When the Supreme Court abolished women’s right to abortion in 2022, it was hard to believe that this could follow in access to contraception. And yet, even before the election, legislative initiatives began to restrict access to certain contraceptives. The Trump administration could continue down this regressive path, suggesting a slippery slope to the brutal brutality of the 1960s.
It’s time for men to do their part. After 70 years of research, several new male birth control options have succeeded in clinical trials. Accelerating their development could slow the ongoing assault on women’s reproductive health. But this requires a new regulatory perspective, more research funding and a commitment to prioritizing innovation in a market that has stagnated for more than half a century.
Post-choice demand for contraception, abortion pills, long-term contraception, permanent contraception and requests to replace still effective IUDs exploded. AND similar wave he followed Dobbs v. Jackson Women’s Health Organization decision overturning Roe v. Wade. This time the fear seems more palpable. Trump-Vance campaign rhetoric on abortion and access to contraception has been inconsistent, fueling pre-existing fears. Is this fear based on facts? Is access to contraception really at risk? Does the increased demand for vasectomy suggest that men want a greater role in pregnancy prevention? That. That. And yes.
Contraceptives are under attack
Early signs show that access to contraception is indeed at risk. An archaic interpretation of the dormant Comstock Act seems worthy of condemnation. The so-called “Sexual Purity” Act of 1873 prohibited the mailing of obscene materials, contraceptives, and anything that might induce abortion. (It was previously used to stop the sale of diaphragms in the 1920s. To overcome this, activist Katharine McCormick had diaphragms sewn into fur coats in France for resale in America).
After the Dobbs case, anti-abortion activists and conservative states began reinterpreting the Act to restrict access to “abortion pills” (mifepristone and misoprostol), even in states where abortion is legal. What is important, this drug allows safe early termination of pregnancy two thirds of those seeking an abortion. The Department of Justice under President Biden considered the Act to apply to drugs used illegally. The FDA expanded the number of people who can prescribe abortion pills and adjusted the requirements for in-person visits to allow easier access via telehealth. A Trump-Vance administration could repeal those protections and/or implement the Comstock Act. Several local ordinances already support the Act, making it illegal to receive abortion pills through the mail.
If Comstock can be used to restrict the abortion pill, can it also be used to restrict contraception? Unfortunately, yes. Its passage would allow states and local jurisdictions to determine whether women can have access to contraceptives. This is already underway in Indiana and Oklahoma, where new laws reduce access to certain methods of female contraception based on false claims and conflations of their potential use in abortions. Echoing a similar theme, Justice Clarence Thomas called the Supreme Court to review the 1965 decision that established the right of married couples to use contraception in his concurring opinion in the Dobbs case.
There is also the issue of Medicaid coverage for birth control and Medicaid funding for Planned Parenthood. Reductions or restrictions could make it harder for vulnerable populations to access contraceptives. The Affordable Care Act (ACA) requires insurance plans to cover birth control without out-of-pocket costs. The changes could affect access to contraception for tens of millions.
Men must play their part
It is unclear how these potential attacks on female contraceptives play out over time. What is that’s clear 46% of all pregnancies in the US are unintended. Terminating a pregnancy is never a desirable option, but if birth control becomes more difficult to access, women don’t have many alternatives. The growing shortage of safe abortion drives unwanted parenthood or unsafe termination of pregnancy. This future is already getting closer. AND JAMA July 2024 study found that self-induced abortions increased when women tried to terminate a pregnancy by using drugs or alcohol, lifting heavy objects, taking a hot bath, hitting their stomachs, or inserting objects into their bodies.
In this context, we need a new perspective on a problem as old as humanity itself. One innovation could change things: male contraception. For the first time in 70 years, new male contraceptives achieve success. And it was high time. The female pill turns 65 next year, marking more than half a century of the same thing: every patch, injection, implant and ring introduced in the last 65 years prevents pregnancy with hormones. Women complain, and not unfairly. Innovations in male contraception are even worse: 169 years have passed since Charles Goodyear commercialized the modern condom.
The government, women’s health advocates, investors, and anyone dissatisfied with their birth control method must prioritize innovation in contraception. Men have only three options: condoms, vasectomy and abstinence. Researchers are testing three new options for men in human studies: hormone-free birth control pills, the “male IUD” and a hormone gel for dermal application. Data show that there is a high demand for new contraceptives among women and men, but meeting this demand requires funding to accelerate them and promote future research. Prioritizing women beyond their childbearing capacity isn’t just about investing in reproductive health, it’s also about men: The FDA should examine how it views risk so that men—even without risk of childbearing—can participate in clinical trials for male contraception.
Finally, consider this: If men had more birth control options, would restricting access to contraceptives be a thing? Interestingly, recent anti-contraception rhetoric does not mention condoms. Perhaps contraceptives would be viewed more favorably if birth control were not seen as “women’s work”. This will not be clear until men have more options.
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