[Editorial] Male Birth Control- Barriers and Options

What is male birth control?

  • Birth control is the practice of using devices, drugs and other procedures to prevent conception.
  • Some of the methods include barrier method, intrauterine devices, surgical method and hormonal method.
  • Women have a number of effective options such as pills, IUDs, implants, injections, patches, vaginal rings, etc.
  • On the other hand, men have only a limited number of options, that too not very effective ones.
    • Withdrawal has a failure rate of 20%.
    • Condoms have a much smaller failure rate at 2%. However, this requires proper usage, otherwise the failure rate increases to 13%.
    • Vasectomies have a less than 1% failure rate. However, this procedure requires surgery (even if minimally invasive) and is considered as a permanent contraception.
    • Also, unlike condoms, the other two methods don’t provide protection against sexually transmitted infections.
  • In India, some 53% of couples use some form of contraception, with permanent methods being the most popular, according to the National Family Health Survey-4.
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What are the barriers to male birth control?

  • There hasn’t been a new male birth control option since the 1980s, with the last introduced option being the ‘no-scalpel vasectomy’.
  • While the WHO, governmental agencies and NGOs have been supporting male contraception development, their drug development infrastructure cannot compare with that of the big pharma. Their programs are run by just a few personnel and clinical research organizations. They are also slowed by financial limitations.
  • Pharmaceutical companies haven’t been showing interest in the field either. Some of the reasons include market uncertainties which may outweigh development costs.
  • There are also uncertainties about the regulatory requirements for the new products to be cleared for marketing and about who would be responsible for dispensing such products.

What is the way ahead?

  • Historically, the burden of birth control has mainly fallen on women. The National Family Health Survey-4 showed that 36% of women go for sterilization while merely 0.3% men opt for vasectomy.
  • Developing safe, affordable and reversible male contraception options would encourage men to participate and share the responsibilities and reduce the number of unintended pregnancies.
  • Researchers are working on a number of options. In 2019, the Indian Council of Medical Research completed the clinical trials of an injectable male contraceptive- the first in the world.
    • It was developed as an alternative to surgical vasectomy.
    • It stays effective for 13 years and then loses potency.
    • It showed a success rate of 97.3% during the trials.
    • A notable advantage is that this product showed no side-effects.
  • Some other methods being developed include:
    • The hormonal methods are the furthest along in the development.
      • These methods involve the use of gels, injections or pills containing 2 hormones- testosterone and progestin.
      • Progestin helps supress the 2 pituitary hormones involved in sperm production.
      • Testosterone is needed for sperm production, but it is included in the contraceptive to ensure its availability for other body functions. Circulating testosterone, with the help of progestin, could even limit sperm production by supressing the same 2 pituitary hormones.
    • The researchers are also working on drugs that mimic the functions of progestin and testosterone, but in a single compound.
    • Non-hormonal methods:
      • Some use drugs to specifically target the testes to reduce sperm numbers or function.
      • Other methods involve reversible blocking of the vas deferens with the help of hydrogels (a polymer).

Conclusion:

While population control programs have predominantly focused on female contraception, surveys show that people are ready to adopt new male birth control solutions. What is needed is collaboration across pharmaceutical and academic sections in addition to the governments and non-profits, to develop options that are safe, acceptable and accessible to all.

Practice Question for Mains:

What are the barriers to the adoption of male birth control? What is the way ahead? (250 words)

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