Shared Responsibility?

The 1960s sexual revolution promised carefree sex and a more empowered role for women with the invention of the birth control pill. It didn’t entirely live up to its promise. Over half a century later, even protected sex is rarely risk-free. When it comes to birth control, it’s women who still live with the unintended consequences, from birth control side-effects to pregnancy. In an age of self-driving cars, we haven’t perfected birth control yet.

We might be closing in on it though. Indian scientist Suja Guha invented non-hormonal birth control for men back in 1979—two decades after the invention of the pill. It works just like a vasectomy for up to ten years but can be reversed anytime, would have a near-perfect success rate, and has zero side-effects. It’s still in clinical trials in India, and though there are some doubts about its effectiveness—especially with regards to any potential long-term negative effects— it seems to work. Some men in the Indian studies have used the method successfully for up to 15 years.

The Parsemus Foundation, a US based non-profit focused on advancing neglected medical research, seeks to take this male contraception to the US. Since Indian trials do not adhere to FDA (the Food and Drugs Administration) standards, the trials in the US had to start from scratch, and are ongoing. The birth control method is called Vasalgel.

Vasalgel is a gel injected into the vas deferens (tubes the sperm passes through) and once in there stays until it’s flushed out. It works to destroy sperm cells and so prevents pregnancy. The procedure takes place in the hospital under local anesthetic, but since it generally doesn’t require any actual cuts with a scalpel, it’s not considered a surgical procedure. For a more detailed explanation watch the video below (or to see the real thing, click here).

 

So why isn’t this method available yet?

Rob Beerthuizen, a gynaecologist working for the website Anticonceptie Online, who has done research into male birth control seems doubtful Vasalgel will actually make it to the market. He says birth control experiments are easier to conduct with women, “the research is simple. Women get pregnant or not. For men, there is no endpoint.” And if Vasalgel will be embraced by Dutch men remains an open question.

There is a Calvinist mind-set prevalent in the Netherlands, with a focus on cheap and conservative products. This makes it so that for instance the birth control pill  prescribed today is still the same one that was prescribed forty years ago, rather than newer and better but more expensive birth control pills, says Beerthuizen. He adds that “[the Netherlands] used to have a pioneering position, but that has changed.”

Even so, he thinks the male birth control might become popular in the Netherlands since “the Dutch man is pretty willing to do his part.” The statistics bear him out: the Netherlands is the country with the highest rate of vasectomies  in the world according to research done by the United Nations. As such, it seems the ideal candidate for a product like Vasalgel.

But would the Dutch, hypothetically, be ready for Vasalgel?

The first stop for getting birth control is the general practitioner (GP). We asked two GPs, both small town doctors, what they thought of Vasalgel:

Dorieke Huijbregts, who works at practice Hoogezand-Sappemeer,  wouldn’t expect many requests for Vasalgel. “Men have a fear of castration and a loss of their manhood,” she says, which for her makes the product a tough sell. Despite educating themselves men mistake sterilization for castration.

Huijbregts adds she would be hesitant to prescribe Vasalgel as “there are very reliable methods for women now.” She explains that birth control for women is proven to have no side-effects down the line for their children, meaning there’s little need to experiment with male birth control where there is no such guarantee.

Contraception is still largely seen as a woman’s matter, according to Huijbregts. Even if the men came to the practice for birth control—their only option at the moment would be a (permanent) vasectomy— it is because their wives send them, saying: “now it’s your turn.”

Sylvia de Meij, who works at Practice de Meij in Losser, a town in Overijssel, thinks similarly. She says that when men do come into the practice to ask about birth control “they don’t do it gladly. They do it because their wives are right.” De Meij agrees Vasalgel might not become very popular. She mentions it’s practically only women coming in for birth control at the moment, and adds laughingly, “that says enough.”

De Meij, though, would be happy to advocate for Vasalgel, should it come to market in the Netherlands. Asked if she would be recommending anticonception for men when it becomes available, de Meij responded “yes, I surely would.”

After discussing options with a GP, the “patient” might go online seeking more information about birth control. Most online sources in the Netherlands lead towards the Centre for Sexual Health North Netherlands. Ellie Oosterhuis, its director, decides what types of birth control is featured on the website, together with resident medical specialist in sexual health, Sjors Oosterbaan.

Oosterhuis is carefully optimistic about Vasalgel’s future, but adds a disclaimer, “we have heard about male contraception for a long time now and it has never actually made it to the market.”

Sjors Oosterbaan is careful in her optimism as well: “[Vasalgel] has more chance than previous methods,” she says, citing that Vasalgel is, unlike  the male pill, not hormonally based and therefore  unlikely to have serious side-effects. “It’s a step forward,” she says, though she is doubtful men would use Vasalgel as “women won’t give up control over contraconception any time soon.”

“If it was a successful method, it would already be popular in the Netherlands,” Oosterbaan says. “There’s no country where it would go over better.” The problem with acceptance of male birth control, she says, is largely cultural as, medically speaking, it would work.

Oosterbaan says they would offer Vasalgel but advertise it differently than the birth control pill. “It would be offered as an alternative to regular sterilization.”

This is because the pill, for instance, is easy to take and to stop. Vasalgel would still be a medical procedure, making it cost more money in one go than a pack of condoms at the drugstore. Also, the procedure won’t be proven 100% free of failure until the first babies born after stopping the Vasalgel birth control method are fully grown.

Some medical professionals fear a disaster like the Softenon babies and are therefore hesitant to back innovative birth control methods.

Overall though, medical experts seem fairly optimistic about Vasalgel. But what’s the word on the street about Vasalgel as an option?

“Would you also have to do an operation? So that’s the main reason I won’t do it.”

“Women have to carry a baby. It’s her decision, it’s her body, and I think, that’s her responsibility.”

“I think most men don’t really care, so”

“I think it’s a responsibility for the men as well. But, trust is another issue, trust is a hard thing. So I think the responsibility is with the men the same level as with the women, but yeah, you are the one getting pregnant.”

In the guidelines for Dutch GPs there are nine types of birth control for women, none of which has a success rate lower than 90%. For men there are only two: condoms (which fail in about 1 in 5 cases) and vasectomy (which only fails in roughly 1 in 100 cases, and is reversible in roughly a third of the men who have it).

Even in the Netherlands, considered a fairly sexually progressive country with the best healthcare system in Europe, a woman’s chance of getting an unwanted pregnancy in life is 1 in 4. So far it has been possible for men to leave the majority of the birth control up to women.

This may not be the case for long. Now that it is clear condoms are still fairly high-risk, and birth control for women has many unwanted side-effects –due to the fact that it is hormonally based—arguments used by men against a birth control method for him rather than for her grow weaker.

Culture and sexual identity are in constant flux, and it just might be the case that at least the Dutch men will be ready to take the responsibility for birth control soon. Let’s just hope they reach that point around the same time Vasalgel—or a similar birth control method—hits the Dutch market.

Cover illustration: Lia Kantrowitz​

By Maria van Loosdrecht

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