The Different Stakes of Male and Female Birth Control

The Atlantic
Updated

In the past couple decades, scientists have been slowly moving toward developing birth control for men. A recent clinical trial of an injectable hormone contraceptive for men showed super promising results: It was 96 percent effective at preventing pregnancy, which it did by lowering sperm counts. Unfortunately, the trial was discontinued early by an independent committee, which determined that the side effects were such that “the risks to the study participants outweighed the potential benefits.”

The side effects in question? “Mood changes, depression, pain at the injection site, and increased libido.”

Hm. Hmmmmmmmm. Hm. Let’s review some of the possible side effects of currently available birth-control options for women, shall we? Here’s just a sampling.

Minastrin 24 FE, a low-hormone birth control pill: Headaches, nausea, menstrual cramps, yeast infections, breast tenderness, acne, mood swings, and weight gain.

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NuvaRing, a hormonal vaginal ring: Vaginal-tissue irritation, headaches, mood changes, nausea and vomiting, weight gain, breast pain, painful menstruation, abdominal pain, acne, and decreased libido.

The Mirena Intrauterine Device: pelvic or abdominal pain, ovarian cysts, headaches and migraines, acne, depressed mood, “heavy or prolonged menstrual bleeding.”

IUDs can also cause sepsis or perforate the uterus. This is very rare, but still: perforate the uterus.

All of these are FDA-approved contraceptives that are currently on the market and in women’s bodies, and their side effects are just as bad as those that occurred with the injectable male birth control. Nobody halted them in their tracks, saying that perhaps the risks outweighed the benefits. (Women may well decide that for themselves, though; one study found that nearly 40 percent of women stop using the pill within a year of starting it.)

Though men have an equal responsibility to prevent unwanted pregnancies, they don’t share equally in the consequences, and never have.

What’s more, we’re learning more about just how serious the side effects of hormonal birth control may be. A recent study of more than a million women published in JAMA Psychiatry found that women who used hormonal birth control were more likely to be prescribed antidepressants. The study’s design has received some criticism, but it nonetheless underscores that for some women, there are tradeoffs between their reproductive freedom and their mental and emotional health.

Not so for men. Though men have an equal responsibility to prevent unwanted pregnancies, they don’t share equally in the consequences, and never have. The burden of birth control has always fallen largely on women’s shoulders; it is their bodies that will bear the consequences if birth control fails. The only currently available birth-control method for men—short of a vasectomy—is a condom. So a man can either wrap it up, or let the lady handle it. And because condoms are significantly less effective than IUDs, implants, contraceptive pills, and rings, it stands to reason that many will choose the surer thing.

Early versions of the hormonal birth-control pill had tons of side effects, enough that, in a trial done in Puerto Rico in the 1950s, the doctor in charge of the trial recommended against its use. However, as Bethy Squires recently reported in a history of birth control side effects for Broadly, a U.S. pharmaceutical company released the same formulation anyway. (Current formulations use far less hormones, but as we’ve seen, still have side effects.) The Broadly piece also notes that the same group of doctors that studied the female pill originally considered one for men, but testicle shrinkage, among other side effects, led them to abandon it. “It was believed women would tolerate side effects better than men, who demanded a better quality of life,” Squires writes.

The crazy thing is that in this recent study, most men wanted to continue using the injectable birth control—more than 80 percent of them said they would choose to use it. So if men in the past demanded a side-effect-free life, it seems these days many are at least open to taking on the responsibility of birth control themselves. Perhaps the hurdle that remains is that male birth control is unlikely to substantially improve a man’s quality of life. He can already avoid unwanted pregnancies if his partner is on birth control; with his own he’d get the same advantages, except now he might have mood swings.  But for women, birth control has been revolutionary. One-third of women’s wage gains since the 1960s can be attributed to the availability of oral contraceptives, according to a report by Planned Parenthood. College enrollment has historically been higher among women who have access to the pill, and “birth control has been estimated to account for more than 30 percent of the increase in the proportion of women in skilled careers from 1970 to 1990,” the report reads. Not to mention that 86 percent of the declining teen-pregnancy rate in the U.S. is thanks to contraception.

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So it makes perfect sense that women would be willing to endure all kinds of side effects in exchange for, essentially, freedom. Being able to control whether and when they become pregnant has opened up so many opportunities for women, opportunities that men already had greater access to by virtue of being men. Men’s careers, men’s bodies, men’s control over their own lives, have never been at stake in the same way.

A woman using Liletta has a higher chance of experiencing the same side effects than a man using the injectable birth control that was deemed too risky.

I wasn’t in the room when the independent panel decided to halt the recent male birth control trial. I don’t know what their decision-making process was like. Certainly, depression and mood changes aren’t things to be taken lightly, and of course it’s in everyone’s best interest to have new drugs be as safe as possible.

However. In the male birth control trial, 4.7 percent of men experienced mood swings, and 2.8 percent experienced depression. These were two of the side effects cited as reasons for ending the trial. On the other hand, let’s take Liletta, an IUD approved by the FDA in 2015—5.2 percent of its users experienced mood swings, and 5.4 percent experienced depression. A woman using Liletta has a higher chance of experiencing the same side effects than a man using the injectable birth control that was deemed too risky. The standards are different.

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In 2007, the pharmaceutical company Bayer gave up on a male contraceptive “that involved an annual implant and a quarterly injection,” as my colleague Olga Khazan reported in 2015. The company, she wrote, “concluded that men would consider the regimen—in the words of a spokesperson—‘not as convenient as a woman taking a pill once a day.’”

Well, yes. That is far more convenient—for the men. Women will put up with it, of course, as they have for years, because the stakes are that high. And as research into male birth control accelerates, we are starting to see this hypocrisy more clearly—that the burdens women bear in exchange for their reproductive freedom are considered too much to expect men to deal with.

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This article was originally published on The Atlantic.