’s), then it was going to be me who was the one to deal with contraception.
A big reason for that is that as someone with a uterus, I’ve just had a lot more temporary options for birth control than have my partners without.
Indeed, birth control pills have been an available since 1960. And these days, we also have access to patches, shots, rings, implants, IUDs, diaphragms, cervical caps, spermicides, and sponges.
And it’s not just that these methods are available. They are also used in great numbers.
According to the CDC, more than 99% of women aged 15–44 who have ever had vaginal intercourse have relied on at least one method of birth control to prevent pregnancy. Yet despite a percent like this, the only things that people with penises have at their disposal are condoms, withdrawal, and vasectomies.
Why is that?
Though many people assume that science is the biggest barrier to an effective, safe, and reversible birth control for folks with penises, the reality is a little more complicated.
While the difficulties of developing a new birth control for another set of reproductive anatomy are real, what is also real is the reluctance by pharmaceutical companies to invest in it when effective and lucrative birth control already exists.
And what does this come down to?
Both cissexism and sexism.
The cissexism that comes into play here should be pretty obvious, but I’ll spell it out for you: It’s because the medical field, by and large, thinks of people with penises assumedly as men – which ties directly into the sexism part:
Further delaying more “male” options is the impact of some pretty gendered ideas about reproduction and ideas about whose job it is to make sure a pregnancy does or does not happen.
Taken together, these factors contribute to the fact that while every few years there is some announcement about a pill like this that is just around the corner, in most parts of the world, that corner still seems pretty far off.
It isn’t surprising, living in an oppressive (and especially cissexist and sexist) world, that beliefs about birth control are often based on gender stereotypes. A lot of people just assume not only that preventing pregnancy is a woman’s job, but that doing so is also something that men are neither interested in, nor able to be trusted with.
But the idea that women should be the ones who are responsible for birth control hasn’t always been the prominent view. In fact, throughout history (and still in many situations today), pregnancy, and the ability to prevent it, remains squarely a man’s call in a relationship.
This imbalance was part of what drove (the often controversial, but still important) Margaret Sanger to claim that women would never be truly equal until they had contraception that they could control. That argument directly contributed to the invention of the birth control pill and the shift of contraceptive responsibility in the West from men’s laps into women’s.
But while the ability to independently control fertility is crucial for women, modern equality demands that men take part in shouldering the birth control responsibility.
So, can they be trusted to do so?
A lot of folks seem to think that the men they know could (as evidenced by all the people who bank on condoms and vasectomies and withdrawal), but that the “average man” would be too cavalier about using male birth control to be depended on.
As Lisa Campo-Engelstein writes in the American Medical Association Journal of Ethics:
Many mainstream news articles assert…that most women’s response to male contraceptives would be something like, ‘Are you kidding? I can’t even trust him to take out the garbage!’ In contrast, academic studies show that women in committed relationships would trust their male partners to use new contraceptives. Furthermore, while they may not be a representative sample, it seems safe to assume that women who have agreed to join clinical trials for male contraceptives, knowing it meant they could not use any other forms of contraception, trusted their partner to use the new contraceptives.”
But it not just a fear of irresponsibility that gives people pause when considering new birth control options.
Some worry that men would flat out lie about being on the pill in order to have unprotected sex – or, more nefariously, would lie about this in order to get a partner pregnant. Though reproductive coercion is real and troubling, opposing contraception options on these grounds sure isn’t the way to tackle this problem!
Others seem to assume that men are too macho, ego-driven, or lazy to pursue birth control.
As researchers from the UK write, “It has been asserted that it is part of the image of male masculinity to exhibit fertility rather than preventing it. Similarly attributed to the traditional masculine role are men’s reluctant attitudes towards taking care of their own health because that would be a sign of weakness. Compared to women, men have less regular contact with health care professionals and are less likely to seek preventive reproductive and sexual health information and contraceptives.”
Still, despite such gender barriers, a lot of men express interest in birth control.
Indeed, the few men I casually talked to about birth control all seemed enthused about the idea for a variety of reasons. A lot simply wanted to give their partners relief from the responsibility or felt they had an ethical duty to participate.
Others, like my friend Noam, a 38-year-old married father of two, had a slightly different motivation. He saw it as a way to ensure his peace of mind. As he explained, “I would have liked more control of my reproductive ability while I was dating. I hated having to ask a women about her stance on abortion early on and having to be subject to her opinion.”
Of course, it isn’t just my random pals who are open to it.
Multiple surveys have found that men around the world do want to be able to control their reproduction.
For example, in a cross-cultural study of attitudes toward hormonal contraception conducted in Edinburgh, Cape Town, Shanghai, and Hong Kong, the majority of the (cis) male participants said they would use a contraceptive pill.
In another survey, of over 9000 (cis) men between 18 and 50 from nine countries, 29–74% of various nationalities expressed willingness to use a hormonal contraceptive, with an overall willingness rate of 55%.
Combine these numbers with the fact that in the US, 12% of men have vasectomies and in Canada, 22% do, and it becomes clear that there is definite birth control interest from men.
