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The future of contraception is male

The pill hit the market over 60 years ago – so why is the male equivalent taking so long?

This article is part of our Future of Sex season  a series of features investigating the future of sex, relationships, dating, sex work and sex worker rights; tech; taboos; and the next socio-political sexual frontiers.

Most people picture an orgiastic, technicolour circus when thinking about the 1960s sexual revolution: naked, long-haired flower children; miniskirts; screaming Beatles fans orgasming in their seats; acid tabs; the summer of love. Less riotous was the catalyst for this sea change: the docile queues of women outside pharmacies, there to pick up their prescriptions for the contraceptive pill.

The contraceptive pill was made available on the NHS in the UK in 1961. Although you technically had to be married to receive a prescription for the pill, many single women still managed to get a hold of the miracle drug – sometimes by pretending to be married and passing a fake wedding ring around a GP waiting room. Then, in 1967, the rules were relaxed and the pill was made available to all women, married or unmarried. By the end of the year 12.5 million women worldwide were taking it. Fast forward to 2022, and one third of people with uteruses aged 16 to 49 take the pill in the UK.

The ramifications of the pill were enormous. For the first time, women were allowed to prioritise their education and careers. It granted them true reproductive autonomy. Time magazine went as far as putting the pill on the cover.

Although it’s indisputable that the pill propelled the fight for gender equality forwards, in recent years, it seems as though progress has stalled. That’s not to say other forms of contraception haven’t been created – the copper coil was invented in the 1960s, the Mirena coil in 1976, and the implant in 1998 – but there’s been a glaring omission in these advances for reproductive health. The NHS website lists 12 contraception options for women (or people assigned female at birth) – 13 if you include the morning-after pill – but still only two for men (or people assigned male at birth): good old-fashioned condoms, or a vasectomy.

“Because the birth control pill is so effective and widely used, I think it has led to the perception that birth control – as an issue facing women – is solved,” Dr Sarah Hill, author of How the Pill Changes Everything, tells Dazed. “Those who invest in research into new contraceptive methods have confused women’s willingness to take hormonal birth control, despite side effects, as a sign that it’s a great experience for us. They don’t realise that the reason that so many of us take it isn’t that it’s great – it’s because of how important contraception is to us.”

As Dr Hill says, “birth control as an issue facing women is not solved.” Sociologist professor Andrea M Bertotti has even suggested that ‘fertility work’ is yet another instance where women are made to undertake a disproportionate amount of domestic labour. It’s true: more often than not, women are the ones reading up about side effects and weighing up the different options; they’re the ones ringing up underfunded sexual health clinics begging for an appointment every morning; they’re the ones remembering to take their pill or get their implant replaced.

This is unsurprising: ultimately, if contraception fails, the person with the womb is left holding the child. “The fact that women are usually the ones who become pregnant may partly account for the fact that they are more likely to take responsibility for contraception, but not entirely. After all, it mirrors that way women disproportionately take responsibility for other work too, such as caring and cleaning,” Louise McCudden, advocacy and public affairs advisor at MSI Reproductive Choices, tells Dazed. And for women living in conservative US states post-Roe, this burden has just gotten considerably heavier.

“My wish is that the future of contraception is non-hormonal, safe, effective, and something that is shouldered equally by both men and women” – Dr Sarah Hill

On top of this pressure to organise contraception, women (and people with uteruses) are also expected to put up with the myriad adverse side effects caused by hormonal contraception like decreased sex drive, mood swings, and acne. Some of these side effects are life-threatening: the pill puts women at higher risk of blood clots and studies have shown that the use of hormonal contraception triples the risk of suicide. Even non-hormonal contraception has its drawbacks, with some report excruciating, traumatising pain from invasive coil insertions.

“We need more research into more options. Not all women are able to tolerate the side effects of hormonal birth control and there aren’t a lot of other fabulous options for women,” Dr Hill says. “My wish is that the future of contraception is non-hormonal, safe, effective, and something that is shouldered equally by both men and women.”

It’s not that there aren’t ideas for male contraception. In recent years, there has been talk of a male birth control pill, a contraceptive gel, a testicle bath, and a male contraceptive injection, but many of these have run into difficulties during the development process. One study into a contraceptive injection was called off in 2016 after 20 men dropped out due to side effects like muscle pain and acne – despite the fact that women have been managing similar side effects for decades. Meanwhile, COSO – the aforementioned testicle bath – is still looking for funding to get clinical trials off the ground.

According to Professor Gunda Georg, who is currently leading research on a non-hormonal male birth control pill, it could be between five to ten years before more male contraception options are made available. Georg explains that selling a male contraceptive drug to pharmaceutical companies is particularly challenging. “The safety bar to bring any contraceptive to the market is very high,” she says. “It is very difficult to develop a drug that has no or few side effects. This is high risk, and drug discovery companies are risk averse.”

Overcoming these hurdles isn’t the only issue – sexism and misogyny also needs to be addressed. 50 per cent of men in the UK said they probably or definitely would not consider taking hormonal contraception, while 22 per cent don’t think responsibility for contraception should be shared (a minority, albeit a sizeable one). There’s also the issue of trust – how can women trust men who say they’re on the pill, when stealthing – non-consensual condom removal – is so widespread? Mitchell Creinin, another male contraception researcher, has previously suggested that “male contraceptives would ideally need to make the penis purple and glow in the dark so women would trust it”.

But there is hope. In March, Georg’s new non-hormonal contraceptive pill for men was been found to be 99 per cent effective in preventing pregnancy in mice, with no observed side effects. A study presented at the annual Endocrine Society meeting in June reported that two male birth control pill candidates were effective in suppressing sperm production. Most recently, in August, Australian researchers recently found that a stinging nettle leaf extract reduced male fertility in mice. Attitudes are beginning to shift too. “As stereotypes about gender, sexuality, and gender identity are increasingly broken down, there will be more and more room for us to challenge reproductive health inequalities across the board,” McCudden says.

Slowly but surely, we’re inching us closer to a world with even more contraceptive choices – for all bodies. There’s a long road ahead, sure, but at least the ball is rolling. As McCudden says: “the good news is it’s already getting better.”