Whither methods for men? Emerging gender issues in contraception

Reproductive Health Matters

Volumn 4, Issue 7, 1996, Pages 79-89

  Ringheim, Karin ^a  

^a NONE

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EID: 10644272617     PISSN: 09688080     EISSN: None     Source Type: Journal    
DOI: 10.1016/S0968-8080(96)90008-7     Document Type: Article

References (17)

1. The most recent UN statistics (1994) indicate that globally, 57 per cent of 899 million couples of reproductive age are using a contraceptive method. Methods for men account for 31 per cent of current contraceptive use worldwide. Britain is one of only two countries (with the Netherlands) in which the percentage of sterilised men is equivalent to that of women.
2. Huezo C and Malhotra U, 1993. Choice and Use-Continuation of Methods of Contraception, A Multi-Centre Study. International Planned Parenthood Federation, London. From 35 to 76 per cent of method use discontinuation in Guatemala, Kenya, Trinidad and Tobago, Nepal and Jordan was due to side effects. Only in Hong Kong was this substantially lower, 16 per cent of total discontinuation. Clinic waiting times were longest in Kenya and Nepal, where a quarter of women spent four or more hours in the clinic. Kenyan, Nepalese and Guatemalan women had the longest journeys to the clinic; more than a quarter travelled one and two hours.
3. Demographic and Health Survey data from country studies (1987-1995) published by Macro International Inc, Calverton MD, US. In the 11 countries for which this data is available, 30-61 per cent of pill discontinuation and 34-81 per cent of IUD discontinuation in the first year of use was attributed to side effects. This represents the most frequently given reason for stopping use of the method.
4. Matlin SA, 1994. Prospects for pharmacological male contraception. Drug. 48(6): 851-63.
5. Handelsman D, 1991. Bridging the gender gap in contraception: another hurdle cleared. Medical Journal of Australia. 154:230-33.
6. Waites GMH, 1993. Male fertility regulation: the challenges for the year 2000. British Medical Journal. 49(1):210-21.
7. World Health Organization Task Force on Methods for the Regulation of Male Fertility, 1996. Contraceptive efficacy of testosterone induced azoospermia or oligozoospermia in normal men. Fertility and Sterility. 65:821-29.
8. Annual Technical Report. Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, 1992.
9. World Health Organization Task Force on Methods for the Regulation of Male Fertility, 1990. Contraceptive efficacy of testosterone-induced azoospermia in normal men. Lancet. 2:955-59.
10. Testosterone enanthate (TE) was the prototype used in WHO clinical trials. When used alone, a relatively high dosage is required to induce and maintain subfertility. Because the blood level of testosterone is then raised above normal levels, the likelihood of adverse effects is increased. Future clinical trials will use a longer-acting androgen or combine hormones to shorten the time to infertility, and decrease the frequency of injections to 1-3 months. It is expected that new formulations will maintain androgen levels within the normal physiological range, reducing the risk of side effects. The role that prototype drugs play in research is frequently misunderstood, as evidenced by a recent article by Bonn D, 1996. What prospects for hormonal contraception for men? Lancet. 347:316. For a response by the WHO, see Griffin PD, 1996. Hormonal contraception for men. Lancet. 347:830-31.
11. Testosterone enanthate (TE) was the prototype used in WHO clinical trials. When used alone, a relatively high dosage is required to induce and maintain subfertility. Because the blood level of testosterone is then raised above normal levels, the likelihood of adverse effects is increased. Future clinical trials will use a longer-acting androgen or combine hormones to shorten the time to infertility, and decrease the frequency of injections to 1-3 months. It is expected that new formulations will maintain androgen levels within the normal physiological range, reducing the risk of side effects. The role that prototype drugs play in research is frequently misunderstood, as evidenced by a recent article by Bonn D, 1996. What prospects for hormonal contraception for men? Lancet. 347:316. For a response by the WHO, see Griffin PD, 1996. Hormonal contraception for men. Lancet. 347:830-31.
12. Rogers EM and Shoemaker F, 1971. Communication of Innovations: A Cross-Cultural Approach. Free Press, New York.
13. Creating Common Ground in Asia: Women's Perspectives on the Selection and Introduction of Fertility Regulation Technologies. Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, 1994.
14. A 12-month follow-up survey of participants in the oligozoospermia trial, ([7] above) World Health Organization, 1994-6. (Unpublished).
15. Ringheim K, 1995. Evidence for the acceptability of a hormonal method for men. International Family Planning Perspectives. 21(2):75-80.
16. The focus on gender issues in this paper should not minimalise the fact that adverse effects were experienced by a few participants. Interviewees included the two couples who left the trial due to adverse side effects. From a scientific standpoint without a control or comparison group, few conclusions can be drawn from this contraceptive efficacy trial about whether perceived effects, positive or negative, are attributable to the androgen or other factors. Attention to the experience of those who leave a trial may be as important as that of ongoing participants for developing a safe, effective method for men.
17. Plan of Action, International Conference on Population and Development, Cairo 1994. United Nations, 1995.