“Why are women still bearing the brunt of responsibility for contraception?”

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Harriet Hall
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A recent trial of male contraceptives was halted because of ‘intolerable’ side effects, but would the same have happened for a drug for women? Harriet Hall investigates

A few Saturdays ago, I cried four times in the space of an afternoon.

No personal tragedies or catastrophic global events had occurred (this was pre-Trump, I should add); I simply couldn’t plug the waterworks. After having dissolved into tears at the Lloyds Bank advert (something about those running horses, that music), I started to recognise the familiar symptoms. And then I glimpsed what was responsible – that familiar little green foil packet poking out of my make-up bag.

Just like an estimated 100 million women around the world, I take the contraceptive pill, both as a means of contraception and a way to deal with the pain of my periods. And along with many of those women, I weather many of the common side effects – water retention, headaches, low energy and frequent low moods.

But in the back of my mind I can’t help but worry about the rare side effects too – a small risk of DVT and strokes (which is raised if you smoke or are severely overweight); an increased risk of certain cancers (although the pill does decrease the risk of some others too).

In fact, every morning, when I pop that little yellow pellet, I consider how high a price I am paying to avoid pregnancy. So when I learned last week that long-standing trials into a male contraceptive hormone injection had been halted in America because of ‘intolerable’ side effects (depression, muscle pain, mood swings, acne and libido alteration – those seemingly identical to what I and many other women have suffered for donkey’s) – to say I was disappointed is to make a wild understatement.

In fact, it was reported that the trial of the 96% effective male injection was stopped after 20 out of a 320-man sample complained, despite 75% of participants saying they would be willing to take it long term. Now I am by no means suggesting that men should just grin and bear it – these were severe and serious side effects (it also took a while for some of the men in the trial to return to full fertility) – but were the female pill to be tested now, would the results be very different? History tells us that it might.

After all, an investigation by feminist website Broadly recently discovered that three women actually died in an early trial for the contraceptive pill in the Fifties and Sixties, and many reported side effects such as nausea, headaches, stomach aches, dizziness and vomiting – but the drug was still released. Some studies also show that today, 30% of women who take birth control pills experience depression, while in the trials for this injection it was only reported in 3% of men.

Indeed, after the trial was stalled, arguments began to surface that perhaps this represented something of a double standard. “These risks are not fatal risks like women endure with their birth control,” said Elisabeth Lloyd, a faculty scholar at the Kinsey Institute. “You have to compare what women are doing in terms of taking hormones with what men are doing in terms of taking hormones. Are they taking their life into their hands when they take the hormones? Women are.”

Of course, for most of us, the contraceptive pill is safe and convenient, and scientists are keen to point out that the benefits outweigh the risks (of every 10,000 women taking the combined Pill, on average six will develop blood clots as opposed to two in 10,000 for women not on the Pill). But why in 2016 – after the development of a male pill actually began in the Fifties – are women still bearing the main brunt of responsibility for contraception? “Male pleasure has long been prioritised over female enjoyment of sex,” says sex educator, Alix Fox. “Coping with the unwanted symptoms of taking synthesised hormones could be viewed as yet another way in which women have been expected to sacrifice their own happiness and wellbeing in order to conveniently please men.”

Blame your hormones

Of course the Pill isn’t the only contraceptive for women. Since its introduction in 1961 (which sparked the so-called ‘sexual revolution’), we’ve also been offered the copper coil and the injection (both during the Sixties), the implant (Nineties) and the patch (2002). And yet, despite science’s ability to put to market all these variations for women, men remain limited to the surgical vasectomy and the humble rubber (which for some is uncomfortable and potentially unreliable).

According to a recent peer-reviewed study, 50% of men would be willing to take a hormonal or non-hormonal contraceptive. So why has it taken so long for any sort of progress? While medical advances have progressed in leaps and bounds in the last two decades – seeing stem- cell research reverse life-threatening diseases, the development of HIV preventatives, a human hand transplant – developing a hormonal male contraceptive has proven more difficult.

“Unlike the cyclicality of the female reproductive system, male hormones are [mostly] static and therefore it’s difficult to get a contraceptive effect without having an effect on their secondary sexual characteristics such as hair growth, libido or erectile function,” explains Allan Pacey, professor of male reproductive health at the University of Sheffield.

But not everyone agrees. “Considering that women can only get pregnant for six days each month, but men are able to impregnate a woman every single day, it makes little sense that women take on the burden of avoiding pregnancy by using side effect laden and dangerous medications and devices,” says Holly Grigg-Spall, author of Sweetening The Pill: Or How We Got Hooked On Hormonal Birth Control. “It seems science hasn’t had its feminist awakening quite yet.”

But while it is clearly difficult to produce these drugs, it’s not impossible. And the real problem, arguably, seems to be a lack of financial interest. “The road to drug development is long and unpredictable. And it becomes even longer in areas like male contraception when funding is in such short supply,” says Aaron Hamlin, executive director of the Male Contraception Initiative. Female contraceptives bring in billions so why would pharmaceuticals risk losing that for something with an unpredictable take-up rate?

