Shared Risk: Addressing the Ethics of Male Contraception

A mandate for all physicians far and wide is “Do No Harm.” A mandate in which the health of the patient is prioritized above all else, and the health benefits of any treatment should outweigh the risks of that treatment. This creates a situation in which life-saving therapies with powerful and sometimes dangerous side effects are easily justified, because without treatment a very serious diagnosis could kill the patient entirely.

However, not all conditions are life-threatening, and not all therapies are life-saving. At some point, there begins to be a grey line between what treatment is ethically justifiable for a given condition. What maximum degree of health risk can a user be ethically exposed to for a minor treatment?

Contraceptives are not immune from this calculation of ethical risk. Like all drugs, existing forms of female hormonal contraception come with some medical risk. This risk can range from undesirable side effects all the way to serious medical conditions that can, rarely, result in death (1,2). However, the risks of hormonal contraceptives for women are easily justified because the substantial benefits of preventing an unplanned pregnancy outweigh the health risks surrounding an unplanned pregnancy.

When considering the ethics of a male contraceptive, one substantial difference is presented: ​Men don’t get pregnant.

The health risk associated with both contraception and unplanned pregnancy is largely borne by the female partner, while the male partner suffers no health risks. However, to justify a man taking a contraceptive, there must be some broader benefit to outweigh the risks associated with the treatment. In this case, it requires a risk analysis that includes both parties.

Shared contraceptive responsibility is a rallying point for male contraceptives (3). A viewpoint in which women do not solely bear the burdens associated with contraception, and men are granted some form of reproductive autonomy. And when viewing risk through this lens of shared responsibility, the concept of Shared Risk emerges (4).

Shared Risk justifies male contraceptive use by considering the sum risk to both male and female partners. Exposing a male to a small health risk in his use of a male contraceptive is ethical in that it mitigates a much larger risk in the partner of an unplanned pregnancy.

​Shared Risk is just one of the many ways that male contraceptives can change the way we think about long-standing norms. With the potential to improve relationships, gender dynamics, and reproductive autonomy for all, male contraceptives represent an opportunity for men and women alike.

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1 - ​Mortality from venous thromboembolism in young Swedish women and its relation to pregnancy and use of oral contraceptives – an approach to specifying rates | SpringerLink
2 - New Findings for Maternal Mortality Age Patterns: Aggregated Results for 38 Countries (plos.org)
3 - Campo-Engelstein, L. (2012). Contraceptive Justice: Why We Need a Male Pill. AMA Journal of Ethics, 14(2), 146–151. https://doi.org/10.1001/virtualmentor.2012.14.2.msoc1-1202
4 - Campelia, G. D., Abbe, C., Nickels, L. M., McElmeel, E., & Amory, J. K. (2020). “Shared Risk”: Reframing Risk Analysis in the Ethics of Novel Male Contraceptives. Contraception, S0010782420301621. https://doi.org/10.1016/j.contraception.2020.05.014

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To learn more about the topic of "Shared Risk", please check out this article co-authored by MCI's Logan Nickels: ‘‘Shared risk”: Reframing risk analysis in the ethics of novel male contraceptives