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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.

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Geopolitics

Utter Pessimism, What Israelis And Palestinians Share In Common

Right now, according to a joint survey of Israelis and Palestinians, hopes for a peaceful solution of coexistence simply don't exist. The recent spate of violence is confirmation of the deepest kind of pessimism on both sides for any solution other than domination of the other.

An old Palestinian protester waves Palestinian flag while he confronts the Israeli soldiers during the demonstration against Israeli settlements in the village of Beit Dajan near the West Bank city of Nablus.

A Palestinian protester confronts Israeli soldiers during the demonstration against Israeli settlements in the West Bank village of Beit Dajan on Jan. 6.

Pierre Haski

-Analysis-

PARIS — Just before the latest outbreak of violence between Israelis and Palestinians, a survey of public opinion among the two peoples provided a key to understanding the current situation unfolding before our eyes.

It was a joint study, entitled "Palestinian-Israeli Pulse", carried out by two research centers, one Israeli, the other Palestinian, which for years have been regularly asking the same questions to both sides.

The result is disastrous: not only is the support for the two-state solution — Israel and Palestine side by side — at its lowest point in two decades, but there is now a significant share of opinion on both sides that favors a "non-democratic" solution, i.e., a single state controlled by either the Israelis or Palestinians.

This captures the absolute sense of pessimism commonly felt regarding the chances of the two-state option ever being realized, which currently appears to be our grim reality today. But the results are also an expression of the growing acceptance on both sides that it is inconceivable for either state to live without dominating the other — and therefore impossible to live in peace.

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