Most contraceptive methods are aimed at women, an issue which Jackie Brown examines in a recent article in The Oxford Student. Brown discusses the great difference between the options available for women and men, and the inequality which arises from this. In response, retired gynaecologist Richard Grossman delves further into the complexity of side effects for both genders, highlighting that there can also be positive side effects, and argues that the difference lies in the technical challenge of male contraception, more than sexism.

By Pernilla Hansson and Richard Grossman

Against a backdrop of increasing sexual activity among young people, Jackie Brown examines contraceptive methods in her recent article “Women in Need of Protection? The Fundamental Problems with Contraception”. Brown chalks up this increase in sexual activity to changing social attitudes towards sexuality, and more importantly to the development and accessibility of contraceptive methods. The crux of the matter is that the majority of contraceptive methods are aimed at women.

Many contraceptives can cause a range of side effects. In her article, published in The Oxford Student, Brown mentions weight gain, acne, drops in mood, and blood clots as side effects of hormonal treatments such as the pill, and heavier and more painful periods as side effects of non-hormonal methods such as the copper Intrauterine Device. Ms. Brown herself was diagnosed with polycystic ovarian symptoms caused by a hormonal imbalance in the body, an imbalance that she says the hormonal effects of most female contraceptive methods would exacerbate. This condition affects 1 in 10 women. She doesn’t mention that, for many women, the side effects are positive rather than negative, as Dr. Grossman discusses below.

While there are a range of options available for women (the pill, Intrauterine Devices, implants, transdermal patches etc.), contraceptive alternatives for men presented on the NHS website were few: condoms or a vasectomy.

The article also raises the issue of convenience. While condoms can be bought relatively cheaply from any supermarket, current contraceptives for women are not only a rather expensive investment in most countries, but also often require the woman to visit her GP, a family planning clinic or a pharmacy. This can be both embarrassing and shaming.

New male contraceptive alternatives, such as a male equivalent of the pill, are being developed, but are still far from being ready for the market. According to a BBC article, some tests have reached phase three in clinical trials, while others were stopped at phase two due to side effects such as acne and drops in moods – which Ms. Brown points out have been seen as accepted side effects experienced by women on the pill. While the BBC article speculates that low commercial pressure is behind the slow development of male alternatives, Ms. Brown rather thinks it reveals the prevalence of a deeper, ingrained cultural sexism.

The development of the pill was championed by second-wave feminists as a method for women to gain freedom and control over their own sexuality without the risk of unwanted pregnancies. It does however put the responsibility of family planning on women. Little seems to have changed over the years; as professor Adam Watkins says in The Conversation, “the burden of family planning looks to remain firmly on the shoulders of women for now.” Brown argues that “sexuality should never be a burden, nor should it be driven by the profit of fundamentally patriarchal, capitalist institutions.” If the burden is to be carried solely by women, it brings with it an inherent imbalance to heterosexual relationships.

The article ends on a hopeful note for the future of contraceptive alternatives. Pushing for new male contraceptive methods would increase the equality of contraception use, something which would be of benefit to all.

TOP asked the experienced gynaecologist Dr. Richard Grossman for a comment on Ms Brown article:

I agree with most of what Jackie Brown wrote in “Women in Need of Protection? The Fundamental Problems with Contraception”. My viewpoint is of a retired, vasectomized male OB-GYN with a primary interest in family planning.

Yes, most contraceptive methods are for women. Although there is ongoing research on contraception for men, there are currently only three methods for men—condom, vasectomy and coitus interruptus (withdrawal). Please, Ms. Brown, don’t forget withdrawal!

Although it has a fairly high failure rate—almost a quarter of women who rely on withdrawal will conceive in a year—it is used successfully by many couples. While practicing in Puerto Rico, when asked about birth control, many women told me “my husband takes care of me.” Many of those couples had used withdrawal for years without failure.

All contraceptive methods have possible side effects. For men, latex condoms can cause an allergic rash in a very sensitive place! Vasectomy can result in infection or hematoma. Withdrawal alone is likely to be problem-free, except for the failure rate.

Fortunately, there are benefits to condoms (male or female) in addition to preventing pregnancy. They are the most effective way to decrease the transmission of infections.

While it is true that hormonal contraception may cause all the side effects that Ms. Brown lists (weight gain, acne, drops in mood and blood clots) and more, these hormones also have beneficial side effects. These include lighter and less crampy periods, fewer ovarian cysts and decreased risk of certain cancers. Although some women will have complexion problems from hormones, many have had their acne improve with certain birth control pills. For many cases of polycystic ovarian syndrome, the first-line treatment is birth control pills.

Is it a male conspiracy that is keeping scientists from researching male contraception? Or perhaps the industrial-medical complex is at fault? Perhaps one or both are culpable, but I doubt it. I think the most likely reason that most contraception is for women is a difference in physiology. To start with, most women only make one egg a month while men make many millions of sperm each month. Female endocrine functioning depends on delicate timing and for that egg to mature, which is easy to disrupt with exogenous female hormones. There is no equivalent manipulation for men of which I’m aware.

This lack of symmetry between men and women is paid back, however, in the ease of sterilization. While a woman’s sterilization (tubal ligation) can be performed relatively simply, it still involves entering the peritoneal cavity—which is defined as major surgery. A man’s sterilization procedure (vasectomy) is simpler to perform because the ducts the sperm travel through—the vas deferens—hang out in the breeze. I strongly recommend vasectomy over tubal ligation to any couple that has finished childbearing.

Fortunately, there is a small smorgasbord of contraceptive choices. Unfortunately, there are some couples for whom there is no perfect method. I hope that research will continue to develop new contraceptives—especially for men.

Please visit www.population-matters.org for more essays from Richard Grossman about human population (don’t forget the dash in link, to distinguish his website from the British organisation). You can subscribe to receive these monthly essays by email while you are at the blog.

If you want to read about overpopulation and the role medical professionals can play in solving it, TOP suggests reading a newly published article, entitled “Doctors and overpopulation 48 years later: a second notice“, by Jan Greguš and John Guillebaud.