Why contraception is considered solely women's care

Text: Nadya Makoeva

There are themes suitable for family dinner., there is a little less suitable, and there are those that always provoke scandals. I don’t know why I mentioned vasectomy between the second course and apple pie. Somehow, by the way, we had to, because in our surroundings many families suddenly became large, and they decided that there were probably enough children. The issue of birth control has arisen before us - we have three children - and with familiar couples really seriously, without the right to misfire.

That evening at the table turned serious battles. To my reasonable question, why in our country vasectomy is so unpopular - the vast majority of men do not consider it at all - the male part of the family has come into undisguised excitement. My grandfather boiled over and asked how I can offer all men to remain crippled. The husband tried to get away diplomatically from the answer: "Do I want more children? No. Is I going to have children with other women? No. Is I ready to think about a vasectomy? No." And this is a modern man who attended the birth three times and is involved almost more than me in the process of raising our children.

Persistent unwillingness to at least discuss the issue of male contraception among intelligent and educated people is a reasonable question. Why throughout the history of the prevention of unwanted pregnancy was a purely female responsibility? The answer is obvious: it is women who ultimately have to deal with the consequences of pregnancy, paying for their health, social life, and sometimes life in general (according to WHO, in the world every day about 830 women die from causes related to pregnancy and childbirth). After conception, nothing changes in the man’s body, but everything in the woman’s body. It is the woman who bears and gives birth to people - and the cases of “made the child and disappeared” continue to be a part of life.

Since there is almost no request for participation in birth control by men, there are few available methods of contraception. There are more than a dozen ways to prevent unwanted pregnancy for women (and hundreds of specific drugs), and only two - condoms and vasectomy (ligation or removal of a fragment of the vas deferens) - for men. And yet there are shifts, there are developments on the creation of oral and injectable hormonal contraceptives for men. So far, all these drugs have an impressive list of side effects - and their long-term safety has not been studied. "Risks outweigh the potential benefits of the application" - this streamlined formulation of pharmacologists does not promise any obvious progress in the matter in the near future.

There are more than a dozen ways to prevent unwanted pregnancy for women and only two - condoms and vasectomy for men.

Interestingly, such frightening side effects in the development of new contraceptives for men are mood swings, depression, pain from the injection and increased libido. For comparison, here is a list of side effects of one of the popular COCs for women: pain in the mammary glands, irregular uterine bleeding, bleeding from the genital tract of unspecified genesis, arterial and venous thromboembolism, depression, drowsiness, decreased libido, nausea, vomiting, dyspepsia, varicose veins veins, weight gain and more.

This is not about drugs in the development process, but about contraceptives that use hundreds of millions of women. However, reproductive freedom - the ability to choose when and from whom to have children - is more important than potential risks. And of course, everything is known in comparison: in the past, almost the only method of control available to women was artificial interruption of pregnancy. So, in the fifties and sixties of the last century, just before the appearance of contraceptive pills, up to 1.2 million illegal abortions per year were committed in the United States, from which 200-300 women died each year. Russia, unfortunately, is still in the top countries with the highest abortion rates in the world - and, of course, it is better to use reliable contraception with a number of side effects than to expose yourself to the risks associated with abortion.

According to Elena Gevorkova, a gynecologist and endocrinologist, the development of male contraception is also limited by the fact that, purely physically, men can either block the production of sperm cells or prevent their contact with the egg cell - these are the only options. In women, there are much more points of contraception: you can “stop” sperm at the level of the vagina (spermicides) or of the cervix (diaphragm), eliminate implantation (spiral), prevent passage through the tubes (intersection of the fallopian tubes), prevent the ovum from leaving the ovary (hormones - pills, patches, rings, injections, implants) or to solve the problem after the fact (emergency contraception). In principle, male contraception is being developed - for example, Vasalgel polymer gel, which is injected into the sperm ducts and blocks the release of sperm. This is a reversible method that does not require regular use, the effect of which is leveled with an additional injection. However, while the use of the drug is studied only in monkeys, so it will take a long time to wait.

