CAIRO — In his pharmacy in the Egyptian capital, Muhammad Abdel Majeed sells different types of contraceptives. No doubt, there is a great demand for birth control in Egypt, the world’s 14th most populous country. But his wife does not use any of them.
After giving birth to their second child, his wife decided not to take birth control pills due to a previous experience with them, where she suffered from depression, weight gain and disturbing hormonal disorders. So she asked her husband to take on the responsibility: the 32-year-old pharmacist his now finally using condoms.
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“It is a very safe method of preventing pregnancy, but some men do not like to use it,” Abdel Majeed said.
He believes that the culture of men using condoms has not spread enough in Egypt compared to the methods used by women. “Men depend on women to think about it,” he said.
A shared responsibility
Global statistics confirm the pharmacist’s observations. A 2015 United Nations study shows that more than a third of couples of reproductive age around the world do not use any contraceptive method at all; and when they do use it, female contraceptives are the most common choice. Direct male contraceptives are less common: 8% use condoms and only 2% undergo vasectomies, the study showed.
So why don’t men use contraceptives, and when will men take over their responsibility in the reproductive process?
Abdel Majeed thinks men fear birth control methods may affect their fertility. “I know men who are afraid to ask the doctor about reproduction and contraception,” he said, “Instead, they come and ask me.”
is impossible for medications not to have side effects, especially hormonal medications.
Yet Islam Al-Sawy, an engineer in his 40s, says he refuses to use a condom as a main method of birth control because he believes it is his wife’s responsibility. “My wife once asked me to use it. I refused, so she decided to take birth control pills,” he said.
Contraceptive methods for men vary, from condoms to the contraceptive injection and vasectomy, to the male birth control pill, which is still in experimental trials. Al-Sawy said that most of his friends do not know anything about male contraceptives. “It is too early in our Arab society to try something new and not medically reliable, such as injections,” he said.
Social acceptance
There are no official statistics in Egypt that reveal how many men heard about male contraceptives, nor the extent of their acceptance of taking responsibility for birth control. An online poll by Al-Manassa found that 58% of men had heard about contraception for men.
The poll of 205 men aged 29 to 45 years old from across Egypt, also found that many reject the idea of using contraception because they fear its impact on their sexual ability. While 69.3% believed that men have a role and responsibility in the birth control process with their partners, only 21% agreed to use it instead of their spouse, and 10% would likely to use contraception if it had no harmful side effects. The majority said they would refuse to try it.
“It is impossible for medications not to have side effects, especially hormonal medications, which is why don’t think women take them either. There are other natural and guaranteed methods, such as condoms,” said Hisham Naguib, a teacher in his 40s.
How do male contraceptives work?
Dr. Hassan al-Fakahani, professor of Masculinity and Infertility at the Faculty of Medicine, Minya University in southern Egypt, divided contraceptive for-male methods into hormonal and non-hormonal ones.
He said that hormonal methods depend on reducing testosterone levels in the testicles. “This is done either by injection, chip implant, oral pills, or patches,” he said.
Non-hormonal contraceptives work directly by impeding the movement of sperm through injection and remain effective for ten years, al-Fakahani said.
The other method depended on tying sperm ducts temporarily or permanently, so that the sperm are unable to enter the duct, he said.
A women’s issue
Some men say that the contraception are a women’s issue.
“There is no time for these things.This is a story that concerns women. We are the ones who have to get the money,” said Muhammad Al-Asyouti, a 33-year-old who described a male contraception as “shameful and strange.”
“Why should I try strange and new medicines when there are safe methods for women? Their side effects are known, and we can treat them. But for men, they are unknown and not guaranteed,” he said. Al-Assiouti’s point of view is widespread among men who see male-contraceptive methods, such as condoms, reducing their sexual ability and pleasure.
Men can take themselves off the issue at any time. They are not responsible.
Ola Ahmed’s husband falls into that category. “He says these methods are not useful, and interrupts sexual spontaneity. There are many men like my husband who think so. How do we convince them to use birth control, whether pills or injections? The issue will take generations for this culture to change,” she said.
Yet Dr al-Fakahani rejects those ideas. “It has no effect on fertility or sexual and reproductive ability,” he said, “and the side effects of using hormonal methods are limited to mood swings, the appearance of acne, and an increase or decrease in sexual desire. As for the injections, they may cause temporary swelling in the testicles.”
Education first
While the idea of sharing responsibility for contraception has not gained much momentum in Egypt’s male-dominated society, there are scattered attempts by feminist initiatives to spread information.
The Female initiative’s “Mama Under the Ruins” campaign worked to raise awareness among women in the countryside about the side effects of birth control pills for women over 35 and to highlight safe methods that men can use. The initiatives coordinator, Sarah Kahla, attributes men’s lack of interest in family planning to government campaigns that focus first on women. Men largely believe that their role within the family is limited to earning money, Kahla says, and attempts to discuss family planning are considered “exhausting and empty talk.”
“Men refuse condoms, and women are always the ones who get involved. Men can take themselves off the issue at any time. They are not responsible,” she says.
“I don’t depend on my husband,” says Noura Ragab, a mother of two, “because he will surely forget one time to take it and I will become pregnant, unintended pregnancy. The matter is difficult.” In her 30s, Ragab says she can bear the side effects of birth control pills, including mood changes, depression and weight gain.
Despite encouraging medical reports and doctors’ confirmation that male contraceptives are safe, such methods are still not widespread in Arab societies. And it will take time to convince men to use them.
Abdel Majeed’s job as a pharmacist definitely affects his outlook. He says he is willing to try any new birth control medication instead of his wife in the future.
