What the Research Says About Contraception

With the global population continuing to grow and men’s options for contraception still limited to condoms and vasectomy, the time is ripe for another contraception revolution¹​.​

​Access to and use of contraceptives can meaningfully reduce unintended pregnancy rates in both developed and developing countries and contexts². Empowering people to determine their family planning outcomes (i.e., number of children) has far-reaching impacts, including: eliminating health disparities³, helping people achieve educational goals⁴, reducing poverty⁵, decreasing gender inequalities⁶, developing more sustainable production and consumption patterns⁷, and more. In fact, improvements to family planning programs, products, and services is a key component of achieving global sustainable development goals⁸.

​We know that there is both a need and a demand for dual contraceptive use (i.e., for both partners to use a form of contraception)⁹¹⁰. We know that women would trust their partners to use a form of contraception¹¹. We know that men are actively seeking better alternatives to their limited contraceptive options¹²¹³¹⁴¹⁵¹⁶¹⁷. And we know that there is promising research being done in the field¹⁸¹⁹ to address the lack of male birth control options both with respect to non-hormonal²⁰²¹²²²³²⁴²⁵²⁶²⁷²⁸²⁹³⁰³¹³²  and hormonal options³³³⁴³⁵³⁶³⁷.

So what should we do to change this? A critical first step that must be taken is to engage with and listen to men in order to give proper attention and weight to their unmet needs with respect to contraceptives³⁸³⁹. We then have to reframe how we define “risk” with respect to unintended pregnancies so that it is expanded beyond the direct physical risk and take into consideration the impact on men⁴⁰⁴¹. We also need to more completely link male and female contraceptive methods and appreciate that women will benefit from male birth control methods just as men benefit from female ones⁴²⁴³. Further, we must also ensure contraception is linked beyond sexuality and reproductive freedom and weight is given to its systemic implications vis-a-vis global challenges⁴⁴⁴⁵⁴⁶  and sustainability aspirations⁴⁷. And as the field of non-binary sexual health continues to expand, we must also expand our thinking around the contraceptive needs of all users/beneficiaries/people⁴⁸⁴⁹⁵⁰⁵¹⁵²⁵³.

So how do we proceed? Ensuring people have access to safe, effective, modern forms of contraception will require a recommitment from nations to meeting their citizenry’s family planning needs and goals, with an associated increase in capital investment⁵⁴. This needs to be coupled with focused demand generation activities in order to catalyze interest in populations that may not currently be aware of the impact that modern contraceptives can have on improving their lives⁵⁵ as well as considerable efforts to improve access to and distribution of contraceptives⁵⁶⁵⁷⁵⁸⁵⁹. We also must shift away from the traditional approaches of drug research and development activities to foster collaboration through different problem-solving methodologies to offset the limited financial support for the field and in an effort to accelerate the product development timelines⁶⁰⁶¹⁶². Furthermore, in order to engage with society at large more effectively and ensure that people have the base knowledge necessary to understand and appreciate the importance of contraception, we need to improve our educational efforts with regards to sex and reproductive biology⁶³⁶⁴⁶⁵.

There is a clear need for us to move beyond the currently available birth control methods for men⁶⁶ since, despite the challenges inherent to contraception⁶⁷ generally, increasing the number of methods for men and getting men to engage with family planning objectives more meaningfully⁶⁸ will be necessary to reduce instances of unintended pregnancies⁶⁹. Moreover, engaging men in reproductive health has the opportunity to increase the overall health of a demographic that seeks preventative care less frequently than other groups⁷⁰⁷¹⁷²⁷³.

Male contraception has had an intriguing past⁷⁴, is currently experiencing an exciting present⁷⁵, and is on track towards an optimistic future⁷⁶. Contraceptive methods targeting sperm producers should be front and center in helping people achieve reproductive autonomy⁷⁷ and be the catalyst for the next contraception revolution⁷⁸​.

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¹ Anderson DJ. Population and the Environment - Time for Another Contraception Revolution. N Engl J Med. 2019 Aug 1;381(5):397-399. doi: 10.1056/NEJMp1906733. PMID: 31365795.

² Bearak J, Popinchalk A, Alkema L, Sedgh G. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. Lancet Glob Health. 2018 Apr;6(4):e380-e389. doi: 10.1016/S2214-109X(18)30029-9. Epub 2018 Mar 5. PMID: 29519649; PMCID: PMC6055480.

