Tomorrow is World Contraception Day, a perfect time to remember just what a radical difference birth control, and particularly the pill (60 years old this year), has made to women’s lives. What you may not know is that contraception is also about to experience a revolution: we are on the cusp of – wait for it – a new male contraceptive.
Allow me to recap. In October last year, a team of international scientists announced that they had developed a hormone injection (so, not a pill) for men that is almost 96% effective at preventing pregnancy in their partners. This makes it about as reliable as condoms when they are used correctly, which frequently they’re not.
Sadly, there’s a caveat to this happy story. Clinical trials had to be stopped after some men pulled out due to side-effects including mood changes, depression and acne. And there, quite abruptly, the revolution ends.
For as long as anyone can remember, contraception has been largely a woman’s burden. Despite promises of a male contraceptive, it looks as though unless something painless, simple and largely free of side-effects is invented for men, it will probably remain a woman’s responsibility.
To be fair, making a male pill isn’t easy. The female pill mimics the natural hormone fluctuations of a woman’s monthly cycle. Reproducing an equivalent chemical process in men is technically more difficult, although not impossible.
In the meantime, women continue to sample from the cornucopia of sometimes uncomfortable and occasionally risky birth control options. Please, take a seat while I scroll through the menu. There’s the diaphragm, cap, coil, sponge, patch, rod and ring. If you’re willing to live on the wild side, there are helpful apps to tell you where you are in your fertility cycle. There are also injections. Even more drastically, there’s sterilisation.
And then there’s the female pill. It has been six decades since it was approved by the United States Food and Drug Administration, and it remains the most popular form of female contraception in the UK, with about 3 million women taking it. But given the array of newer alternatives, does it make sense for women to continue opting for the pill, or should we – like men – be giving it the cold shoulder in favour of something better?
The side-effects and risks associated with the combined pill, which is a mix of oestrogen and progesterone, and is the most commonly prescribed type, are fairly small. The older the pill gets, the more data scientists have about its health impacts. A Danish study published in November 2016 linked women who use hormonal contraceptives with higher rates of depression. Researchers at the University of Copenhagen followed more than a million women between the ages of 15 and 34, and found that those taking oral contraceptives were 23% more likely to take antidepressants.
For most women, however, the main problem with the pill, when it’s weighed up against newer alternatives, is that it’s just not as effective as it should be. Women often skip doses, intentionally or by accident. It’s a hassle to remember to take it. The situation is complicated by government funding cuts to the NHS, which have had an impact on sexual health services. Implants and intrauterine devices need to be fitted by a health professional, unlike the pill, which needs only a prescription. Julia Bradley, a lead nurse and education manager at the British Pregnancy Advisory Service, says that, until a few years ago, long-acting reversible contraceptives enjoyed a push from government, but now “with the pressure on GP practices, women are finding it really hard to get a GP appointment”. She knows of one patient who had to wait a month to get a coil fitted. “In that time, accidents can happen,” she says.
Let’s not forget that contraceptives such as these are a medical intervention we make that isn’t medically necessary. We choose to introduce discomfort, pain and health risks into women’s lives because there are few other options if we want to avoid pregnancy. Bradley recalls instances of older female patients who have taken the contraceptive pill for decades finally asking their male partners to have vasectomies after they have had all the children they want. When men refuse, she says, “it does sometimes feel unfair”.
With abortion such a heavily politicised issue, it’s surprising that more isn’t made of the birth-control burden that women are expected to shoulder as a matter of course. This is the story of our lives. Period pain? Get on with it. Heavy bleeding? Stick on a fresh pad and carry on. Hormonal migraines, mood swings or depression? Suck it up. Anxious about the pain of childbirth? “More women should be prepared to withstand pain,” said senior midwife Dr Denis Walsh in 2009, suggesting women forgo epidurals. It’s hardly a surprise that when offered an imperfect contraceptive pill, women just swallow it. Absorbing pain is expected of us.
But I’m inclined to hold out for something better, the contraceptive that causes me no pain or side-effects. The kind I never even have to think about. By that, of course, I mean the male pill.
Inferior: How Science Got Women Wrong and the New Research That’s Rewriting the Story, by Angela Saini, is published by Fourth Estate. To order a copy for £11.04 (RRP £12.99) go to bookshop.theguardian.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min p&p of £1.99.