This blog post is written by Male Contraceptive Initiative's Executive Director Heather Vahdat, and is response to the article "The young women choosing to go without contraception"
It’s Saturday and I’m supposed to be finishing a project that was meant to be a Christmas gift for my mother-in-law...last year. However, I allowed myself a quick look on the computer to find a sewing pattern I need and poof, here I am frustrated and writing a blog post. I can’t say I’m surprised that I find myself writing about contraception - it’s the classic “one quick peek at facebook/linkedin/wherever you saw the article couldn’t hurt”. But tell me, how can I not be distracted after seeing this article in my newsfeed?
Ms. Jimenez’s article strikes several sensitive notes for me, forming a chord that sounds an awful lot like someone screaming in frustration. As a woman who has struggled through multiple methods while attempting to find the “least worst option”*, I have long been frustrated by the feeling of apparent acceptance that what we have is “good enough”. Side effects are just part of the deal. Would you rather have an unintended pregnancy? “I’m bleeding three weeks a month, but at least I’m not pregnant!”. This argument is, well, insane, and such thinking is one of the key reasons we still lack adequate contraceptive options.
As an advocate for sexual and reproductive health, I have seen my personal frustrations amplified as I have spoken to women all over the world who face the same struggles. It is not, as I had always assumed, just my biology that is not compatible with available methods. It turns out that we, as a society, just sort of moved on after contraception became more mainstream. We’ve got a solid 12 options or so that should do, right? Um, no.
Working in contraception, you become pretty accustomed to what would far exceed the definition of “oversharing” in most contexts. My contraceptive life is pretty much an open book. However, I have kept one aspect to myself all of these years. I made the same choice as the women in Ms. Jimenez’s article. Frustrated with the miserable, painful, self-esteem-destroying side-effects that I experienced with the many methods I tried, I simply stopped using contraception. Mind you, there is a laundry list of entitlements that allowed me to make this decision, but nonetheless I made it. I was in a committed relationship, we weren’t ready to have a child yet, we did want one eventually (i.e., vasectomy was not an option), we didn’t want to use condoms, and so we “hoped for the best”. Turns out, that wasn’t so great either.
Every month, there would be a few days where I would hold my breath, wondering if “hoping for the best” had worked. After a while, the worry compounds: why haven’t I gotten pregnant? What if I can’t get pregnant?
Cue the wake up call that came about ten years ago when I met Dr. David Sokal while working at an International NGO. We were working on a female contraceptive project together and he mentioned his interest in expanding male contraceptive options as well. Wait, what? Can we do that? That would be awesome!
As I spent the next decade building my career in the contraceptive field, I continued to speak to women that we, as public health advocates, were trying to serve with better contraceptive programming and education. I continued to hear stories of women put in the desperate position of using a crummy method or risking getting pregnant. As time went on, these conversations included more and more women and men, asking, “what about male options”?
However, when the idea of bringing more male methods into play is raised among the reproductive health community, the idea is often immediately dismissed because, “there is no funding, men won’t use it, and women won’t trust them”. Ugh. Those words will be on my tombstone. The most positive response is often, “maybe someday, we just don’t have the data to feel confident that there is a market”.
Right, data. Okay, we could spend tens or hundreds of thousands of dollars, and decades on “testing the water” before we jump, but even if we did, often these results are published with immediate dismissal with scoffs of, “it should have been done differently” or “that’s only applicable to a select group of individuals”, or my favorite - the tail chasing “but these results are hypothetical because there are no actual male options available yet”.
We at Male Contraceptive Initiative have first-hand experience with this. As a small organization, we put every available dollar towards supporting research and development to get promising non-hormonal, reversible male contraceptive products to market. However, we are also here to advocate for the field, and if demonstrating a market will bring in more support for product development, we are happy to lead that effort. In 2019, we published a consumer research study that estimated as many as 17 Million men in the US are looking for new methods of contraception. We were excited to have these data available for the community to share as a case for supporting their efforts. However, the results were immediately met with, “that’s only men in the US; men in developing countries will never use contraception” or “how were those men recruited? Are they representative of x, y, or z?” Frankly speaking, the cost of that study resulted in little to no measurable change in the amount of funding for male contraceptive product development.
Understandably, we can’t simply default to anecdotal evidence or “hunches” in most situations. However, if we take a step back, we are actually talking about 50% of the population who has no access to acceptable, reliable, reversible contraception. If we also consider the current estimates of women’s unmet need for contraception, including women who have abandoned contraception as mentioned in Ms. Jimenez’ article, this has the potential for serious impact.
If we are being honest with ourselves, we are already accepting that men will not use contraceptive methods and that their partners will not trust them based on conjecture and anecdotes. Delaying a contraceptive effort that has already been dragging on for 50+ years will continue to result in devastating and far-reaching social and environmental consequences related to unintended pregnancies. We certainly have sufficient data for those indications:
To put this into perspective, the current annual population growth rate is projected to be 81 million people, far below the average rate of unintended pregnancies annually. Add to this the United Nations’ projected impact associated with addressing population growth through the Sustainable Development Goals (SDGs) and there is the potential to see marked global impact on:
Let’s stop chasing the data to describe a need that we already know exists and increase funding to get these methods to market faster and generate the impact that we are all seeking.
* - shout out to Dr. Logan Nickels for defining this selection process perfectly.