Facts of Life
Facts of Life:
Issue Briefings for Health Reporters
Vol. 9, No. 2
February 2004
The Contraception Question: Barriers and Choices
The Issue
The Facts
Why Not a Pill for Men?
Expert Sources
References
The Issue:
Fifty years after the
debut of the birth control pill, 20 years after AIDS made condoms necessary
and just months after the Food and Drug Administration’s
decision to consider over-the-counter emergency contraception, people still
search for the perfect birth control. Adding to the weight of the decision,
certain birth control options carry health implications including increased
cancer risks and varying degrees of protection against sexually transmitted
diseases.
Choices for Most
Contraceptive
of choice varies with lifestyle, age and family circumstances. Few people
rely on the same contraceptive throughout life. For instance, 43 percent
of new and expectant mothers use or consider a different method than they
used prior to pregnancy, according to a recent survey. [1] Contraceptives
like the diaphragm or sponge may become more acceptable to women as they
age. [2] But men’s choices lag far behind women’s.
Despite all the
options, some women report concerns with proper condom use, fears of side effects
and worries about reversibility. In a study of more than 3,000 women, about 7
percent regretted getting a tubal ligation or their partner getting a vasectomy.
[3] In some cases, miscommunication with a health care provider can cause women
to skip contraception all together, one study found.
[4]
The Facts:
- Studies of the rhythm
method of birth control have found that only 30 percent of women ovulate
within the range of days usually considered most fertile, 10 to 17 days
after the start of their menstrual cycles. [5]
- In 2002, only 20 percent of a national sample of obstetrician-gynecologists
reported inserting an interuterine contraceptive device (IUD) in their
patients. The low number may be due in part to IUD health and litigation
controversies in the 1970s. [6]
- In a 2000 study,
women who took a single dose of emergency “morning-after” contraception
were not more likely to have unprotected sex than those who received
only information about emergency contraception. [7]
- A survey of 320 Pennsylvania pharmacies found that
35 percent would be able to fill a prescription for emergency contraception
within 24 hours.
[8]
- Women who put condoms on their male partners
incorrectly are also more likely to report breakage or slippage
problems with the condom, according
to a 2003 study of college students. [9]
- Non-latex condoms are associated with higher
rates of clinical breakage than latex condoms, according to
a review of studies comparing the two.
In almost all comparisons, however, the non-latex condoms were
preferred by their users. [10]
- Among
a group of 210 women trained to use a female condom, rates
of later semen exposure varied with
income level and
the length of the women’s
current relationship. [11]
- Although the female condom is often touted
as an alternative to the male condom, a 2003 study found
that women whose partners consistently
used male condoms were also more likely to use female condoms.
[12]
- Long-term contraceptives such as Norplant
may be more effective than birth control pills in preventing
teenage mothers from becoming pregnant
again within a year after the birth of their first child.
[13]
- Minnesota high school students
were more apt to take advantage of free contraception
if they could get the birth control directly from
school
clinics rather than using vouchers at local pharmacies,
according to a recent study. [14]
- Latinas
who believe women should stay at home and not work are four
times more likely to skip a few birth control pills
than those with a more favorable impression of women in the
workplace. [15]
Why
Not a Pill for Men?
Although he
is considered the father of the pill, chemist Carl Djerassi, Ph.D.,
has always envisioned a “contraceptive
supermarket” where people could find a variety of methods to
suit their age, income, religious and cultural beliefs. [16] He and
others acknowledge, however, that men are shortchanged when it comes
to birth control.
“When we consider that of the three male methods, withdrawal
has low effectiveness, the condom faces psychological resistance and
a 3 to 15 percent failure rate and vasectomy is not reliably reversible,
the selection for men seems paltry,” says Elaine Lissner, director
of the Male Contraception Information Project.
The demand for more and
better male contraceptives exists: An international survey of more
than 2,000 men found that most would use a male contraceptive
pill if it were available. [17] A 1997 Kaiser Foundation study found
that two-thirds of American men would take a male pill. [18] Richard
Anderson, M.D., one of the world’s leading researchers in male
contraception, says his surveys have shown a small but definite market
for male birth control.
Most male contraception
research is done by public sector and individual scientists rather
than industry researchers, making progress in the
field “exceedingly slow compared to commerce,” Anderson
says. In recent decades, according to Anderson, pharmaceutical companies
have abandoned contraceptive research to focus on more lucrative psychiatric
and cardiovascular drugs.
Despite this, the past three years have been a boom time for research
on hormonal and other chemical preparations, ultrasound techniques
and even tiny injectable plugs used for male contraception. These methods
have improved significantly within the past decade, now blocking most
sperm flow in most men.
Hormonal and some plug methods take two to three months to become
effective, which means that they will probably be used more by older
men planning ahead than teens in search of a quick solution, Anderson
says.
