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08/15/2016

Why We Need a Male Pill: Enhancing Men’s Reproductive Autonomy and Unburdening Women’s Contraceptive Responsibility


One of the key tenets of
reproductive autonomy is being able to control if, when, and with whom one
reproduces. Men’s reproductive autonomy is inhibited by the lack of good
contraceptive options available to them. Whereas women have 11 types of contraceptives—including
barrier, hormonal, permanent, and long-acting reversible—men only have two
types—the male condom, a barrier method, and vasectomy, a permanent method. It
is not just the number of methods that is problematic; it is also the lack of long-acting
reversible contraceptives (LARCs). Many men want to maintain their future
fertility, thus ruling out vasectomy, but do not want to rely on condoms,
especially if they are in a long-term monogamous relationship. While part of
the reason some men do not like condoms is because they can decrease sexual
sensation, another reason is that the failure rate for actual use is so high:
17%. Female LARCs, in contrast, have much lower failure rates for actual use,
which enhances their reproductive autonomy because they are equipped with effective
methods to enact their reproductive desires (i.e. avoiding pregnancy).


The lack of male LARCS causes some
men to rely upon their female partner to contraceptive since she has more and
better contraceptive options. Yet this dependence on his partner may also
comprise his reproductive autonomy because he has to trust that she is
consistently and correctly using female methods. If she does become pregnant,
he has no recourse and, in many settings, is legally responsible for any
offspring, including financial and even social obligations to the child.


Placing the majority of
contraceptive responsibility on women due to the lack of male methods is not just
bad for men; it is also bad for women. Women have to shoulder the health-related
side effects of contraception, which tend to have more serious side effects
than male methods because they include hormonal methods. Not surprisingly then,
the most common reason for nonuse of modern contraceptives among women with an
unmet need is health concerns and side effects. Additionally, side effects are
the most cited reason why women discontinue contraceptives and most forms of
contraception have discontinuation rates near 50% after one year of use. The
fact that women continue to use a particular method does not mean she is happy
with it; she (and her partner) may simply see it as their best option among
poor choices.


In addition to the health related
side effects of contraception, there are also the financial burdens of
contraception. In the US, although the Affordable Care Act requires health insurance
companies to cover female contraceptives, not all women are aware of this and
very few women realize that certain forms of contraceptive, such as IUDs and
tubal ligation, are covered. Even if the cost of contraception is covered,
women still have to invest the time to acquire contraception: all methods
except the female condom and the sponge require at least one health care
provider visit and hormonal methods require an ongoing prescription. In the
global South, women may face difficulty affording contraception, especially if
their government does not prioritize reproductive health services.


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