Op-Ed: Reproductive inequality: a history continued

Disclaimer: For the purposes of this article, I will be referring to the new contraceptive shot, as well as a previously tested contraceptive gel as “male” contraceptive options, though its users could be of any gender identity and expression. Similarly, I will refer to existing hormonal birth control options as “female” contraceptive pills, though the same applies. The term “male contraceptive” is most commonly used in clinical trials and is used in this piece to remain consistent with the language of those trials.

 

Imagine: You are 16 years old and entering a doctor’s office. You are told that you’re about to be given a medication; this medication is useful, as it greatly minimizes the likelihood of pregnancy, but abstaining from using it would not lead to any immediate harm. The only catch is that using this medication could cause mild to severe changes to body weight, skin, hair and mood, even resulting in increased risks for clinical depression. In some cases, the medication could create a greater risk for blood clots, stroke or breast cancer. Your doctor tells you that because of the benefits of this medication, the likelihood of a “lesser” side effect is inconsequential and simply “comes with the territory.”

“The pill” has a nuanced and oftentimes paradoxical history, much like the reproductive rights movement itself. Though both ideologically and materially liberating since its first commercial introduction in 1960, the contraceptive pill has had many enduring consequences related to access as well as effects. Though not available to unmarried people in all states until 1972, “the pill” was devised and tested in multiple iterations as early as 1950, beginning with a fertility study funded by Gregory Pincus and John Rock.

Unlike the subjects of today’s trials, Pincus’ and Rock’s first participants were unaware that the substance they were ingesting was intended to prevent pregnancy by way of hormonal manipulation, and many dropped out in droves due to side effects much like those still caused by oral contraceptives.

Later on, Pincus and Rock moved their trials outside of the continental United States, announcing their study of a contraceptive option to uninformed, impoverished Puerto Rican women, who first signed up to participate in droves, but often dropped out of the study due to extreme side effects.In these trials, roughly 17 percent of women experienced nausea, vomiting, stomach pain and headaches. While the doctor in charge of the trials declared that the pill had "too many side reactions to be generally acceptable," this did not stop G.D. Searle & Co. from releasing the first version of the pill, Enovid, in the same formulation. Accordingly, each iteration of the contraceptive pill, as well as other hormonal options such as the contraceptive ring, patch, shot and implant, have grown less potent over time, and with very good reason. The first releases of the contraceptive pill contained more than three times the amount of progestin and estrogen than many of the pills offered today. Yet somehow, very much unlike a recently tested male contraceptive option, these products were released. Call it added caution in federal regulation or call it scientific progress; maybe, just call it sexism.

I find it hard to imagine that any other medication could last on shelves for a year — much less five decades — if a major portion of its users experience some form of negative side effect, and if of those users, some women experience more severe side effects, such as the fatal deep vein thrombosis (DVT) or increased risks for various cancers. Worse still, more common side effects of hormonal contraceptives are frequently dismissed due to stereotypes regarding female tolerance of pain. Often cited research by Diane Hoffmann and Anita Tarzian in the Journal of Law, Medicine & Ethics found that medical professionals are more likely to tell women that their symptoms are psychosomatic, whether or not emotional factors are in fact the cause of their pain. Similarly, a 2008 study published in Academic Emergency Medicine, designed to gauge gender disparities among emergency room patients, found that even after adjusting for race, class and triage assessment, women were still 13 to 25 percent less likely than men to receive high-strength opioid pain medication. Those who did get opioid pain relievers waited an average of 16 minutes longer to receive them. Simply put, not only are women experiencing higher rates of side effects from contraceptive medication than would be found in many other medication types, but they are also less likely to be trusted when pain emerges from any medication or condition, resulting in a horrible potential for miscommunication between patients and their doctors, as well as delayed responses to potentially hazardous conditions.

The options for male contraception currently in review are not only effective, but have been found to be more effective than traditional contraceptive pills, with a failure rate of about 7.5 percent. By contrast, The U.S. Centers for Disease Control and Prevention reports that male condoms have an average failure rate of 18 percent, and that in women, birth control pills, patches and rings have a failure rate of roughly nine percent. With this in mind, the products currently under review have lower failure rates than nearly all available contraceptives today, with the exception of female implants and intrauterine devices (IUDs) with a failure rate of around one percent, as well as sterilization surgeries in both men and women. Yet, despite this evident success, due to reports of side effects almost identical to those experienced every day by women, the process of releasing these products has been halted.Just 20 of the 320 men (roughly six percent) found the side effects of the injection intolerable, and as such, it was decided that more research needed to be done to try and counteract these effects.

While one could easily argue that the hesitation to release a male birth control option is largely the result of increased medical standards, it is also important to note the implications of this caution. Who is the Food and Drug Administration, or further, the medical community at large, truly concerned about? In the advent of a Trump presidency, it is without doubt that access to reproductive healthcare will be threatened. Without pushback from the federal government — which appears highly unlikely due to a Republican-dominated House, Senate and executive branch — states hostile to reproductive healthcare will slash funding to clinics like Planned Parenthood and challenge state-owned insurance programs established under the Affordable Care Act; they could also reinstate “religious freedom” exemptions, allowing employers to deny birth control access under company healthcare policy. Even more frightening, some of these “religious freedoms” could grant employers the ability to challenge employees’ access to contraception — particularly emergency contraception or IUDs — altogether.

Historically, the weight of contraceptive side effects has fallen most heavily upon society’s least powerful, which is ironic given that these communities often have the most difficult time obtaining affordable contraceptive options. Women of color, native women and the incarcerated have endured decades of forced sterilizations, while disabled women and the mentally ill have been compelled to enter medical trials. Transgender women and gender non-conforming individuals are often harassed or denied coverage at hospitals; transgender men experience similar harassment, or are denied basic prenatal care due to appearance. In Trump’s America, millions of individuals, with the exception of the cis-gender men new contraceptive options are geared towards, will have to fight diligently to protect their reproductive rights, much less access to affordable contraceptive options. As it stands, all women face the difficult choice of withstanding various side effects for the sake of reproductive health for themselves, as well as for their partners. If this is the case, it seems only reasonable that men must be expected to do the same.