“There’s been a perception that men would be looking for
long term methods of contraception, implants and injections, but one
should keep an open mind,” Anderson says. His research suggests
men’s birth control preferences are “very much related
to their previous experience with contraception.”
If a man’s experience
has been with women who use the pill, for instance, he may be most
interested in a fast acting, short-term
method. Men familiar with the three-month Depo-Provera injection could
be drawn to similar long-term devices or drugs, Anderson notes.
“There’s
no reason to think men wouldn’t want to
change their minds [about birth control] as much as women would,” he
says.
Expert
Sources:
Felicia
Stewart, M.D., Ph.D.
Univ. of California, San Francisco
(415) 502-4098
fstewart@itsa.ucsf.edu
S. Marie Harvey, Ph.D.
University of Oregon, Center for the Study of Women in Society
(541) 346-4120
mharvey@oregon.uoregon.edu
Victoria H. Jennings, Ph.D.
Georgetown Univ. Medical Center
(202) 687-1392
jenningsv@georgetown.edu
Richard Anderson, M.D.
University of Edinburgh
+44 131 242 6200
r.a.anderson@hrsu.mrc.ac.uk
References
1. Contraceptive needs of new mothers are unique and unmet, Emory University
School of Medicine news release, May 7, 2002. http://www.eurekalert.org/pub_releases/2002-05/pn-cno050702.php.
2. Harvey, S.M. et al. (2003)
Who continues using the diaphragm and who doesn’t: Implications for the acceptability of female-controlled
HIV prevention methods. Women’s Health Issues, 13, 185-193.
3. Jamieson, D.J. et al.
(2002) A comparison of women’s regret
after vasectomy versus tubal sterilization. Obstetrics and Gynecology,
99, 1073-1079.
4. .Isaacs, J.N. and M.D. Creinin (2003) Miscommunication between
healthcare providers and patients may result in unplanned pregnancies.
Contraception, 68, 373-376.
5. Wilcox, A.J. et al. (2000)
The timing of the "fertile window" in
the menstrual cycle: day specific estimates from a prospective study.
British Medical Journal, 321, 1259-1262.
6. Stanwood, N.L. et al. (2002) Obstetrician-gynecologists and the
intrauterine device: A survey of attitudes and practice. Obstetrics
and Gynecology, 99, 275-280.
7. Raine, T. et al. (2000) Emergency contraception: Advance provision
in a young, high-risk clinic population. Obstetrics and Gynecology,
96, 1-7.
8. Bennett, W. et al. (2003)
Pharmacists’ knowledge and the
difficulty of obtaining emergency contraception. Contraception, 68,
261-267.
9. Sanders, S.A. et al.
(2003) Condom use errors and problems among young women who put condoms
on their male partners. Journal of the
American Medical Women’s Association, 58, 95-98.
10. Gallo, M.F. et al. (2003) Non-latex versus latex male condoms
for contraception. Cochrane Database Systematic Reviews, 2, CD003550.
11. Lawson, M.L. et al. (2003) Partner characteristics, intensity
of the intercourse and semen exposure during use of the female condom.
American Journal of Epidemiology, 157, 298-300.
12. Cabral, R.J. et al.
(2003) Do main partner conflict, power dynamics and control over
use of male condoms predict subsequent use of the
female condom? Women’s Health, 38, 37-52.
13. Stevens-Simon, C. et al. (2001) A village would be nice but...:It
takes a long-acting contraceptive to prevent repeat adolescent pregnancies.
American Journal of Preventive Medicine, 21, 60-65.
14. Sidebottom, A. et al. (2003) Decreasing barriers for teens: Evaluation
of a new teenage pregnancy prevention strategy in school-based clinics.
American Journal of Public Health, 93, 1890-1892.
15. Brown, J.W. et al. (2003) Exploring contraceptive pill taking
among Hispanic women in the United States. Health Education and
Behavior,
6:663-682.
16. Djerassi, C. (1981)
The politics of contraception. San Francisco: WH Freeman & Co.
17. Martin, C.W. et al. (2000) Potential impact of hormonal contraception:
cross-cultural implications for development of novel preparations.
Human Reproduction, 15, 637-645.
18. Henry J. Kaiser Family Foundation (1997) Contraception in the
90s: Which methods are most widely used? And, who uses what? Survey
conducted June 1997.
.
The Center for the Advancement
of Health is an independent nonprofit organization that promotes
greater recognition of how psychological, social, behavioral,
economic and
environmental factors influence health and illness. The Center advocates the highest
quality research and communicates it to the medical community and the public. The
fundamental aim of the Center is to translate into policy and practice the growing body of
evidence that can lead to the improvement and maintenance of the health of individuals and
the public. The Center was founded by the John D. and Catherine T. MacArthur Foundation
and the Nathan Cummings Foundation, which continue to provide core funding. Funding for
this series was provided by the Robert Wood Johnson Foundation.
For Information Contact:
Kristina Campbell
Editor, Health Behavior News Service
Center for the Advancement of Health
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