The good news

That all said, male contraceptive research is inching along. Just slowly. Along with the now-defunct hormone injection trial (which was designed to lower sperm count by acting on the brain’s pituitary gland) scientists are also currently working on several non-hormonal methods of contraception for men, the frontrunner of which is Vasalgel – a polymer gel that causes a reversible inhibition of sperm production, injected into the sperm-carrying tubes under general anaesthetic. Vasalgel could be tested on people as early as 2017 and other non-hormonal contraceptives have undergone human trials in Indonesia and the United States. Here in the UK, King’s College London is working on what has been charmingly dubbed the ‘clean sheets pill’, which inhibits ejaculation altogether, while maintaining orgasm.

“It is unfair that the most effective methods of birth control are still in the hands of women,” says Hamlin. “But once we see new male contraceptives available, we’ll see a shift. That’s a positive for everyone.” It’s heartening that progress – however glacial – is being made. But it’s still galling that women have had to shoulder the burden for so long. Male contraceptives would be life changing for both sexes, whether that be sharing the responsibility, reducing the chance of side effects, or even lowering the risk of some STIs in the case of the ‘clean sheets pill’. After all, when we have equal contraceptive options – that’s when the real sexual revolution will begin.

The future of contraception

Keep your eyes peeled for these suitably sci-fi options currently in development

The male pill

The ‘clean sheets pill’, when taken a few hours before sex, will prevent men from ejaculating. It lasts for 16 to 24 hours, and works by relaxing the longitudinal muscles in the vas deferens (the tube that carries semen from the testicles).

The ‘reversible vasectomy’

A longer-lasting option is Vasalgel, which will act like a reversible vasectomy: a gel is injected into the vas deferens, which forms a barrier, blocking the sperm from getting through. It can last for years, until being flushed out with another injection. the hormone injection A recent study found that by injecting a mix of the hormones progesterone and testosterone every couple of months, men can reduce their sperm production. It was nearly 96% effective at preventing pregnancy – almost the same as the contraceptive pill for women.

Remote control

Researchers are working on a contraceptive microchip that, when inserted under the skin, can deliver a daily dose of birth control hormones, governed by remote control. At the press of a button, an electrical current releases the seal in the microchip, allowing the medication into the body.

The male implant

A German carpenter called Clemens Bimek has invented a valve which, when implanted on the vas deferens, can block the flow of sperm from the testicles. The valve is opened and closed by a switch which is inserted under the skin of the man’s scrotum, so he can turn it on and off as he wishes.

So, who would actually use it?

We asked men how they feel about the new wave of male contraceptives

“I’d definitely do it”

Paul Livingston, 26, is a barrister and has been in a relationship for nine months

“Yes. I’d have the injection because I’d prefer not to have to think about taking a pill before having sex. When I first started dating my girlfriend and I found out that she wasn’t on the pill, I googled how likely it is that the male pill will be developed. This isn’t the case now, but in the past I’ve been in relationships where I’ve felt scared about relying on my partner to take the pill, worried they might forget. Many women feel pressured to be on the pill even if it makes them feel rubbish, and that seems totally unfair.”

“I don’t want to be the first”

Adam Lewis, 30, is a management consultant and has been with his girlfriend for seven years

“No! I’ve absolutely no idea how reliable the male pill and injection are, so I would be very nervous they wouldn’t work and we would end up pregnant. I’m not going to be first to try them out just for the good of humanity and equality.

I do believe contraception is a shared responsibility – we share responsibility now by using condoms. That said though, if we were confident in these new methods, I would prefer to be the one to take a pill: if my girlfriend is going to carry our child, I’d rather my body were affected beforehand.

“I’d like to be in control”

Dev Desai, 32, is a PhD student. He has been with his partner for three and a half years

“Yes. There’s something appealing about being the master of your own fertility. I would prefer to have it under my control. I find it weird people argue male contraception would be a feminist development though. Society is set up so that men have control, but this is one of the few areas where that isn’t the case. I would want to see how the male pill and injection affected me though – my wife and I would need to compare side effects. But even if she was OK, I would welcome the chance to have control too.”

“We’re fine at the moment”

David Warwick, 43, is a freelance translator and has been with his girlfriend for four months

“Not right now. But I don’t think contraception is the woman’s or the man’s responsibility – it’s the couple’s. I’ve been using condoms for years and I’ve always been the one who buys them. So if I was with a woman who didn’t want to take long-term contraception because of the side effects, I’d be up for having a go. But if you asked me to take the male pill or injection tomorrow, I wouldn’t see the point. My partner gets on well with the coil so, for the moment, we have no reason to try anything else.”

“It would make things equal”

Shawn Phillips, 29, is an IT account manager. He has been with his wife for nine and a half years. They have two children

“Yes. I think this is a very interesting development – but I would need reassurance it would be safe. At the moment, long-term, reversible contraception is dependent on the woman, which is unfair. I know many women, including my wife, don’t get on with the pill due to the impact the hormones have on the body and the way it makes them feel. The male pill or injection would give us another option – although my wife would worry about me forgetting to take it, and that would be a legitimate concern!”

“To be honest I’m not keen”

David de Jong, 29, is an entrepreneur. He’s been in a relationship for three and a half years

“I definitely believe in equality, but given that so far the side effects have been shown to be quite serious – serious enough for the male contraceptive pill/injection to not be made widely available – I’d feel very nervous about putting those hormones into my body. I like to feel I have control of my health and everything that goes into my body, and the thought of any hormones taking a while to leave my system scares me a little bit, to be honest. I’m not keen.”

Case studies and additional words: Moya Sarner