Would Women Trust Men With the Sole Burden of Contraception?
As we speak, a groundbreaking clinical trial is underway at the University of Edinburgh. 450 men in stable heterosexual relationships are testing a new hormone gel — a mixture of progesterone and testosterone — as their sole form of contraception for the next 12 months. The goal of the study is to analyze the extent and manifestations of the contraceptive’s side effects and more importantly — its success in preventing unplanned pregnancy.
Research into developing a male Long-Lasting Reversible Contraceptive (LARC) has been gaining speed over the past few decades. Options outside of condoms, withdrawal, and vasectomies are now on the cusp of clinical trials. While all details of efficacy and potential side effects are essential to scrutinize, there are also sociological threads we need to pull at by examining people’s attitudes towards potential male contraception.
Can men ever be as intentional, honest and motivated as women — for whom the social, financial, physical and emotional consequences of contraceptive failure are much higher — when it comes to using LARCs? To phrase it another way, will women be able to trust men with the responsibility of contraception?
“Even if the man was ready to take responsibility for contraception [hypothetically], I wouldn’t be at peace. I would want to take it up myself initially. Because if something goes wrong, I’m going to end up pregnant, not him. I simply have more to lose,” says Mahima Kapoor, a 24-year-old journalist. Meghna Chaudhary, 30, entrepreneur, chimes in with a resounding no: “I would never, ever trust the man because the risk comes to me. I have to carry the output of our dalliance; he doesn’t.”
“I would trust the man, provided I know he’s as averse to pregnancy as I am,” says Prajakta Parkar, a 26-year-old marketing manager. After pausing, she adds: “Maybe I’d want to police him, as in, [ensure] he has the tablet in front of me.”
The advent of the Pill in the 1960s, which catalyzed the simmering women’s sexual revolution in many ways, was a resounding success. Today, 11 contraceptive options exist for women, including barrier methods like the female condom, hormonal methods like the Pill and LARCs like intrauterine devices. There are only two options for male contraception — condoms and vasectomy — neither of which are hormonal methods or LARCs, and both of which have troublingly low usage. This difference is problematic. Between 2017 and 2018, men made up only 6.8% of those who underwent surgical contraceptive procedures; between 2015 and 2016, the National Family Health Survey found that 95% of sexually active Indians were not using condoms. This reluctance can be attributed to reasons like “condoms reduce sexual pleasure,” and “vasectomies make men sterile.”
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Apart from the diminishing of men’s reproductive autonomy in deciding when and whether to father children, this lack of options forces women to assume most of the financial, physical and other burdens of contraception. Female contraceptive methods tend to be more expensive than male ones, complete with physician’s fees and renewed prescriptions. Then, there are the potential side effects from various hormonal contraceptives, time and energy dedicated to contraceptive care in the form of doctor visits, prescription refills and personal reminders, various do’s and don’ts to ensure the method works, invasive procedures like pelvic exams and IUD insertions, and the ever-present stress about the possibility of an unwanted pregnancy.
Tarini, who prefers to be identified by her online pseudonym, is a 25-year-old who is on the Pill. “The burden definitely falls on women because men don’t have to deal with pregnancy scares and apparently for men, it feels better without a condom. Pleasure wins over responsibility,” she says. She is currently based in China, so her sister-in-law pays for her prescription, but only because Tarini couldn’t find the right brand where she lives. “Before that, it used to cost me close to 120 Euros (close to Rs. 9,000) for 12 months of pills in Europe,” she says. She explains that when she moved to China, she couldn’t find the exact Chinese equivalent to her European brand, and neither did she have the money to see an international doctor in China. Not having the confidence to confide in her parents (ah, stigma, our old friend), she reached out to her brother’s wife, who is also a doctor. “She wrote me a prescription and I picked them up when I saw her at her wedding. For refills, she just couriers the pills to me.”
In committed relationships where there is a framework of trust and cooperation, and in marriages, where there is a framework of law and shared finances, the burden of childbirth gradually begins to fall on both partners. “I would trust my husband with the responsibility if a [LARC] was to be developed for men because even though we’ve only used condoms until now, he’s always been honest about them,” says Megha Mathur, a 35-year-old digital media producer. “He feels that if we get pregnant, it is his responsibility to give that child a safe and healthy upbringing, which is cost-intensive. So, he always has that pressure whether we can afford [another] child.”
Tarini, too, sees no reason why her male partner would not carry out the contraceptive process “outside of the fact that it is inconvenient.” She says, “I’ve known men who are really into using condoms because they are decent and don’t want to catch a disease or get you pregnant. I can see men in committed relationships being even more inclined [towards LARCs] so they don’t have to deal with issues related to unprotected sex.” In the same breath, she adds, “[…] though, in relation, I suppose men would prefer women to bear the burden. It’s kind of like housework. Why take any responsibility for it when the woman can take full responsibility for it?”
Purvasha, a 24-year-old student in a six-year-long relationship, says: “I am on the birth control pill because my boyfriend and I live together and have sex often. We also use condoms to prevent STDs, but sometimes, every now and then, we end up relying on the withdrawal method, so it’s nice to have that security of the Pill. He and I have actually discussed him using male contraception if the option ever arises because I don’t cope well with the anxiety the Pill gives me sometimes.” She says the trust is something you have to work on: “I don’t know if I would have been this comfortable with it five years ago.”
The more women get intimate and settled with a specific partner, the more likely they are to trust them to use male contraception correctly and consistently — a pattern not dissimilar to condom usage trends. Academic research also corroborates this takeaway.
A study, “Psychological Factors in the Acceptance and Use of Oral Contraceptives,” published in Psychological Perspectives on Population, based in 1960s America, 107 women — some attending a Family Planning Clinic, some college going — were asked “If there was a pill for men like the pill for women, who would you prefer to be responsible for contraception?” 72% of the women said they wanted to be in charge of the contraception, 16% felt it should be the man’s responsibility, and only 12% thought the burden of contraception should be shared. It is important to note that they were not asked if they would specifically trust their partner to use it. In 2012, the University of Kansas Medical Centre conducted a study to gauge male and female public opinion regarding a possible male contraceptive pill by interviewing 165 women across the world. Of those, women who were in stable relationships were specifically asked whether, if long-lasting male contraception was available, they would use it either now or in the future. It emerged that 65.6% of women believed they would use it and that their male partners would also be compliant.
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This jump in perception is best summarized in the results of a study, published in the Human Reproduction journal, which performs a quantitative analysis of women’s trust in men regarding contraception: “On the whole many women have rather cynical views of men in general which do not reflect their views of individual men — especially their partner.”
So, in some ways, there still remains a trust gap between the two genders — one that will affect women in nonmarital relationships unfairly should male contraception arrive. A two-fold change could reach contraceptive equality: a change in technology — well on its way, with billions of dollars being pumped into research and development — and a change in the ideology that places the burden of childbirth and childcare on women primarily, leading them to shoulder the burden of contraception as well.
In a 2012 entry in the AMA Journal of Ethics, Dr. Lisa Campo-Egelstein says: “Besides the fact that it is women who actually carry a child, though, the main reason pregnancy has more long-term consequences for women is that women are the assumed primary caretakers of children.”
Blaming socially constructed gender roles and placing this discourse on interpersonal trust in the feminist context, she adds: “If men become the primary caretakers of children (or at least to equally share the role of primary caretaker with women), then pregnancy would also carry significant consequences for them.” A cut-the-head-off-a-snake-and-the-body-will-die kind of approach. So, let’s get on with it, shall we?