Women have been taking the birth control pill for 60 years. The first oral contraceptive, Enovid, was first approved for commercialisation in the US by the FDA on 11 May 1960. The UK approved it a year later on the NHS but for married women only; it was only in 1967 that the pill became widely available in the UK. Its commercialisation represented a significant step forward for female emancipation, but its controversial nature sparked strong reactions: to many, it represented a threat to male control, an immoral means of preventing pregnancy and a way of encouraging sexual promiscuity. A major reason behind introducing the pill was to avoid clandestine abortions which often led to life-threatening infections; abortions were illegal until 1967 and were only legalised in Northern Ireland last October. For women, the contraceptive pill was a fundamental tool in gaining control of their fertility, their body, and the course of their life. By deciding when and with whom they wanted to bear a child, women gained autonomy and no longer needed to rely on men to ‘be careful’. The pill was crucial in helping alleviate the pressure of the prospect of an unwanted pregnancy for which women were given full responsibility. Without DNA tests or legal abortions, women faced the anxiety of having to bring up a child on their own, and it therefore made sense for them to be able to gain control of their bodies through hormonal contraception.

Society has come a long way since then. DNA tests mean that fathers can be forced to face legal obligations towards their children, abortions are legal and female participation in the workforce is continuously on the rise, meaning male/female relationships are increasingly levelled. Though the pill helped women gain control and autonomy, it has also contributed to the systematic exclusion of men from the reproductive health sphere. It is extremely common and even often assumed that young women will go on the pill once they become sexually active as a precaution. In the UK, the contraceptive pill is currently the most popular method of contraception, with 39% of women taking it in 2018/2019 according to the NHS. Worldwide, 100 million women are on the pill.

“Loss of libido, mood swings, depression and weight gain.. Why are these side effects acceptable for women and not for men?”

It is surprising that to this day, the only available contraceptive methods for men are condoms and vasectomies. Research towards a male alternative to the female contraceptive pill has been ongoing for the past 60 years, and not without success. There is however the persisting issue of the pharmaceutical industry’s lack of interest in these solutions. Under capitalism, the pharmaceutical industry must weigh up supply and demand before funding and commercialising a product. It is unfortunately assumed that the market for male contraceptives is not interesting enough for sufficient research to be undertaken and for these options to become widely available.

The research itself includes projects for a male pill, a gel or an injection, all solutions which have shown promising results. The World Health Organisation was even involved in trials for a male hormonal pill. This pill used a synthetic version of testosterone and progestogen to stop sperm production. The results of the first trials were extremely successful: 96% of the men no longer produced any sperm, and the remaining 4% produced less than a million, making this pill a promising contraceptive. However, in 2012, the project was scrapped after side effects experienced by the men were judged too severe. The side effects described by the patients were not so different from the ones commonly experienced by women who take the pill, and included loss of libido, mood swings, depression and weight gain. Further research and the adjustment of hormone doses could have decreased these side effects, but instead of pursuing the project, it was abandoned without further consideration. So why are these side effects acceptable for women but not for men? Why is the medical world more concerned with preserving the male body than the female one?

The gender gap within the pharmaceutical industry could be an influential factor, given that men continue to dominate leadership roles. But perhaps it is gender stereotypes that play a defining role in society’s approach to contraception. Mood swings and hormonal fluctuations are considered normal for women because of their menstrual cycle, and therefore makes tampering with their natural cycle with synthetic hormones more acceptable. Society’s perception of hormonal variations as ‘female’ in a way justifies the exclusively female use of hormonal contraception. Testosterone on the other hand is a much more valued hormone, perceived as crucial in defining manhood. Lowering its levels or combining it with a female hormone, progestogen, challenges stereotypical perceptions of manhood, masculinity or virility. There is therefore a natural bias towards using hormonal contraception on women only.

“It is now time for the pharmaceutical industry to catch up and offer equal contraceptive options for men and women.”

There is also a financial incentive to only manufacture a female pill. The imminent threat represented by pregnancy for women makes them a much larger consumer base than men who are not as directly impacted. The risk of mood swings, weight gain, loss of libido, depression and blood clots is counterbalanced by the security of 99% effectiveness against pregnancy. Having to take the pill every day provides a sense of security but also reinforces gender roles surrounding sexual health by being a constant reminder for women that they are responsible for not becoming pregnant. The fact that their male partners do not even have to think about it strengthens the unbalance in responsibility when it comes to contraception.

Female contraceptive pills have not exactly remained unproblematic from a health perspective. The pharmaceutical group Bayer for example has been under fire for its third and fourth-generation pills (Yasmin, Yaz, Yasminelle) containing drospirenone, a synthetic hormone which increases the risk of blood clots by up to three times in comparison with previous generations of pill. Bayer has faced legal proceedings and paid 2 billion dollars to 17500 women outside of a judicial framework according to Kristen Esch’s Arte documentary. Bayer’s drospirenone-based pills continue to be distributed across the UK and the world despite the higher risk of venous thromboembolism. The normalisation of hormonal contraception within society leads to women underestimating risks and side effects.

Endocrinologist Stephanie Page of Washington University, a participant of the WHO male pill project, says it will most likely be another ten years before a male hormonal contraceptive is perfected and commercialised. It appears that until a male pill is created that has significantly lower side effects than those created by the female pill, the commercial appeal will not be significant enough for the pharmaceutical industry to invest in and distribute it. What started off as a tool for female emancipation now reinforces traditional gender roles. A decrease in uptake of the pill in the past 4 years (from 45% of women in 2015 to 39% in 2019 in the UK) shows that women are already having second thoughts about oral contraceptives. With the change that has been achieved in the past 60 years for women’s rights, it is now time for the pharmaceutical industry to catch up and offer equal contraceptive options for men and women.