Written by Rebecca Callahan, Scientist, FHI 360 and Dominick Shattuck, Senior Research Officer, Institute for Reproductive Health, Georgetown University
The terms “family planning” and “birth control” are synonymous with women’s health and associated with the struggle for equal rights and women’s liberation. And while the advent of the pill and subsequent advances in contraceptive technology have had enormous implications for women’s health and agency over the last 60 years, male-controlled methods have been responsible for a substantial portion of prevented births for millennia. This reality often goes unnoticed as health care providers and family planning advocates—not to mention the general population – typically focus on women’s fertility. One might argue that men deserve a contraceptive revolution of their own.
The simple fact is current family planning options do not fully meet the needs of men or women. Nearly half (45% or 2.8 million) of the 6.1 million annual pregnancies in the United States are unintended. Fathers and mothers independently report unintended pregnancy rates similarly – just under 4 in 10. However, when men and women describe their fertility desires, use of family planning, and timing of next pregnancies, their perspectives diverge significantly. Data from the National Survey of Family Growth indicate that among single men in the U.S., 75% of births were unintended, with more than 10% of these men unaware of the pregnancies until after the birth. Also, men are not receiving family planning information. Men between 15-44 years old who have health insurance and attend regular check-ups are counseled on family planning only 10% of the time.
Evidence worldwide shows that contraceptive use increases when more methods are available to a larger portion of the population. Not only would new male contraceptives add to the method mix, they would also provide men with an opportunity to take a more proactive and equitable role in their own reproductive health and that of their family. Perhaps surprisingly, current contraceptive use patterns indicate that men are already actively involved in family planning. Globally, over 150 million couples rely on male methods of contraception (condoms, vasectomy, and withdrawal). This accounts for more than one fifth of all contraceptive use. The addition of fertility awareness methods, which require active male involvement, further increases this figure. In the U.S. and more developed countries, male methods account for more than 40% of contraceptive use among married couples. While a commonly cited excuse for the dearth of research on new male contraceptive technologies is that men will not use family planning, current use patterns suggest that men not only are interested, but are already engaged.
More evidence that men are interested in using family planning comes from clinical trials of new hormonal male methods. While none of these products have reached the market yet, male trial participants and their female partners consistently report satisfaction with the methods under study. In addition, surveys conducted across the globe of men’s and women’s attitudes toward hypothetical male methods indicate that men are interested in male contraception and that their partners trust them to take on the responsibility. A study of more than 9,000 men in nine countries and four continents found that more than half of the men would be willing to use a hormonal male method. Other global acceptability studies report similar findings. Forty-four to 83% of men in Scotland, South Africa, and Hong Kong said that they would use a male pill and 75% of new fathers surveyed in Australia reported a willingness to try a new male method. Not surprisingly, men’s preferences for route of administration (oral, injectable or implant) and frequency of administration varied largely by their experience with female methods having similar characteristics. Based on these data and others, it has been estimated that there may be 44 million potential users of male contraception worldwide.
Reaching men with contraceptive methods that meet their needs (and the needs of their partners) should be a priority for the international family planning community. The current global commitment to reduce unmet need for contraception must include fully engaging men, not only as supporters of women’s use of family planning methods but as users themselves.
While commercialization of new male methods is still years away, we can lay the foundation for their introduction by: 1) implementing programs that challenge traditional gender norms; 2) providing men with existing methods and decreasing barriers to their access; 3) integrating forward-thinking policies and language that include men in reproductive health services; and 4) continuing to promote women’s methods and raise awareness of familial benefits associated with proper timing spacing and limiting of pregnancies. Of course, boosting research and development investments in novel male contraceptive methods is also key. Funding such research will be addressed further in the final blog of this series.
As a community, we need to make this second contraceptive revolution happen so that both men and women have a comprehensive range of family planning options available to meet their changing needs throughout their reproductive lives.