Society

His Pill? We're Long Overdue For Male Contraceptive Alternatives

Male contraception, both pharmaceuticals and procedures, is gaining increasing interest. Yet to date, there is no male contraceptive drug authorized on the market.

A man holds male contraception device Andro-Switch

An example of male contraception called Andro-Switch

Daniel Murillo and Caroline Watillon

If contraception has been a woman's business since the 1960s, it was in the 1990s that international bodies began to take an interest in the idea of sharing the burden of contraception. After the United Nations International Conference on Population and Development (Cairo, 1994) and the Fourth World Conference on Women (Beijing, 1995), calls emerged for sharing the responsibility for birth control with men.

By affirming gender equality in all spheres of life — societal, familial, sexual and reproductive — men are challenged to take personal and social responsibility for their sexual behavior and fertility.

A selection of reproductive health supplies for women

Reproductive Health Supplies Coalition

A possible improvement

Here in Belgium, despite having the best contraceptive coverage in Europe, there still is undoubtedly room for improvement. There are still 20,000 abortions per year, and 45% of them occur following contraceptive failure caused by improper use, or by the inefficiency of the contraceptive method.

It is regrettable that the contraceptive burden rests primarily on women, who are the ones suffering the consequences of contraceptive failure. Moreover, the choice of male contraception should always go hand in hand with the empowerment of men, which involves, among other things, the generalization of emotional and sexual education in schools and other settings, but also by strengthening access to female contraceptive methods.

However, male contraception today remains limited to inefficient techniques or methods such as the withdrawal method or condoms. The latter, which is often described as restrictive, nonetheless remains the only contraception that also protects against STDs and HIV-AIDS. Another option is a vasectomy, which is effective but difficult to reverse. Although many hormonal and non-hormonal contraceptive options for men have been explored and proven to be effective, there continues to be poor uptake in comparison to female contraceptive options.

Today in Belgium, the younger generations are questioning female hormonal contraceptive methods, with demands for "natural" methods increasing and those of vasectomies even more, as some men want to be able to manage their contraception.

Finally, the third and fourth generation pill crisis and the #MeToo movement have led to a demand for the rebalancing of the contraceptive load within heterosexual couples. Other voices such as renowned researchers have also been vocal in their call for access to reliable, reversible and affordable male contraceptive methods. It is undeniable that male contraception is gaining increasing interest. In addition, improving access to it would improve birth control and couples' reproductive health as well as allow men to control their fertility and reduce the number of unplanned pregnancies. Yet to date, there is no male contraceptive drug with marketing authorization.

A public health issue

For 30 years it has been said: The male contraceptive pill is for tomorrow! Despite countless Phase 2 studies that have proven the effectiveness of hormonal male contraception, and although a few doctors prescribe it in France, its development remains blocked. Uncomfortable routes of administration (injections, implants, etc.), institutional obstacles, gender stereotypes about virility and the reluctance of the pharmaceutical industry that claims it won't be profitable, prevent Phase 3 studies that would lead to commercialization.

Non-hormonal alternatives exist, including male thermal contraception which was developed in the 1990s by a French team. It is based on artificial cryptorchidism, in other words, the artificial raising of the testicles to the base of the groin. It is a simple, non-drug required, reversible and effective method, but like other forms of male contraception, it is sorely lacking in evaluation studies. Recently, this experimental technique has been adopted by groups of men concerned with controlling their fertility, but also eager to share the contraceptive burden with their partners.

Encouraging contraceptive diversity 

In Belgium, the internet, social networks, the media, and committed men and women have shed light on this technique, which has contributed to a regular increase in requests for information and use in young men between 20 and 35 years old. However, although protocols for the medical management of thermal contraception have been published and training exists in France, our health professionals are not educated in this method and the staff in this sector are not equipped to direct the public effectively.

Faced with this growing increase in demands, whose leitmotif is mainly that of sharing the contraceptive onus, we caregivers believe that these are legitimate and take responsibility in responding to them. The information available on the internet must be medically supervised (side effects, precautions for use, monitoring, etc.); to leave these couples and men to cope with what they find would be irresponsible.

In view of these observations and in agreement with first and second-line organizations in lifelong education and health promotion, we ask for active public policies in favor of male contraception and contraceptive diversity: political support and academic research and evaluation of methods, training of caregivers in contraceptive diversity, generalization of EVRAS and teaching of a comprehensive approach to sexual and reproductive health, accessibility of vasectomy in the first line of health care (family planning center, medical centers, etc.), promotion of new male contraceptive methods and the involvement of the pharmaceutical sector in their marketing.

