The Responsibility We Cannot Share

I cook, he does dishes. He takes out the trash, I clean the kitchen. My husband and I balance responsibilities so that it feels even to both of us. But there is one responsibility that I cannot share with him, not because he would not take it — he absolutely would. But because the options available for him are not good enough. I am talking about preventing pregnancy.

His options are condoms and vasectomies. Condoms are subject to human error and vasectomies are not always reversible. And for us, neither option is quite right. So as in most heterosexual relationships, I, the woman, take the responsibility and I cope with the physical effects of my choice.

Women cope with the mood changes, weight gain, depression, reduced libido, and even increased risk of breast cancer that come with taking hormonal contraception in the form of a pill. We cope with the pain of insertions of IUDs and implants done with only local anesthesia. We wear skin patches and cope with headaches, nausea, and increased risk of heart attacks. We insert vaginal rings into ourselves at home and cope with soreness and tenderness. We cope. The alternative is no birth control and the possibility of an unwanted pregnancy. And even when studies show that more than 80% of men in heterosexual relationships want to participate in pregnancy prevention with their partners, women cannot share the responsibility. A long-acting, reversible, and reliable contraceptive method for men does not currently exist.

The pill, the first long-acting reversible contraceptive method for women, has been around since 1950. Since then, newer, more effective and less dangerous versions of the pill and a multitude of other contraceptive options have arrived. Over the last 70 years, long-acting and reversible contraceptive options for men have remained unavailable.

Pregnancy prevention is not a women’s issue. It is everyone’s issue.

Researchers explain that this is partially due to males’ reproductive biology. Females release one egg a month. Males release millions of sperm per milliliter of semen, which makes their reproductive capacities harder to manipulate. But researchers also acknowledge that the lack of research on contraceptive options for men is due to the overwhelming success of the women’s pill. Once it became widely used, it was taken for granted that women would continue to be the ones preventing pregnancy and experiencing the side effects.

The assumption that the pill had solved the problem of unwanted pregnancies also resulted in very little investment in developing contraceptive options for men.

The challenge of having men participate in contraception does not stop there. Market research shows that 80% of men would prefer a non-hormonal option (although 1 in 8 did not know the meaning of hormonal vs non-hormonal) and 89% want it to be reversible. The same study found that men have little tolerance for side effects, particularly for depression and reduced libido (Who does? Not the partners). Men also want this hypothetical product to be 99% effective. The challenge is finding a product that fits the market.

But we might be getting closer to a male option.

One new method, described as the IUD for men, is currently undergoing clinical trials. This procedure involves an injection into the vas deferens (the tubes that transport sperm) which acts like a temporary vasectomy. This minimally invasive procedure is done with local anesthesia, is expected to take less than 30 minutes, and prevents pregnancy for up to a year. But the clinical trials might fail to show a positive effect, and we might never see this product on the market.

If and when contraception products for men are available, their marketability — and, consequently, the success of future contraceptive methods — will depend on whether or not men use it. Enthusiasm equals money. If men are enthusiastic about male contraception, pharmaceutical companies will invest in improvements and new methods.

Pregnancy prevention is not a women’s issue. It is everyone’s issue. Recognizing the existing inequity is a huge first step. And, as women’s reproductive rights are being stripped away, men’s participation in family planning needs to extend beyond taking out the trash.

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