There won't be a male birth control pill
July 26, 2011
To be clear, I'm not saying men are irresponsible monsters. I'm saying that people are generally unmotivated to step up unless they have to. (Here's a good article that really lays out why people don't do stuff they know they should do until it's really pressing itself upon them.) Men don't use contraception because women are already on it. It's the same principle in play as toilet-cleaning. I'm sure many men in heterosexual relationships imagine themselves to be the kind of people who would totally clean a toilet. But since the toilet miraculously is cleaned before they can get to it, their noble intentions are rarely tested in the real world. For men to go on the pill in large numbers, large numbers of women would have to collectively start refusing to use contraception, and that's about as likely to happen as the pay gap closing up tomorrow.
It's technically possible that drug companies are, for no good reason, sitting on a profitable gold mine and are just unwilling to rake in the dough that they'd get from putting out a male birth control pill. I find that unlikely, especially with all the media pressure on them to develop such a pill. I think the more likely story is that drug companies have done some consumer research and decided, quite rightly, that there's no money in it.
We out in the world can kind of guess at what their research says. To determine interest in a pill, it's not enough to ask men if they'd use it. People have a tendency to overestimate their nobility to pollsters. (For instance, Americans claim to attend church far more than they actually do.) You have to actually measure real world willingness to take on that responsibility. One way to do this is to look at forms of birth control men do have, and look and see how much responsibility men take towards using these.
One good place to look is rates of sterilization. Vasectomies are safer, less invasive, and quicker to heal from than tubal ligations, but the rate of female sterilization in the U.S. is twice the rate of vasectomy. (Actually, according to the CDC, women get sterilized at three times the rate of men.) If men, on average, were invested in taking responsibility for contraception, we should see those numbers basically reversed, since tubal ligations are more dangerous. In addition, sterilization is a form of birth control that's most commonly chosen by people in long-term relationships who've had all their children, i.e. people with the maximum amount of commitment to their partners. In the group of people we're talking about, the woman has likely been using contraception, has had a couple of pregnancies, and now they're deciding together to go for sterilization. This would be the time that men are most likely to feel like taking one for the team, and yet they do so at less than half the rate of women.
When it comes to other male-controlled methods, the numbers are also not compelling to suggest widespread male interest in taking responsibility for birth control. The two most popular forms of birth control are the pill and female sterilization; vasectomies don't even rate as popular enough to get their own pie slice, but are bundled into "all other forms". Female sterilization and the pill combined are three and a half times more popular than condoms, even though condoms have added protection against STDs. And that's not even the entire story on condoms. I couldn't find any research on who in sexual situations is making the decision to use a condom, but it's clear that condom companies have some internal research that shows women are more likely than men to insist on it. Condoms are framed as being women's business, just like all other forms of contraception---most drugstores stock them next to the tampons, i.e. the aisle where men are not expected to go. Condom advertising is increasingly addressing itself to women's desire to use condoms vs. men's desire not to use condoms. Trojan's heavily covered "Evolve" campaign, for instance, was based on this premise, and I'm guessing they had internal research to back it up. PSAs are working that premise heavily, too.
I read Tracy Clark-Flory's interesting examination of the question of whether or not men will use a birth control pill, and the thing that struck me is that the evidence that there's interest is really, really thin. Basically, the claim is that the pill could work for men who are worried about knocking someone up that they really don't want to get pregnant, such as the mythical man-trapping girlfriend or the mistress that you don't want your wife to find out about or the one-night stand whose contraception use is iffy.
In other words, all the examples are of men who already won't use condoms.
I'm sorry, but if I'm a drug company looking for an investment opportunity, I'm not going to bank millions of dollars on men who can't be bothered to go to the drugstore and buy a box of condoms being willing to go to a doctor, get a prescription, and use a pill every day to prevent a health condition in someone else.
Which isn't to say that I think men as a rule are irresponsible. Most men are responsible. They are aware that their partner is using contraception, and they basically figure she's got a handle on it. That's my point. From a drug company's perspective, the only potential market for this drug are men who are probably too irresponsible to use it and a very small percentage of men who have partners who have exhausted all other potential forms of birth control, and that number is tiny. There is some demand, sure, but not enough to justify the R&D from a profit-driven perspective.
The problem is that contraception is simply viewed as a woman thing in our culture, for reasons that are obvious (they're the ones who get pregnant) and reasons that are kind of sexist (women tend to be given responsibility for the less glamorous work in our society, and making sure that the sexual experience is free and fun and feels unencumbered is right up there with the other support staff kind of tasks that women dominate).
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