As Elaine Lissner, founder of a San Francisco-based non-profit group called the Male Contraception Information Project says, “In the past, people believed that men weren’t interested in contraception. But the numbers disprove that. Men are already using the only two contraceptives they have – condoms and vasectomy – in great numbers. At least in the United States, the idea that men aren’t willing to participate is clearly out of date.”
So though it is still folks with uteruses who become pregnant, and as a result have to deal with the outcome of an unwanted pregnancy in a much more hands on way than do those without, many of the latter would like to share the burden for birth control in ways both physical and financial.
Scientific and Pharmaceutical Barriers
It’s not only our outdated ideas about men and contraception that have delayed the progress on this issue. There is also the matter of the complicated relationship between scientific innovation and pharmaceutical investment.
Currently, there are two main types of research into alternative contraceptive options. One involves using synthetic hormones to temporarily stop the development of sperm, and the other is a gel that would be injected into the vas deferens to prevent sperm from leaving the body.
Hormonal options are complicated for a few reasons.
Oral contraceptives for people with uteruses trigger hormonal changes in the body that mimic pregnancy and prevent ovulation. But people without don’t have a similar phase when they would be temporarily infertile, so researchers can’t try to replicate a natural state.
Plus, unlike people who only release eggs about once a month from puberty until menopause, folks with penises make sperm daily from puberty until the day they die. This makes the whole process of thwarting sperm particularly difficult.
Like others who have had to contend with a whole host of not-so-nice hormonal birth control side effects (including moodiness, lowered sex drive, and in rare cases, blood clots), the potential side effects of alternative contraceptives are a big issue.
As Jack, another friend of mine, said when I asked him if he would be open to using a birth control pill: “I’d take the pill. But my potential reservations would be similar to some of the concerns women have with the pill. What are some of the side effects?”
Unfortunately for Jack and others like him, the answer can be a pretty long list.
Researchers have found that (cis) men taking hormonal birth control in clinical trials experience a range of side effects including weight gain, loss of libido, gynecomastia, liver function impairment, depression, other changes in mood, and a lowered level of HDL cholesterol.
Another barrier is that, for reasons not totally understood, not all men respond to , and some continue to make sperm even while using a hormonal method that suppresses sperm production in others.
A Reversible ‘Vasectomy’
But hormonal methods aren’t the only idea in the pipeline. There is another contraceptive called Vasalgel that is in development.
This is similar to a vasectomy, but unlike a vasectomy, which involves cutting the vas deferens (the tube the sperm swim through) to prevent sperm from leaving the body, with Vasalgel, a gel is injected into the vas deferens.
This gel can last almost a decade and prevents sperm from leaving the body through the penis. Unlike a traditional vasectomy, which is designed to be permanent, with this method, it’s possible to flush the gel out with another injection any time one wants to restore fertility.
Vasalgel is set to start clinical trials this year, and there definitely seems to be interest in it. So far, over 18,000 people have signed up to hear about its latest developments.
The Cost Factor
Bringing any new contraceptive to market is complicated and expensive – like, multi-million dollar expensive. It’s also something that pharmaceutical companies have been turning away from.
As Madeline Schwartz writes in a recent New Yorker article on the future of birth control:
“At this point, most of the research and development for new contraception is performed by nonprofit companies and by government agencies… But funding for contraceptive research and development has been declining in the public sector, too… In the current political climate, even that amount may not be stable. The budget for government research depends on Congress, and on foundation money on donors’ comfort levels.”
Ultimately, most pharmaceutical companies don’t see the need for these types of birth control.
Since many birth control methods for people with penises (like Vasalgel) are long-term solutions, they also don’t see a financial return that is anything like the one that comes with the daily hormonal pills that many people already take. As a result, there is even less incentive for companies to move forward.
Where Do We Go Now?
It seems like the most likely way for birth control advancements to occur will be through a lot of grassroots advocating and fundraising. These are things that just aren’t likely to have an impact on big pharma and their big wallets.
As Elaine Lissner explains, “Support for methods that are farthest along in the development pathway is most needed and some promising methods do not advance due to simple lack of funding. Additionally, it is important that people let their opinions about male contraception be heard, since there is still an outdated concept that men would not use male birth control methods.”
But whatever developments actually become available, for now, our options remain what they long have.
That doesn’t mean that people with penises can’t participate in pregnancy prevention.
Condoms, withdrawal, and vasectomies are all options. So is sharing the cost burden for a partner’s birth control. Plus, it never hurts for partners to acknowledge the impact on another’s life and health that many methods of birth control can have.
Preventing a pregnancy can easily become gendered, but even with today’s limited options, it doesn’t have to stay that way.
Ellen Kate is a Contributing Writer for Everyday Feminism. She’s a health educator, sometime writer, and mom. She has worked at Manhattan’s Museum of Sex, developed sex education curricula in Mumbai, India, and run HIV prevention programs for at-risk teens in the South Bronx. Currently, Ellen teaches human sexuality at Brooklyn College (something she also did at Rutgers University). Ellen also runs About.com’s LGBT Teens site. More of Ellen’s writing can be found here. Follow her on Twitter @ellenkatef.
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