Contraception: A Woman's Heavy Burden

The US Food and Drug Administration has approved Lybrel, the first continuous use drug product for prevention of pregnancy. One side effect of the drug is that it eliminates a woman's regular menstrual cycle. Like other available oral contraceptives, Lybrel is effective for prevention of pregnancy when used as directed.

The risks of using this pill are similar to the risks of other conventional oral contraceptives and include an increased risk of blood clots, heart attacks, and strokes. The labeling also carries a warning that cigarette smoking increases the risk of serious cardiovascular side effects from the use of combination estrogen and progestin-containing contraceptives.

When I read of research findings like this that seem to guarantee some results but with plenty of side effects to go with it, I wonder at the fact that such few options are available for male contraception and so little research goes into it. When we think about contraceptive availability this way and what contraceptive options are available to men, the answer is that only three purely male methods exist - withdrawal, the condom, and vasectomy (male sterilization).

This contrasts with the list for women - the diaphragm, the sponge, IUDs, the pill, cervical caps, "morning after" pills, Norplant, Depo Provera, natural methods, ovulation detectors, the female condom, foams, jellies, suppositories, sterilization, and more. From the portfolio of products available for women, it would appear that society is selling the message to women that birth control and contraception are fundamentally women's issues and the market is out there.

Further, of the three male methods withdrawal has low effectiveness, the condom faces psychological resistance and a 3-15 per cent failure rate, and vasectomy is not reversible, and it seems inevitable that men should be left alone in assigning responsibility for birth control. One common argument against providing a male contraceptive supermarket is that there is little expressed demand among the men of our society.

Having read this far, it would seem that society has put an inequitable burden on women and this seems to be based on the premise that since it is women who get pregnant it is their lookout to take steps to ensure and prevent pregnancy. Men who are at the fore front of research, and science have found it natural to invest time, money and energy in ways to prevent women from getting pregnant, while promoting negligible research in male contraception.

In some ways, it is good that women have tools at hand that can prevent pregnancy for the burden of an unwanted pregnancy is a heavy one to bear and that too if one has to bear that burden alone, especially in conservative societies like India.

But these technologies do not come cheap, either in economic terms or in terms of their linkages with potentially damaging health consequences. Even so, for those who can afford them, they have that limited use, that they do protect one from unexpected and unplanned pregnancies.

What is inequitable however is that although condoms are cheap and have little side effects, they are often not the preferred tool for temporary birth control. Other invasive tools that women need to use are the preferred ones, even if they are much more expensive. Condoms might be cheap but they interfere with the "pleasure" of the sexual act and hence are largely not in vogue.

As far as permanent methods are concerned, vasectomy, especially the modern, no scalpel vasectomy (NSV) is a hassle free out patient procedure, but because it supposedly interferes with men's virility, it is not popular and its association with Sanjay Gandhi and his coercive methods has made it an even bigger object of loathing. So tubectomy, a comparatively more complicated procedure which is invasive is used, even though it requires usually at least a day of hospitalization and some more days of rest is the one routinely suggested to women even as the man is standing by.

The cafeteria approach to family planning and birth control so popular in government programs has a bouquet of products for a woman to choose from and a few nuggets for the man and even they are cursorily explained and promoted. Clearly the research, the range of products, the marketing and the promoting of the birth control motifs make it abundantly clear that the balance is unevenly tilted against women who alone seem to have the responsibility to ensure that they do not get pregnant.