Pulling Out from the Onus of Pregnancy Prevention
FEATURE | SEX
Written by Lily Chen (she/her) | @lil.ychen/@lilsticles | Contributing Writer
TW: Sex, Sexuality, Reproductive Rights
Disclaimer: Birth control is often framed as an issue for people with the capacity to become pregnant, and this limited framing prevents individuals from learning about information that is important for their sexual health and safety. In Aotearoa, our trans, non-binary and gender-diverse whānau are still subject to gender essentialism when accessing perinatal care. By using inclusive language, we empower everyone to make informed choices. While this article specifically explores evidence of gender asymmetry between cisgender men’s and women’s experiences of contraceptive use, reproductive injustice affects us all.
The side effect sheet of my birth control pill moonlights as a blanket. Double-sided and measuring 15 x 11 inches (38cm x 27cm), the sizable piece of paper comprehensively outlines the countless risks of oral contraception — risks that I must undertake for the reward of preventing an unplanned pregnancy. Truly, there is nothing sexier than having your body bloat and bleed from being pumped full of hormones! While non-hormonal alternatives are available, the horror stories pertaining to painful IUD insertions turned me off permanently. Oh, the price we pay for pleasurable sex without making a baby in the process.
Historically, contraception has always been a ‘woman’s issue’. In 1961, the contraceptive pill revolutionised the post-war socio-cultural landscape of Aotearoa. Gaining access to birth control was flagged as a feminist win, as women were finally able to make real choices over their fertility. In this new era of reproductive justice, more women delayed their ‘duties’ of marriage and motherhood, opting to study at university or stay longer in the workforce. Within two decades, the national birth rate halved. By breaking the bond between intercourse and reproduction, sex is seen to provide benefits beyond pregnancy.
Nowadays, the buffet of birth control caters to a variety of preferences. Sexual Wellbeing Aotearoa (formerly known as Family Planning) offers the daily oral pill, alongside long-acting reversible contraception; such as the injection, the implant, and two types of IUDs. Yet the availability of male contraception is limited to condoms and vasectomies only. Despite four decades of research and news reports promising a breakthrough every 5 years, no male-oriented birth control has ever made it into the mainstream market.
Currently, there are several types of male contraceptives being developed and tested around the world. With hormonal and non-hormonal options and a plethora of delivery methods, men should be spoiled for choice. Unfortunately, most of these approaches require ten weeks to become effective, and continuous treatment to maintain efficacy. A similar amount of time is expected for reversals. Another barrier is the scientific difficulty of defining what level of sperm count constitutes sterility, if not zero, in order to provide sufficient protection. Given that 1,500 sperm cells are produced per heartbeat (how romantic!), finding a way to defend the egg from these enthusiastic swimmers could be a life-long research commitment. Considering these shortcomings (haha), there is an unfulfilled need for male birth control that is effective and reversible.
Research into male contraception is a barren land, but scientists and scholars are confident that half a century of interdisciplinary effort will bear fruit. Multiple clinical programmes have commenced, with some methods escalating from rodent experiments to human trials. One option is a male oral contraceptive pill, which is designed to suppress hormones required for conception when taken daily. Another project showing promise is a hormonal gel rubbed onto shoulders and upper arms. This substance contains synthetic progestin, which prevents the production of testosterone in the testes, and thus, sperm being produced. By extension, replacement testosterone is added to reduce possible side effects, such as low libido. Alternatively, there is a non-hormonal gel that gets directly injected into the vas deferens, which is the tube that transfers sperm from the epididymis to the ejaculatory ducts. The injection contains a polymer serving to block spermatozoa from travelling into seminal fluid.
These studies are obviously groundbreaking, but the regulatory framework for introducing new medication into the market has become much stricter since the development of female contraception. Back then, there were barely any guidelines about clinical trials, resulting in controversial incidents that violated research ethics and abused human rights. Due to this newfound scrutiny, potential side effects for male contraception are regarded as particularly problematic for contemporary regulators, as exemplified by a clinical trial that was paused indefinitely because participants reported acne, mood swings, and injection site pain. Many criticised this decision, as the widely-used birth control methods for women warranted similar, if not more severe, symptoms. This outcry illustrates the disproportionate burden placed upon those with ovaries to prevent pregnancies.
Due to the dearth of male contraceptive options, such a lack of technological advancements has shaped societal attitudes and beliefs about who is primarily responsible for birth control. The introduction of the female contraceptive pill fundamentally changed the lives of women, and the impact was so profound that it quickly became the most popular method. Accordingly, parents, partners, and peers, normalised oral contraceptives as the logical choice for sexually active individuals. Yet by only focusing on people who can get pregnant, patriarchal institutions infer that we must face the mental and physical toll of contraception, and accept culpability if unplanned pregnancies arise.
Birth control is an incredibly gendered issue. The patriarchy socialises those who are capable of getting pregnant to bear the burden of pregnancy prevention by shaming and stigmatising unplanned pregnancies. In our sexually liberated world, many men assume that their female counterparts would manage contraceptive needs, as this is preferable to using a condom or considering other options that threaten their own comfort. Such gendered expectations undermine reproductive freedom. By challenging these power imbalances via narratives that purport to share the responsibility of contraception, disempowered parties are able to negotiate safe sex on their own terms, and thus, their bodily autonomy. As Aotearoa anticipates the hard launch of over-the-counter male contraception, kiwi men equally must overcome oppressive structures and systems that operate to limit reproductive justice.