Another reason why women often deliberately refuse to transfer birth control into the hands of men is the stereotypes of "unreliability" and "irresponsibility" of the latter, who, of course, "forget, do not follow, fail." It sounds like the old-fashioned view that raising children is a woman’s concern, isn't it? To this day, some women are convinced that the children cannot be trusted by the fathers, because they will do everything wrong. The question is whether the men are ready to go beyond the setting of "I am a man only as long as I am able to inseminate." So, progress is limited by prejudices on both sides.

According to recent surveys in the United States, the opinion that decisions about contraception are made jointly by partners is shared by 92% of men who have a long-term relationship. Men younger than fifty are more likely to take contraception on themselves than older men - 82% versus 69%. According to a UN report, in the United States in 2015, 10.8% of men who were married or in stable relationships made a vasectomy. In Canada, this figure is twice as high - 21.7%, about the same in the UK. At the same time, in front of the Russian Federation in this column is a sad zero: the number of men who have decided to do a vasectomy in our country is nothing more than a statistical error.

As Dr. Gevorkova says, among her patients who are in stable relationships, many discuss contraception with a partner - but in the overwhelming majority of cases it is the woman who offers the options, explains their essence, argues, and reflects the objections. At the same time in Russia, if we talk about Moscow, the issue of contraception and pregnancy planning is at a good level. The regions are much sadder, and the farther from Red Square, the more cases of early abortions, septic complications, infertility after abortion.

Women tired of the need to protect themselves more often than men resort to irreversible methods: according to the same UN report, in 2015, more than 19.2% of married women or women’s relations went for a sterilization operation around the world - and 2.4 % of men. In this case, the same vasectomy, albeit a radical procedure, but technically not the most difficult and takes about half an hour. In the same USA, half a million men make it every year; if desired, the patency of the ducts can be restored, that is, a vasectomy can be called a reversible procedure - although a different, more complicated operation will be required to restore it. Finally, the cost of such contraception beats less on the family budget: these are ten to fifteen thousand rubles one time - comparable to the fact that a woman spends on birth control pills for a year or two.

One of the reasons why women often refuse to hand over birth control into the hands of men is the stereotypes about the “unreliability” of the latter.

According to the expert, in her practice there are men who consider a vasectomy - but this is a great rarity. As a rule, these are men who already have children, at sexually active age, for diseases that increase the risk of having unhealthy children, when it is not possible to use female contraception. Increasingly, among young people there is a method of "separate protection" - when a man always uses condoms, and a woman - hormonal contraception, also always. This reduces the risk of both unwanted pregnancy and infection - and also shows that modern men are increasingly taking the issue of contraception seriously.

Weak awareness of contraception is fertile ground for a variety of myths and fears. Although in fairness it should be noted that the problem of lack of knowledge about various types of contraception applies to women. Of course, it leaves an imprint on both the low economic level, and the lack of education, and mentality. Dr. Gevorkova tells about what she faced while working in Armenia: a 28-year-old woman came to the reception, behind whom she had a dozen abortions at various dates. In response to a proposal of barrier protection, the doctor heard that "condoms are a shame for a real man." She offered pills and was confused - which pills? As a result, the patient asked to write the name of the drug and said that she would buy it to the whole village and distribute it to everyone.

Contraception is to make sure that there are no children after sex. On the one hand, relationships, family and children are a social concept, on the other hand, a phenomenon based on a powerful natural instinct, sexual desire. Today’s reality is a mix of biological, social, rational and emotional approaches to the issue of pregnancy planning. The emergence of hormonal contraceptives preceded the sexual revolution, gave women reproductive freedom, emancipation and access to completely new opportunities in education, career and social life. Half a century later, when gender relations in the working field and in family life are revised, when partners in modern families more or less equally distribute responsibilities for home and child-rearing, it is time to share this responsibility - and it does not have to be surgical.

Photo: Alexandr Mitiuc - stock.adobe.com, krasyuk - stock.adobe.com, michaklootwijk - stock.adobe.com