Contraception: Whose responsibiliy is it?

New contraceptive jab for men opens up debate

By Adam Richardson and Amanda Mcdonnell

Condoms: remember the first time you bought them? Standing in the queue in Boots trying not to make eye contact with the girl behind the counter? Checking your mates/ parents/ teachers weren’t around. Once considered exclusively the domain of women, the issue of responsibility in contraception is beginning to balance out, as evidenced by the emergence of a male contraceptive jab.

Recent research by a team from the University of Edinburgh, working with the World Health Organisation, has to led a belief that an new injection for men could be a new answer to contraception. The team are currently trialling the injection which contains the hormones testosterone and progesterone which leads to a reversible decrease in sperm count and thereby reduces the likelihood of conception.   

The injections are administered on a bi-monthly basis, similar to the female contraceptive injection (usually administered every eight weeks), offering more convenience than some existing contraceptive methods.

The researchers, who are currently looking for couples in the south east of Scotland to trial the drug, hope that if successful the injection could lead to more wide spread availability of such male focused methods.

The trials in Scotland are to form part of a larger study involving 400 couples, comprising of women under 37 and men under 45, from countries around the world. Professor Anderson, a member of University’s reproductive and development sciences division, said: “This larger study is needed to add to the evidence as to how good these longer acting injections are and what couples think about it.”

Currently the only mainstream contraceptive methods targeted towards men are condoms or vasectomy. Condoms are a popular form of contraception as they not only provide protection against pregnancy but also against sexually transmitted infections (SDIs). Britain is one of only three countries where the number of vasectomies outnumber the number of tube ligation procedures which can be considered the female equivalent.

This follows the recent development of a contraceptive pill for men, suggesting that research efforts focused on contraception targeted at men are beginning to gather pace. However the majority of mainstream contraceptive methods currently available continue to be targeted at women. It has been claimed that female contraceptives are easier to produce due to the greater body of knowledge on the female reproductive system. It has also been pointed out that whilst women are fertile for only a few days per month men are able to produce viable sperm on demand, making it more complex to control male fertility.

Existing Methods

One of the favorite forms of contraception especially amongst
students is condoms. Readily available and even handed out in freshers goodie bags, condoms remain a firm favourite with students, possibly due to the added bonus of protection against STIs.

In a survey for the Office for National statistics, around 90 per cent of both men and women who used condoms cited prevention of pregnancy as one of their reasons for using them, and almost half (45 per cent) cited prevention of infection.

They also claim that condom use has caught up with the pill, being used by 25 per cent of women under 50 an equal percentage to those who use the pill as contraceptive device. The pill, available in the UK for over 45 years, is 99 per cent effective provided it is u

sed correctly.        

There are at least two main types of contraceptive pills. The most commonly used being the combined oral contraceptive pill (COCP), which is usually taken for 21 days followed by a 7 day ­­­break. As with most all forms of contraception there are both advantages and disadvantages which need to be taken into account. Whilst the pill is claimed to be 99 per cent effective, missed doses drastically reduce the effectiveness. In contrast to condoms, it also offers no protection against sexually transmitted infections. Added non-contraceptive benefits include the easing of some premenstrual symptoms and there is also evidence suggesting it may reduce the risk of ovarian and cervical cancers.   

In addition to the pill, there is also a female contraceptive injection. The injection which contains a type of progesterone known as medroxyprogesterone (Depo-Provera), is administered as an intramuscular injection. Reliability is similar to that of the pill but fertility may take up to a couple of months to return to normal after the cessation of use.

There are many other forms of contraception available from chemists or health care providers. These include: the male condom, the diaphragm,
spermicides, the intra-uterine device or coil, patches and implants

Not Just Pregnancy

When talking about contraception, it is important to note that unplanned pregnancy is not the only risk that needs to be taken into account when selecting a method of contraception. Safe sex can also help prevent a range of sexually transmitted infections.

Condoms and some other methods offer not only a barrier to children, but also a barrier to STI’s. The most common of these are chlamydia, gonorrhea and syphilis.

STI rates in the UK have risen rapidly, and Leeds is no exception. The area of Leeds with the highest reported cases of STIs is LS6, an overwhelmingly student area. A much used statistic by university unions and health clinics states that around one in 10 students are affected by Chlamydia. With Chlamydia and some other STIs the biggest problem is that it usually has no symptoms – at least to begin with. This unfortunately leads to a greater risk of infecting others and the condition can lead to infertility in women if left untreated for too long. The only way to know you’ve got it is to get tested. Whilst testing campaigns have had a limited amount of success it is generally acknowledged that more needs to be done to encourage students and young people who are sexually active to get tested.

Luckily, Leeds is home to numerous centres that offer free testing and treatment for STI’s. Chlamydia testing is available periodically in the Union. The Terrance Higgins Trust, located on Oxford Place next to the Town Hall, offer a drop in sexual health check up for students on Monday and Thursday afternoons, testing for most common STI’s. The Leeds Student Medical Practise located across from the Parkinson building offers pregnancy testing as well as sexual health advice and testing.

