Vasectomy rates suggest it’s not likely that men would take a birth control pill

After decades of research and numerous failures, there is a new hope for a male oral contraceptive. A non-hormonal pill tested in mice was 99% effective in preventing pregnancies, and is expected to start a human trial by the end of the year. The pill won’t be available for human use for years, but it revives hopes of a better balance in sharing the contraceptive burden.

Only a couple of years ago, a likely effective hormonal contraception pill was found to have side effects that men found excessive, although they didn’t seem dissimilar from those currently associated with female hormonal contraception — including weight gain, depression, and lower sexual desire.

The new pill is expected to have fewer side effects, but it still presents a fundamental issue with male birth control: Men might not take the pill regularly, because they aren’t as invested as women in contraception.

Vasectomies are underused

One indication of the reluctance among men to take on primary responsibility for contraception is the unpopularity of vasectomies compared to tubal ligations.

At the moment, when it comes to male contraception, the only alternative to condoms are vasectomies, a quick (half hour or less) procedure that prevents sperm from traveling into the ejaculate. The procedure is safe, doesn’t need anesthesia, and doesn’t in any way alter sex or other functions of the male genitalia.

Vasectomies don’t lead to sterility or changes in ejaculation (other than the lack of sperm), and can often be reversed. They are also far less invasive than tubal ligation for women, which is a surgery and and more difficult to reverse — yet women tend to get tubal ligations more often than men get vasectomies. In the US, only about 9% of sexually active men have vasectomies, compared to 27% of women who get tubal ligations — and the rates of vasectomies are declining.

Although vasectomies are more common than female sterilization in some countries — including Canada, the UK, and South Korea — global trends show they are typically pretty rare. In poor countries, in particular, the uptake of vasectomies is low; often less than 1% of men have them.

What the statistics on vasectomies portend for a male birth control pill

Some of the reasons men cite for not wanting vasectomies include the fact that it is considered permanent, thought the procedure is potentially reversible. But others are related to myths connected to it, and might reflect down the line on how likely men are to take a birth control pill: the idea that it might in some form reduce a man’s virility, that it will stop ejaculation, or even the discomfort at the very thought of it.

This is reflected in healthcare approaches to contraception, too. Since pregnancy is considered a woman’s issue, for instance, the Affordable Care Act in the US does not include vasectomies among the contraceptive methods that insurance must cover.

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