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Why contraception is considered an exclusively female concern

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

Serious battles unfolded at the table that evening. To my reasonable question why vasectomy is so unpopular in our country – the overwhelming majority of men do not consider it at all – the male part of the family came into undisguised excitement. Grandpa was seething and asked how I can offer all men to remain crippled. The husband tried diplomatically to evade the answer: “Do I want more children? No. Am I going to have children with other women? No. Am I ready to consider a vasectomy? No”. And this is a modern man who was present at childbirth three times and is almost more involved in the process of raising our children than I am.

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

Since there is practically no request from men to participate in birth control, few methods of contraception are available for them. There are more than a dozen ways to prevent unwanted pregnancy for women (and hundreds of specific drugs), and only two – condoms and vasectomy (bandaging or removal of a fragment of the vas deferens) – for men. And yet, there are shifts, developments are underway to create oral and injectable hormonal contraceptives for men. So far, all of these drugs have an impressive list of side effects – and their long-term safety has not been studied. “The risks outweigh the potential benefits of the application” – this streamlined formulation of pharmacologists does not bode well for obvious progress in the matter in the near future. 

There are more than a dozen ways to prevent unwanted pregnancies 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: breast pain, irregular uterine bleeding, bleeding from the genital tract of unspecified origin, arterial and venous thromboembolism, depression, drowsiness, decreased libido, nausea, vomiting, dyspepsia, varicose veins veins, weight gain and more.

We are not talking about drugs in the development process, but about contraceptives, which are used by hundreds of millions of women. However, reproductive freedom – the ability to choose when and from whom to have children – turns out to be more important than potential risks. And of course, everything is learned by comparison: in the past, almost the only control method available to women was artificial termination of pregnancy. So, in the fifties and sixties of the last century, just before the advent of contraceptive pills, in the United States there were up to 1.2 million illegal abortions per year, from which 200-300 women died annually. Russia, unfortunately, is still in the top of the countries with the highest abortion rates in the world to this day – and it is certainly better to use reliable contraception with a number of side effects than to expose yourself to the risks associated with abortion.  

According to the gynecologist-endocrinologist Elena Gevorkova, the development of male contraception is also limited by the fact that, purely physically, men can either block sperm production or prevent their contact with the egg – these are the only options. In women, there are many more points of application of contraception: you can “stop” sperm at the level of the vagina (spermicides) or cervix (diaphragm), exclude implantation (spiral), prevent passage through the tubes (intersection of the fallopian tubes), prevent the egg from leaving the ovary (hormones – pills, patches, rings, injections, implants) or resolve the issue 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 semen. This is a reversible method that does not require regular use, the effect of which is leveled by an additional injection. However, so far the use of the drug has been studied only in monkeys, so it will take a long time to wait.  

Another reason why women often deliberately refuse to hand over birth control to men is stereotypes about the “unreliability” and “irresponsibility” of the latter, who, of course, “will forget, will not follow, and will fail”. Sounds like the old-fashioned notion that raising children is a woman’s job, doesn’t it? Some women to this day are confident that children cannot be trusted by dads, because they will do everything wrong. The question is whether men are ready to go beyond the “I am a man only as long as I am able to inseminate” attitude. Thus, progress is constrained by prejudice on both sides. 

According to recent polls in the United States, 92% of men in long-term relationships share the opinion that contraception decisions are made jointly by partners. Men under 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 in a married or stable relationship had a vasectomy. In Canada, this figure is twice as high – 21.7%, about the same in the UK. At the same time, opposite the Russian Federation in this column there is a mournful zero: the number of men who have decided to have a vasectomy in our country is nothing more than a statistical error.   

According to Dr. Gevorkova, among her patients in stable relationships, many discuss contraception with a partner – but in the overwhelming majority of cases, it is the woman who offers options, explains their essence, argues, reflects 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 termination of pregnancy.

Women who are tired of the need to protect themselves are more likely than men to resort to irreversible methods: according to the same report from the ONU, in 2015, more than 19.2% of married or relationship women worldwide underwent a sterilization operation – and 2.4 percent had a vasectomy. % of men. At the same time, the same vasectomy, albeit a radical procedure, is 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 recovery will require a different, more complex operation. Finally, the cost of such contraception is less costly for the family budget: it is ten to fifteen thousand rubles once – comparable to what a woman spends on contraceptive pills in a year or two.    

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

According to the specialist, in her practice there are men who are considering a vasectomy – but this is very rare. As a rule, these are men who already have children, at a sexually active age, with 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 contraception” – when a man always uses condoms, and a woman always uses hormonal contraception. This reduces the risk of both unwanted pregnancy and infection – and also shows that modern men are increasingly taking the issue of contraception seriously.

Poor 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, the low economic level, the lack of education, and the mentality leave their mark. Dr. Gevorkova tells what she faced while working in Armenia: a 28-year-old woman came to the appointment, behind whom she had a dozen abortions at different times. In response to the offer of barrier protection, the doctor heard that “condoms are a shame for a real man.” She offered pills and faced a misunderstanding – which pills? As a result, the patient asked to write the name of the drug and said that she would buy it for 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, a phenomenon based on a powerful natural instinct, sexual desire. Today’s realities are a mix of biological, social, rational and emotional approaches to the issue of pregnancy planning. The advent of hormonal contraceptives heralded the sexual revolution, gave women reproductive freedom, emancipation and access to entirely new opportunities in education, career and social life. Half a century later, when gender relations in the working field and in family life have been revised, when in modern families partners more or less equally share responsibilities for the home and raising children, it is time to share this responsibility – and it does not have to be surgical.  

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