Is it time for men to share the physical and mental burden of contraception with women?

BY DR IKUNNA ONWUANIBE

The use of contraception can be lifechanging for young girls, as unplanned pregnancies can be the difference between continuing education and pursuing their future dreams. There is a persistent awkwardness globally when it comes to discussions on sexual health. Parents find it challenging to discuss contraception with their children and protest when schools attempt to include it in their curriculum. “Do not let a boy touch you”, which is hardly contraceptive advice, is the default advice that the majority of young girls receive from their mothers just before they head out to university. Even though a high proportion of young women have sexual intercourse without using contraception, the number of young women with unplanned pregnancies is much lower than expected. Many girls seek back-street abortions because of the stigma of being an unmarried woman with a child. This is changing as more women now choose to be single parents. The use of contraception is low in Nigeria. According to the UNICEF 2021 survey, only four out of ten women in Nigeria use contraception. The barriers to contraception use include social norms, misinformation about adverse effects, and a lack of access to good sexual health advice and clinics. Research has consistently shown that contraception is cost-effective. Contraception helps to plan pregnancies, reduce unplanned pregnancies, and unpremeditated abortions, and reduce maternal and newborn deaths. No woman should die having a child they did not intend to have in the first place.

THE BASICS

A sperm and egg must meet to fertilize the egg for pregnancy to occur. Sperm can survive in women and fertilize an egg up to seven days after sex. However, the eggs survive for only 24 hours after ovulation, resulting in an eight-day fertility window. This means that the fertile time is about eight days; this is anytime from seven days before ovulation to one day after sex. So, pregnancy could be prevented by either abstaining from sex during these eight days or by using contraception.

There should be some discussion on who (the woman or man) holds the responsibility for ensuring that pregnancy is prevented and planned in a relationship. The feminist would argue that both parties should bear equal responsibility for preventing unplanned pregnancies, others believe that as women shoulder the responsibility of carrying pregnancies, the onus lies with the women.

CONTRACEPTIVES AVAILABLE FOR MEN

The male condom is widely accessible for men to use. When correctly used every time one has sex, only two out of one hundred women, who use condoms, will fall pregnant in one year. However, with typical use and less discipline, fifteen out of a hundred women will get pregnant in one year. Condoms are designed to stop sperm and egg from meeting. Condoms are the only contraceptive with the additional benefit of preventing sexually transmitted infections.

Some couples use “the pull-out” or withdrawal method. This is when the man pulls out just before ejaculation. This method is better than not using any contraception, but it is still a high-risk plan because about one in five couples who use pull-out alone will have an unexpected pregnancy. This method is high risk for several reasons: sperm can be released before ejaculation; the man has to pull out at the right time, so he needs to be disciplined; the man must ensure that no semen is deposited anywhere near the entrance of the vagina as sperm can swim up to the vagina and into the womb, enabling sperm and egg to meet. There are documented instances of unplanned pregnancies when women have had unplanned pregnancies without penetrative sex.

Vasectomy, or male sterilization, is also available to men. This is highly effective, as only one in about two thousand couples will have an unexpected pregnancy. It is permanent because it is not easily reversible. Most men do not opt for this method because of social norms (such as the belief that the responsibility should lie with women) and the wrong assumption that it would affect their libido and sexual function.

The critical question is why we do not have a male oral pill. The female combined pill was created 60 years ago, but the long-awaited oncedaily male hormonal drug, designed to stop sperm production, is still being researched. Scientists are working on how to balance effectiveness and adverse effects. So, the wait for an opportunity for men to choose a pill rather than condoms, pull out, and have a vasectomy continues.

BOTTOM LINE

The unconscious bias about who assumes responsibility for contraception remains. Why should women still endure most of the responsibility for pregnancy prevention? However, can women entrust men with the responsibility of pregnancy prevention?

Dr Ikunna Onwuanibe Family Physician at Dennis Ashley Medical Clinic Landmark Towers, Oniru, VI, Lagos @ikupopsicles

Ikunna has over 25 years of experience in family medicine and holds a master's degree in public health from the London School of Hygiene and Tropical Medicine. Her main interests are women’s health and the prevention of long-term illnesses. Ikunna is a co-founder of the Be a Sister Foundation and a director of the Angel Rays Foundation. Both charities support the well-being of young people and motherless babies.