Last fall, my first-year University of Miami daughter came to me with big news: she'd met a special young man and felt that she might soon have sex for the first time. She wanted reliable contraception. Gathering my wits, I was thrilled that she was so open with me and also grateful that she was so thoughtful and mature about it.
But I felt a twinge as well -- I suspected that her boyfriend wouldn't have to go through the process of sorting through a plethora of birth control options, facing uncomfortable, even dangerous, side effects. Today, that milestone should not be one only teenage girls must grapple with -- especially in the face of restrictive abortion access laws in states like Florida and Arizona. On this, the silence of science remains deafening.
How Far Have We Really Come?
Unbelievably, 36 years ago, my mother, assuming rightly as to my serious high school romance, took me to an east side Detroit clinic to get on "the pill." I don't remember much discussion or selection, other than my mother's blunt adamance. I got on the pill -- and took one every day for the next quarter century.
Fast forward to that recent moment with my daughter. Off we went to my, and now her, gynecologist to understand her options. To our surprise, there were 18 different options available to her: the patch, the shot, the progestin-only pill, the estrogen/progestin pill, the continuous use pill, the ring, the cervical cap, the diaphragm, the IUD, the sponge, spermicide, and more, with effectiveness ranging from 70-99%. Although worried about serious side effects, she chose the shot, quarterly.
Just like in 1988, the year I began taking the pill, this key threshold to empowered sex was borne only on the woman's side. For us, it's commonly accepted that contraception options for many women still involve nausea, temporary sterilization, anxiety, weight gain, acne, mood swings, headaches, breakthrough bleeding, blood clots, high blood pressure, breast tenderness, and other side effects, plus building life around a new, often daily, and hugely consequential ritual, to be navigated alone.
Yet, there remains no "the pill" option for men.
According to a BBC article last year, "The weird reasons there still isn't a male contraceptive pill," studies on contraception for men have stalled due to reasons ranging from male discomfort with side effects similar to those endured by women and disdain for the "emasculating" dry orgasm effect of a purported "clean sheets pill." But other trials are still underway. One of the furthest along -- the first, in fact, to have progressed past the initial steps in the clinical trial process -- is an NIH-funded trial for a hormonal contraceptive gel for men (which can be applied on the shoulders). Yet, it may be some time before it would come to market and perhaps even longer before it becomes mainstream (if ever).
So, of the array of contraceptives available to my daughter now, only three also apply to her boyfriend: (1) abstinence, (2) withdrawal, and (3) condoms. The latter dates to 3000 B.C., and remains a heat-of-the-moment gamble with only an 87% success rate even today. Roll the dice on those? I'd rather she didn't.
Considering this three-decade window between me and my daughter first seeking out contraception, during which there has been astounding technological, medical and pharmaceutical advancements, it's striking that for men in our society, the biggest advance focused on male sexuality is sildenafil (Viagra) -- which effectively facilitates more intercourse, without offering any contraceptive effect. Sildenafil, affectionately cited by Time as a "little package of dynamite," was patented in 1996 to correct erectile dysfunction and is not FDA-approved for use by women. (And, to be sure, the two approved "female Viagra" drugs are focused on libido only and require either an injection 45 minutes before sex or a daily pill that can take 4-8 weeks to lead to increased sexual desire. Slightly less appealing, no doubt.)
It's High Time for Male Contraception
Particularly post-Roe, healthcare professionals and policymakers should advance contraception equity access (CEA), broadening discourse to advocate for reliable methods that are the male partner's responsibility.
In a White House fact sheet published in January, the administration announced "New Actions to Help Strengthen Access to Contraception, Protect Access to Medication Abortion, and Ensure Patients Receive Emergency Medical Care." It is encouraging to see extensive thought leadership focused, in part, on increasing access to "affordable, high quality contraception," with call-outs for low-income women, college students, and government employees, among others, plus reinforcement of pregnancy non-discrimination obligations applicable to universities and privacy protections for health data.
The task force's commendable initiatives, however, fall short on advocacy for greater investment in CEA research, which would be a truly relevant and innovative public policy advancement -- especially anticipating the proliferation of restrictive access laws in Arizona, Florida, and elsewhere.
Physicians can play a leadership role in this discourse by asking male adult patients about: (1) contraception awareness, support, and assistance for their female partners; and (2) interest in serving as trial participants for future contraception advancements (noting, for example, the NIH's forthcoming phase III work on the male hormonal contraceptive gel).
FDA approval of the first birth control pill in 1960 spurred an unparalleled revolution in reproductive freedom for women: prompting 1.2 million women to get on it in the first 2 years; leading 65% of U.S. women to use some form of contraception today; and inspiring 19% of teenage girls to use "long-acting reversible contraception" like IUDs.
It's time for a CEA revolution in men. Sustained exploration of CEA, with proactive advocacy from healthcare professionals, could fundamentally engage men as an obvious yet overlooked party in this conversation, deepening accountability to avoid unwanted pregnancy, and possibly even lessening the prospect.
Unfortunately, the focus right now remains on the woman's body. Having entered this phase of my Gen Z daughter's womanhood, the nearly insurmountable post-Roe abortion access standards -- an all-encompassing circumstance that I truly want to avoid her ever facing -- make this moment that much more a time of deep reflection for me.
The reality persists that young women still radically and solely assume the brunt of day-to-day responsibility for maturation to good, safe sex. Their boyfriends want the same -- but continue to be spared the burden. I'm therefore advocating for CEA for my daughter and her boyfriend -- for greater, more equitable science, not just support, in how young people begin their post-Roe sexual lives, with healthcare professionals helping to spark the logical call for greater balance. Both the duty and the duality should have evolved by now.
Corie Pauling, JD, is a mother, a DEI executive, a former civil rights litigator, and a 2023-2024 Public Voices Fellow with Equality Now and The Op-Ed Project.