Contraception for men trudges along slowly

We are familiar with the term “gender democracy” since the early 1990s. One example of this was the campaign “Ganze Männer machen halbe-halbe” (Real men go halves) in December 1996 from the then SPÖ minister for women’s affairs, Helga Konrad: it was about fair division of housework, childcare, and care for relatives.

However, “gender democracy” still has some catching up to do in the field of contraception, and, this time, the gap is at the expense of men. While women have a plethora of family planning methods to choose from, men have only the condom and coitus interruptus (“being careful”), i.e., timely withdrawal of the erect penis from the vagina – and, as a permanent alternative, vasectomy (= sterilisation).

Thus, when it comes to their fertility, men are dependent on their partner’s discretion and good will. Is that a problem? According to the 2019 Austrian Contraception Report, men for the most part acknowledge their limited control over their own fertility with resignation, because it cannot be changed anyway. Women, on the other hand, often think that this situation is fine for men, or that they don’t think about it in any case.

What if things could change though? That is to say, what if modern and reliable contraceptives were available for men? Would they even want to use a new method? 39% of the men surveyed would use an effective reversible method, 40% were not sure, and 21% said no. There is particularly strong support among those who have already had bad experiences (53%), that is, those who have become, or almost become, a father against their will.

Can we rely on men for contraception?

What would women think if men had equivalent options? Who would then be responsible for family planning? 59% of the women surveyed would still prefer to use contraception themselves. Less than half would rely on use of contraception by their partner. These are mainly women in stable relationships (44%), women over the age of 30 (46%), and women with a high level of education (47%). So, the pill for men would not be acceptable for most women because, if he forgets to take it, it is she who gets pregnant.

The development of effective reversible methods for men has so far been unsuccessful despite intensive research. There are primarily biological reasons for this: while a woman has to prevent only one instance of ovulation a month, a man is dealing with the production of hundreds of millions of sperm each day. Not only that: sperm are very tenacious and live a long time, and just one sperm is enough for fertilisation. The biological hurdle is therefore much higher. In order to avoid men having to take something daily and the associated problems – such as forgetting – research is moving more towards long-term methods – for example, a rod, an implant, as is familiar from female contraceptive practice, which works for a few years, or a three-month injection that you don’t have to think about every day. The wealth of current research approaches come together in the International Consortium on Male Contraception, to give one example, in which Austria is also involved: www.ic-mc.info.

A good solution is blocked by law

Until that time comes, however, it would be relatively easy to create a sensible option for men: it would just require a change in the law. If one were allowed to have one’s sperm frozen, the permanency of the vasectomy would be circumvented. However, the Austrian legislature is restrictive: the Reproductive Medicine Act of August 2015 prohibits the freezing of sperm without medical justification. Men therefore have to travel to another country for this, and it is also expensive (the cost of a vasectomy is €600–800 (as a one-off expense); the cost of freezing sperm is approximately €500 (each year)).

The international view stands in contrast to Austria’s rejection of the vasectomy: World Vasectomy Day takes place every autumn. In Thailand, a “vasectomy festival” is celebrated annually on the king’s birthday, during which men receive sterilisation free of charge and without having to register. In the USA, as well, the vasectomy is currently experiencing a boom because more and more states are banning or extremely restricting abortions. The costs of contraception (and abortion) are not covered by health insurance in Austria in principle – neither for women nor for men. (Side note: artificial insemination, on the other hand, is financed very well.)

Speaking of costs

Back to the “Real men go halves” campaign mentioned at the start: only in very few relationships do men pay their share of the costs of contraception, and, because of the lack of contraception alternatives, our society continues to put all the costs of contraception on women, even though it is well known they don’t become pregnant alone. In other countries, the costs have long been financed by health insurance in a gender-equitable manner, which, according to the Austrian Contraception Report would prevent about 1/3 of abortions. As a society, we have to ask ourselves, is it worth it to us?

Sources:

- 2019 Austrian Contraception Report: responses from 881 women and 901 men aged 16–49 years. This sample is representative of Austria.

- § 2b (1) of the Austrian Reproductive Medicine Act (Fortpflanzungsmedizingesetz) from August 2015: semen, oocytes and testicular and ovarian tissue may also be removed and stored for future medically assisted reproduction if a physical ailment or its treatment in accordance with current medical science and experience causes a serious risk that pregnancy can no longer be induced by sexual intercourse.