By Hannah Wakefield
Since the advent of the contraceptive pill in the 1960s, female-based contraceptives have become increasingly popular, with more than 104 million women worldwide using the pill. The idea of a male hormonal contraceptive is hardly ground-breaking – the first forays into research were carried out in the 1970s. However, with the recent revelation that the contraceptive pill can cause depression, the spotlight has become increasingly fixed on the push for a male alternative.
In the same way that the pill sparked the sexual revolution, allowing women to take full control of their fertility for the first time, a male hormonal contraceptive could revolutionise sex worldwide. If both physical and hormonal forms of contraception were available to both men and women the burden of responsibility would be equally split, rather than weighing heavily on the woman’s side. Out of the male-reliant contraceptive methods only condoms currently do not permanently affect fertility, with a vasectomy being the only other truly reliable method of preventing pregnancy. With 150 million couples – one quarter of the world’s total – and 300 million people, relying on male-reliant methods, what is presently on offer is simply not sufficient. Indeed, condoms have a much debated failure rate, estimated to be somewhere between 10-12 percent, which is alarmingly high especially considering that men have very little rights or control with regards to pregnancy.
During preliminary testing of male hormonal contraceptives, the emergence of particular side-effects has slowed their development. These include weight gain, changes in mood and libido, and in some cases depression. Although this is by no means ideal, they are very much the same side-effects experienced by the millions of women who take the contraceptive pill every day. Furthermore the time it takes to regain fertility after one stops taking hormonal contraceptives is similar in both men and women, ranging from a matter of days to up to six months. However, perhaps more challenging than the side effects they produce is the fact that male hormonal contraceptives have shown during testing to have highly varying rates of efficacy in men of different racial backgrounds. This is problematic as the effectiveness of such a pill on any given man could be very different from the next, making it more unreliable and unpredictable than the female contraceptive pill. Moreover, the fact that the pill’s effectiveness is reliant on race would mean that different pills would have to be developed for different regions of the world. Not only would this be costly, but its production would be limited by global inequalities, with poorer parts of the world being unlikely be able to fund such developments.
The issue of effectiveness is perhaps secondary to the risk male hormonal contraceptives pose to the spread of STIs. This raises the question as to whether or not a such a drug would be universally appropriate – although, once again, female-based hormonal contraceptives hold the same risks. In Western countries such as Sweden and the UK, STIs are less of an issue than in the developing world.
The global HIV pandemic is perhaps the most significant reason to limit the availability of male hormonal contraceptives. With around 60 percent of the world’s HIV sufferers living in sub-Saharan Africa, countries such as Uganda exemplify the threats hormonal contraceptives pose. Although unwanted pregnancy is a major issue for Ugandan women due to inadequate access to contraception, the spread of HIV remains a more critical issue. Here, 7.25 percent of adults aged 15-49 are living with HIV/AIDS, one of the highest rates in the world. The rate in Sweden, meanwhile, is just 0.18 percent. Therefore, whilst male hormonal contraceptives have the potential to liberate women, freeing them from the burden of pregnancy and so promote women’s independence, at present they are surely inappropriate for many countries. In Uganda there is currently a widespread campaign to practice sex safe, with the use of condoms, both male and female, being widely promoted. On the other hand there is a general misbelief amongst the population that HIV is not an issue in their country – a belief that is certainly not unique to Uganda – once again reaffirming that a male contraceptive pill could not be used universally as it has the potential to do more harm than good.
In short, although the development of a male hormonal contraceptive may liberate many women and men, there are still many challenges to overcome. Whilst problems of unreliable effectiveness could be resolved, the risk they pose in spreading STIs remains high. For countries with a high rate HIV infection this is particularly problematic, and is a serious obstacle in their development.