A Man's Share

If so, there's more to the story than American cowboy-style machismo. Far from making booted strides forward in the contraceptive arena, American culture is captive to a commercial Catch-22, and American men are ambivalent bystanders. "What [the pharmaceutical] industry is afraid of is anything drastically new, which a male oral contraceptive would be," observes Dr. Laurens Zenerfeld at the University of Illinois, Chicago. With no male options beyond coitus interruptus, vasectomy, and the inimitable condom, monogamous men are made to feel like spectators in the pregnancy game.

The industry, in turn, continues warily to hold its distance from an ostensibly reluctant market. Cautions Rosemarie T'hau of the Population Council, a non-profit research center based in New York, "I think we shouldn't blame men for not taking responsibility for contraception when we offer no options."

That these and other currently available options aren't fitting the bill is best reflected by a telling statistic: among married women using non-permanent contraception (the lowest risk category), 15 percent of all pregnancies are unintended, according to the Alan Guttmacher Institute, a non-profit think tank. In addition to a barrage of potential side effects--the pill may increase a woman's chance of developing some forms of cancer--many options simply cannot be used by some women. Unlike aspirin, notes Polly Harrison at the Institute of Medicine, contraceptives shouldn't be designed as "one size fits all." Leslie Primmer at Women's Policy, Inc. articulates what most of us instinctively infer: "If there's one thing that prevents unwanted pregnancies, it's more contraceptive options."

Evidence provided by the Urban Institute, moreover, indicates that the net impact of innovative, hormone-based male contraceptives, which would be most appropriate for couples unconcerned about STDs, could include increased condom use among young men. In a study conducted in 1991, researchers found that there was a significant correlation between the "male's degree of belief in normative male contraceptive responsibility and condom use among young men." In other words, boys who grow up with dads who use hormone devices may be more likely to view contraception as a male responsibility, and in turn to better protect themselves and their partners from STDs and pregnancy.

So why hasn't industry run with the ball? Defenders of the system point to the complexity of the male reproductive system, arguing that it's more difficult to reversibly annihilate thousands of sperm than it is to halt a single egg on its path. Lisa Kazur at the Guttmacher Institute thinks it's "more Machiavellian than that." Her skepticism is supported by research at non-profits and government agencies like the National Institute of Health, where a testosterone injection system that would safely fool the male brain into temporary infertility awaits industry funds for domestic clinical testing. The response of men who participated in trials of the drug in other nations likewise counters the conventional claim that men have no interest in their own fertility. Participants reported better sex, relief for their wives from side effects, and a greater sense of control. One Australian subject notes that in a monogamous coupling, condom use is a drag: "The idea of having sex is that you get to put your bit inside her bit, so you don't want to wrap it up in a bit of rubber....Sensuality is really important."

Polly Harrison at the Institute of Medicine identifies another reason for stalled research. She laments that "many firms take a look at good science, and say the risks of liability, frivolous suits are so big, they just can't take it on." Upjohn, for example, makers of Depo Provera, ceased all reproductive research in 1985 -- not coincidentally the year that the Dalkon Shield fiasco sent A. H. Robins Co. into bankruptcy. There may be more to the picture, however, than the company's protestations of fiscal infeasibility; when discussing Caverject, the company's brand-new, ultra-unorthodox injectable potency drug which lists a six-hour erection among its possible side effects, Upjohn spokesman Daniel Watts insists that "we wouldn't have any drugs out there if we were concerned about every law suit coming down." The implicit message: If we're going to subject the penis to a needle, we had better be making it more, rather than less, effective at its time-honored reproductive task.

For Kazur, it comes down to the facts that it's "women who have the babies" and that "traditionally it was men who were doing the research, men who were the scientists." Perhaps Dr. Nancy Alexander, new head of the NIH's Contraceptive Development Branch, will successfully shepherd the testosterone method onto the market. If so, it could be the beginning of a real revolution, for women and men alike. Though new methods might not catch on instantaneously, "there would be a change in attitude," as Sandra Waldman of the Population Council observes. And it's long been time for a change, contends Jon Knowles at the Planned Parenthood Federation of America: "I think that boys are a lot more responsible in a lot of ways than they're being given credit for." Even more salient is Kazur's tired entreaty: "It's their turn."