³ Parks, C., & Peipert, J. F. (2016). Eliminating health disparities in unintended pregnancy with long-acting reversible contraception (LARC). American Journal of Obstetrics and Gynecology, 214(6), 681–688. https://doi.org/10.1016/j.ajog.2016.02.017

⁴ Downey, D. B. (1995). When bigger is not better: Family size, parental resources, and children's educational performance. American Sociological Review, 60(5), 746–761. https://doi.org/10.2307/2096320

⁵ Bailey MJ, Malkova O, Norling J. DO FAMILY PLANNING PROGRAMS DECREASE POVERTY? EVIDENCE FROM PUBLIC CENSUS DATA. CESifo Econ Stud. 2014;60(2):312-337. doi:10.1093/cesifo/ifu011

⁶ Hammond, Alexandra, "Disparities in Access to Contraception in the United States: an Intersectional Analysis" (2019). Scripps Senior Theses. 1356. https://scholarship.claremont.edu/scripps_theses/1356

⁷ Kantorová V, Wheldon MC, Ueffing P, Dasgupta ANZ. Estimating progress towards meeting women's contraceptive needs in 185 countries: A Bayesian hierarchical modelling study. PLoS Med. 2020 Feb 18;17(2):e1003026. doi: 10.1371/journal.pmed.1003026. PMID: 32069289; PMCID: PMC7028249.

⁸ Starbird E, Norton M, Marcus R. Investing in Family Planning: Key to Achieving the Sustainable Development Goals. Glob Health Sci Pract. 2016;4(2):191-210. Published 2016 Jun 27. doi:10.9745/GHSP-D-15-00374

⁹ Woodsong C, Koo HP. Two good reasons: women's and men's perspectives on dual contraceptive use. Soc Sci Med. 1999;49(5):567-580. doi:10.1016/s0277-9536(99)00060-x

¹⁰ Ross, J., & Hardee, K. (2017). USE OF MALE METHODS OF CONTRACEPTION WORLDWIDE. Journal of Biosocial Science, 49(5), 648–663. https://doi.org/10.1017/S0021932016000560

¹¹ A.F. Glasier, R. Anakwe, D. Everington, C.W. Martin, Z.van der Spuy, L. Cheng, P.C. Ho, R.A. Anderson, Would women trust their partners to use a male pill?, Human Reproduction, Volume 15, Issue 3, March 2000, Pages 646–649, https://doi.org/10.1093/humrep/15.3.646

¹² Dorman E, Bishai D. Demand for male contraception. Expert Rev Pharmacoecon Outcomes Res. 2012 Oct;12(5):605-13. doi: 10.1586/erp.12.52. PMID: 23186401.

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¹⁵ Sundaram, A., Vaughan, B., Kost, K., Bankole, A., Finer, L., Singh, S., & Trussell, J. (2017). Contraceptive Failure in the United States: Estimates from the 2006-2010 National Survey of Family Growth: contraceptive failure rates in the U.S. Perspectives on Sexual and Reproductive Health, 49(1), 7–16. https://doi.org/10.1363/psrh.12017

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¹⁹ Khourdaji, I., Zillioux, J., Eisenfrats, K., Foley, D., & Smith, R. (2018). The future of male contraception: A fertile ground. Translational Andrology and Urology, 7(Suppl 2), S220–S235. https://doi.org/10.21037/tau.2018.03.23

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²⁸ Khilwani, B., Badar, A., Ansari, A. S., & Lohiya, N. K. (2020). RISUG® as a male contraceptive: Journey from bench to bedside. Basic and Clinical Andrology, 30, 2. https://doi.org/10.1186/s12610-020-0099-1

²⁹ O’Rand, M. G., Hamil, K. G., Adevai, T., & Zelinski, M. (2018). Inhibition of sperm motility in male macaques with EP055, a potential non-hormonal male contraceptive. PLOS ONE, 13(4), e0195953. https://doi.org/10.1371/journal.pone.0195953

³⁰ White, C. W., Choong, Y.-T., Short, J. L., Exintaris, B., Malone, D. T., Allen, A. M., Evans, R. J., & Ventura, S. (2013). Male contraception via simultaneous knockout of α1A-adrenoceptors and P2X1-purinoceptors in mice. Proceedings of the National Academy of Sciences of the United States of America, 110(51), 20825–20830. https://doi.org/10.1073/pnas.1318624110

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