According to the latest available data, more than 40 percent of the six million pregnancies per year in the United States are unplanned. one in five pregnancy ends in abortion. With the Supreme Court decision quashing Roe v. Wade, and the resulting loss of access to safe abortion care for millions of Americans, it is more important than ever to prevent unplanned pregnancies. Using an effective method of contraception is the best way to do this.
As researchers developing hormonal contraception for men, we believe that to reduce unplanned pregnancies and the need for abortion, men should become more involved in contraception. Men are involved in 100 percent of unintended pregnancies, and most men remain fertile for much of their lives.
Male contraceptives have been used for hundreds of years. Condoms made from animal intestines were used in Renaissance Europe. Condoms are a useful tool to prevent pregnancy and sexually transmitted infections, despite having significant failure and discontinuation rates over time. A lot of men and women just don’t like it. Vasectomies have long been performed in the United States, but they are not always reversible and are therefore only attractive to men who have no interest in future fatherhood. Despite these drawbacks, condoms and vasectomy currently account for about 21 percent of monthly contraceptive use in the United States.
While many contraceptives for women exist, including implants, pills, IUDs, and vaginal rings, a significant proportion of women do not have a method that they can use safely or without significant side effects. For example the pill can not are recommended for women with a history of blood clots or women over the age of 35 who smoke. Many women experience side effects of contraceptives, such as abnormal bleeding, weight gain, acne and low libido. In addition, access to birth control, even for these imperfect options, remains a challenge in many situations. With the ability to terminate an unplanned pregnancy unavailable to many, the United States needs innovative solutions to have a major impact on the rate of unplanned pregnancies, which has remained relatively stable over the past two decades despite the introduction of more feminine methods. New male contraceptives keep that promise.
Would Men Use Birth Control If There Were More Choice? Multinational survey data suggests that 29 to 71 percent of men would use a male hormonal contraceptive. Recent market research from the Male Contraceptive Initiative shows that 82 percent of American men ages 18 to 44 whose partners have experienced unplanned pregnancy in the past are interested in new male contraceptive methods, with the majority saying they feel that they share the contraceptive responsibility with their partner. Important, one study found it that only 2 percent of women surveyed said they would not trust their partners to use a male hormonal contraceptive. More work is needed to substantiate this research data with real-life experiences of men and to educate men about contraceptive options.
Reversible hormonal contraception for men has been tested for about 50 years. We know from our own and other research that these methods work well for most men. Several injections and implants have been tested on more than 2,000 couples worldwide, together demonstrating reversibility and approximately 95 percent effectiveness in preventing pregnancy — rates comparable to the female pill and better than condoms.
The Eunice Kennedy Shriver National Institute of Child Health and Development and the Population Council, along with 15 centers around the world — including sites in the Americas, Europe and Africa — are conducting a study of more than 400 pairs of a hormonal contraceptive gel that men put on their shoulders once a day for 18 to 24 months. As researchers helping conduct this trial, we know that men are interested in and involved in using these methods. Our male participants often express a desire to continue using the contraceptive method after their time in the study has ended, and their female partners are often disappointed to return to their previous methods.
Non-hormonal contraceptives for men are less well developed, but show promise in lab tests. A prototype “reversible vasectomy” is being tested in countries such as India and the United States. It includes an injected gel that forms a plug to prevent the passage of sperm; the plug can be broken off or degraded to allow reversal. In the longer term, scientists are working to develop molecules that prevent sperm from swimming or maturing; however, these second-generation male contraceptives are probably more than a decade away.
As clinicians and developers, we are always asked about side effects. A minority of men who test hormonal contraceptives for men experience side effects that will be familiar to some women who have used hormonal contraceptives (for example, weight gain, acne, and increase or decrease in libido). Nevertheless, men say they are willing to share the burden of side effects with women, and the concept of shared risk has been proposed to reformulate the risk analysis in this situation. In this paradigm, men assume the risk of side effects from using contraception to protect their partners from the risk of unwanted effects from their contraceptive or unintended pregnancy. With a number of states further restricting access to safe abortion, the risks of unplanned pregnancy have risen sharply for many women, increasing the need to look at a couple’s shared risk when assessing potential contraceptive side effects.
As developers of male contraceptives, the most common question we are asked is, what takes so long? Investment in male contraceptive development has declined compared to previous decades when major pharmaceutical entities and non-governmental agencies were investors. Today, the National Institute of Child Health and Development and academia provide the vast majority of funding for the development of male contraception; lack of funding is slowing progress in the innovation and clinical testing phases.
Why the loss of engagement? It’s possible that the novelty of male contraception is seen as too risky for profit and the market undervalued for pharmaceutical involvement. In addition, developers suffer from a lack of regulatory guidance from the Food and Drug Administration about how effective these products should be before going to market. Agreement recommendations of the research community have been published suggesting metrics for evaluating new male hormonal contraceptives and establishing effectiveness and safety levels, but whether these will be adopted by regulators is unknown. More advocacy is needed to move the field forward and convince financiers and the pharmaceutical industry that there is a demand for this technology.
We do not develop male contraceptives to replace female contraceptives. Access to contraception and safe abortion is a fundamental human right for all people and a necessary part of public health. Many men want to share the burden of birth control with their partners; others want reproductive autonomy. Men are ready, but their contraceptive options are scarce. Education will be important as products come to market.
With the US Supreme Court ruling that will severely limit people’s options for unplanned pregnancy—a decision that will disproportionately impact poor women—we need to accelerate the development of male contraception more than ever. Lives are at stake.
Stephanie Page and John Amory are professors of medicine at the University of Washington School of Medicine, where they are develop male hormonal and non-hormonal contraception.
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