This post is to draw your attention to the Male Contraception Initiative.
If you had to point to just one thing which has, more than anything else, been responsible for the huge social changes over the last 50 years, it would have to be The Pill. The female contraceptive pill gave women a degree of control over their fertility which they had not previously enjoyed. The door was then open for women to take part fully in the world of work and other non-domestic activities, freed from the threat of a string of unwanted pregnancies.
Men do not have a comparable, convenient, contraceptive. Men have only the condom, which is both inconvenient and disliked. There are, of course, significant health benefits to using a condom if engaging in casual sex. However, my concern here is primarily with contraception methods to be used by people in long standing committed relationships. 85% of men and 90% of women surveyed in the USA believe that men and women should bear equal responsibility for contraception. However, the technology available for the two sexes is not equal and this often leads to the woman taking the primary responsibility for contraception in practice, via the Pill.
Men are disadvantaged in not having the same control of their fertility as women. On the other hand, women are disadvantaged by being unfairly burdened with the side-effects of the hormone-based Pill.
This situation is crazy. The barrier to the availability of a convenient male contraceptve is not primarily technological. A large range of potential options exist as I reviewed here. Moreover, with testicles conveniently hanging outside the body, it would not be necessary to use hormone-based methods for men. The most promising method would be one of the many forms of vas deferens blocking technologies, e.g., Vasalgel or RISUG. Reversibility remains the issue, but these methods have the major advantage of avoiding monkeying about with the endocrine system with inevitable side-effects.
Last year there was a brief spat following the publication of a discontinued trial of a hormone-based male contraceptive due to side-effects (reviewed here). The popular press was full of women’s opinion of what wimps men are, noting that women have to put up with The Pill’s side effects. Well, it wasn’t actually “men” that discontinued the trials, it was the ethics committee. However, it was not the cries of ‘men are wimps’ which interested me most about women’s reaction: it was the evident fact that these women authors were desirous of a male contraception being made available. Women are keen, it appears, for men to take up responsibility for contraception. This is hardly surprising in view of The Pill’s side-effects.
So, if men and women both want a convenient male contraceptive, and if there is no major technological difficulty, why isn’t there one? You will be amazed to hear that the feminists blame men. Apparently it’s because “the scrotum is sacrosanct“.
Err, no. The answer is that to get a new contraceptive to market will take megabucks, in the order of tens of millions of dollars at least. The main cost is in the clinical trials and achieving regulatory consent. Consequently only Big Pharma can do it. For this to happen, Big Pharma needs to believe there is Big Money to be made. Currently, they do not. The reasons are laid out in this research paper. Essentially, they see a male contraceptive as being in competition with existing female contraceptives – which are available in plentiful and cheap varieties. Competing against something cheap is not a route to making large profits.
But they are wrong. A male contraceptive would not be in competition with the female forms. A convenient male contraceptive would cause the total contraceptive market to increase substantially (though condom sales would drop, I guess). Big Pharma need to be convinced of this. At present they are under-estimating the extent to which couples in long-term relationships wish to share the responsibility for contraception. They are also under-estimating the extent to which men who have only casual relationships want a more secure and convenient protection, for themselves, against unwanted pregnancies.
Enter the Male Contraception Initiative (MCI). The MCI is pursuing a strategy based on two strands: to produce evidence that there is a market, and to fund pre-clinical research into options.
Some of the Shibboleths around any new male contraceptive are (a) that men would not use it, and, (b) women would not trust men to use it. Both appear to be incorrect. This US survey indicates that two-thirds of men would use a male contraceptive if in a long-term relationship, and more than half of men would do so outside such a relationship. The same survey indicated that 80% of women in a long term relationship would trust a man to take the contraception. That far fewer women would trust a man with contraception in the case of casual relationships is not so relevant, because, in such cases, the man’s motivation would be more to protect himself. Similarly, this research paper indicates that more than half of men would be willing to use a hormonal contraceptive, and hence substantially more than half would probably use non-hormonal methods. The latter link also uses game theory to show that the total contraceptive market is likely to increase if male contraception became available.
The MCI have recently published some research into the number of unwanted pregnancies which could be avoided by the availability of a male contraceptive, about quarter of a million in the USA. Scaled to the UK, this would be about 50,000 avoided unwanted pregnancies each year. However, this is based on the very conservative assumption that only 10% of men would take up the novel contraceptive. The evidence, above, is that the take-up would be many times higher. I conclude that a male contraceptive would probably avoid most of the 185,000 abortions per year in England and Wales being necessary.
Hence, the impact of a convenient male contraceptive in obviating abortions is motive enough for its development, quite apart from issues of equality in fertility control.
The MCI is realistic as regards what needs to be done to get a male contraceptive to market. There are two key issues. Once a viable option has been identified, there is the megabuck expenditure required to carry out clinical trials and get regulatory approval. This requires Big Pharma to be on board with funding, in the expectation of making fat profits. The assurance of an eventual market, as discussed above, is key to that. However, before that stage it is necessary to develop options to a sufficient extent that they provide a technological good bet as regards investing many tens of millions of dollars in clinical trials. This pre-clinical ‘proof of potential’ phase is know as ‘the valley of death’ because so many seemingly good ideas don’t make it when faced with hard reality.
The MCI is concentrating on funding options to attempt to cross the valley of death. The concept is to assist a number of options to do so, in the hope that one will eventually be taken up by Big Pharma as a good commercial bet. Getting an option across the valley of death costs “mere millions” (as opposed to the tens or hundreds of millions of dollars cost of clinical trials).
As with everything in the men’s movement, having no money is the No.1 barrier to progress. It is worth recalling how women got The Pill. It was not through public funding. It was funded by a rich heiress (Katharine McCormick ) and facilitated by a committed feminist, Margaret Sanger.
It is pleasing, then, that the MCI’s sensible and business-like approach has attracted private funding which has permitted them to offer half a million dollars for promising research options. At the time of writing, MCI are poised to announce the recipient(s).
However, MCI are asking for further donations. Personally I believe male contraception has a better chance to cause a revolution in gender-balance than most issues people in the men’s movement are usually inclined to fund. I have already donated to the Parsemus Foundation’s Vasagel option (one of the more promising options, IMHO) as well as to the MCI directly.
The funds required seem daunting. But that didn’t stop the women, did it? We need to get real about what is required to push men’s issues forward. Just writing blog articles won’t cut it (mea culpa). Nor will marches or going on the streets with banners – not that I would discourage anyone from doing so. It needs money, people. This is the hard reality. Ultimately, big donors with fat wallets are required for the sums in question. But such people are more likely to cough up if initiatives have popular support from many small donors.
And many of us could think seriously about bequeathing more substantial sums in our Wills. No, I’m not thinking of snuffing it any time soon – hopefully – but this is a long term business. I’ve never expected to see much improvement in my lifetime.
To donate to the MCI go here.