Society evolves, and history has repeatedly shown that civil society can be the driver of significant change in the way we live our lives.

*Dr Daniel Murillo is the deputy head of gynecology at the CHU Saint-Pierre in Brussels and Caroline Watillon is a coordinator in the access to global health sector.

**This article was translated with permission from its authors.

Keep up with the world. Break out of the bubble.
Sign up to our expressly international daily newsletter!
Society

What It Means When The Jews Of Germany No Longer Feel Safe

A neo-Nazi has been buried in the former grave of a Jewish musicologist Max Friedlaender – not an oversight, but a deliberate provocation. This is just one more example of antisemitism on the rise in Germany, and society's inability to respond.

At a protest against antisemitism in Berlin

Eva Marie Kogel

-Essay-

BERLIN — If you want to check the state of your society, there's a simple test: as the U.S. High Commissioner for Germany, John Jay McCloy, said in 1949, the touchstone for a democracy is the well-being of Jews. This litmus test is still relevant today. And it seems Germany would not pass.


Incidents are piling up. Most recently, groups of neo-Nazis from across the country traveled to a church near Berlin for the funeral of a well-known far-right figure. He was buried in the former grave of Jewish musicologist Max Friedlaender, a gravesite chosen deliberately by the right-wing extremists.

The incident at the cemetery

They intentionally chose a Jewish grave as an act of provocation, trying to gain maximum publicity for this act of desecration. And the cemetery authorities at the graveyard in Stahnsdorf fell for it. The church issued an immediate apology, calling it a "terrible mistake" and saying they "must immediately see whether and what we can undo."

There are so many incidents that get little to no media attention.

It's unfathomable that this burial was allowed to take place at all, but now the cemetery authorities need to make a decision quickly about how to put things right. Otherwise, the grave may well become a pilgrimage site for Holocaust deniers and antisemites.

The incident has garnered attention in the international press and it will live long in the memory. Like the case of singer-songwriter Gil Ofarim, who recently claimed he was subjected to antisemitic abuse at a hotel in Leipzig. Details of the crime are still being investigated. But there are so many other incidents that get little to no media attention.

Photo of the grave of Jewish musicologist Max Friedlaender

The grave of Jewish musicologist Max Friedlaender

Jens Kalaene/dpa/ZUMA

Crimes against Jews are rising

Across all parts of society, antisemitism is on the rise. Until a few years ago, Jewish life was seen as an accepted part of German society. Since the attack on the synagogue in Halle in 2019, the picture has changed: it was a bitter reminder that right-wing terror against Jewish people has a long, unbroken history in Germany.

Stories have abounded about the coronavirus crisis being a Jewish conspiracy; meanwhile, Muslim antisemitism is becoming louder and more forceful. The anti-Israel boycott movement BDS rears its head in every debate on antisemitism, just as left-wing or post-colonial thinking are part of every discussion.

Jewish life needs to be allowed to step out of the shadows.

Since 2015, the number of antisemitic crimes recorded has risen by about a third, to 2,350. But victims only report around 20% of cases. Some choose not to because they've had bad experiences with the police, others because they're afraid of the perpetrators, and still others because they just want to put it behind them. Victims clearly hold out little hope of useful reaction from the state – so crimes go unreported.

And the reality of Jewish life in Germany is a dark one. Sociologists say that Jewish children are living out their "identity under siege." What impact does it have on them when they can only go to nursery under police protection? Or when they hear Holocaust jokes at school?

Germany needs to take its antisemitism seriously

This shows that the country of commemorative services and "stumbling blocks" placed in sidewalks as a memorial to victims of the Nazis has lost its moral compass. To make it point true north again, antisemitism needs to be documented from the perspective of those affected, making it visible to the non-Jewish population. And Jewish life needs to be allowed to step out of the shadows.

That is the first thing. The second is that we need to talk about specifically German forms of antisemitism. For example, the fact that in no other EU country are Jewish people so often confronted about the Israeli government's policies (according to a survey, 41% of German Jews have experienced this, while the EU average is 28%). Projecting the old antisemitism onto the state of Israel offers people a more comfortable target for their arguments.

Our society needs to have more conversations about antisemitism. The test of German democracy, as McCloy called it, starts with taking these concerns seriously and talking about them. We need to have these conversations because it affects all of us. It's about saving our democracy. Before it's too late.

Keep up with the world. Break out of the bubble.
Sign up to our expressly international daily newsletter!
THE LATEST
FOCUS
TRENDING TOPICS
MOST READ