Victoria Sheard of the Terrence Higgins Trust said: “An increase in condom use is very good news as they offer double protection - against sexually transmitted infections as well as unwanted pregnancy.

“People should be aware of the rising rates of STIs when making adecision about contraception - ditching the condoms could leave you and potentially your partner at risk.”

In an age where sex is becoming less and less taboo, information about sexual health is everywhere. In 2008/09, TV programmes and adverts were acknowledged as the main source of information about STIs by 55 per cent of those surveyed. Newspapers, magazines and books were mentioned as the main source by 16 per cent and government information leaflets by three per cent. Sex information in schools or colleges accounted for 11 per cent.

Responsibility

It is argued that contraceptive research is generally aimed at contraceptive devices for women. Only limited funding is allocated to research into male contraceptive devices. A quick scan of the methods of contraception shown above suggests that more emphasis has been put on women for birth control. However, with the advent of the male contraceptive injection, does the responsibility for contraception shift to a balance between the partners?   

The obvious answer is that both partners should take a shared responsibility. However this assumes that the stakes are equal for both parties. Whilst unplanned pregnancy undoubtedly has an effect onboth people it has the potential to have a much more profound effect on the life of the women, giving her a greater reason to take an interest in contraception.    

This perhaps goes some way to explaining the focus of efforts on female contraception and indeed some studies suggest that women would be reluctant to trust their significant others with the responsibility.

A recent report, commissioned by Teeside Univerity, which took a poll of 380 people concluded that women felt they could not trust men to take the contraceptive pill regularly enough to offer adequate
protection against pregnancy. This suggests that whilst developments are in male contraception are important in providing a greater variety of options for couples, Judith Eberhardt, who lead the research team said: “A positive attitude towards the male pill does not automatically imply that the individual will be confident about its effective use”.

This is consistent with the idea that men are often seen as being too lax about contraception. According to a survey by the Office for National statistics, 59 per cent of men interviewed, who claimed not to be in long term exclusive relationship admitted that information on HIV and STI’s had no effect on their behaviour. However, 34 per cent said they had increased their use of condoms while 6 per cent said they had fewer one night stands. 6 per cent took a test for STI’s when they changed sexual partners.

Perhaps men are becoming better at the contraception thing, but how many male students would go for the injection when they could use condoms or rely on the pill?

Kyle Jackson, a second year Theoretical Physics student said: “I would prefer the injection to condoms based on the fact that condoms ruin the moment. I mean they just aren’t very sexy are they? My only concern would be with STI’s but I think it’s perfect for couples who are in serious relationships like me, not people wanting one night stands.”

This fear about STI’s was echoed by Georgia Emblem of LUU FemSoc, who said: “The prospect of a male injection sounds great, but students should remember the only contraception which protects against STIs and HIV and AIDS is condoms.”

Despite the move towards equality, there is still a way to go. There remains the idea that a woman, the partner with the most to lose, who caries condoms is easy or a slut, whereas a man doing the same may be considered “one of the boys” and to be at the same time acting responsibly.

Latest figures suggest that the number of abortions have dropped, which perhaps suggests that use of contraception is on the rise. The Guttmacher Institute report that four million fewer abortions were carried out worldwide in 2003 compared to 1995 with the rate of unwanted pregnancies also falling, from 6.9 to 5.5 per cent between 1995 and
2008.

The number of people visiting NHS community contraception clinics rose by 7 per cent to 1.3 million in the year 2008-2009. This suggests that people are perhsaps taking a more active role in contraception.The biggest rise was among men with 13 per cent, or 17,000, more attending in 2008/09 compared to the previous year.

Play Safely

In a society where STI’s are a growing problem, the role of the
man in contraception has definitely changed. Condoms are becoming a staple for men to carry, partly due to the greater availability of condoms. No longer is it a job of going down to the barber’s for a haircut and being asking “Anything for the weekend sir?” Condoms are available in lots of male friendly places, and are available free to anyone who has a C-Card.

Madeleine Harris Smith, LUU Welfare Officer commented: “A big part of my role as the Welfare Officer is to promote and encourage safe sex and better sexual health among our students.  Both myself and the Student Advice Centre offer free condoms and more advice, or alternatively you can go along to the Leeds Student Medical Practice to chat about alternative modes of contraception.”   

“The biggest sexual health campaign the union runs is a Chlamydia testing campaign.  One in ten students have Chlamydia, and it can be very hard to spot.  However its really easy and quick to test for and treat and this is the message that the C Swap campaign is really trying to push across to students.”

The issue of responsibility for contraception is a difficult one, but wherever you look for information the overall message seems to be, whatever you do and whoever you do it with, make sure you do it safely!