Why power dynamics and societal taboo might dictate the availability of male contraceptive pills

In 2019, the Indian Council of Medical Research announced successful clinical trials of the world’s first injectable male contraceptive in the country. Four years and a pandemic later, why are we still awaiting its availability?

In 2019, the Indian Council of Medical Research (ICMR) had announced successful clinical trials of the world’s first injectable male contraceptive in the country, which was then sent to the Drug Controller General of India (DCGI) for approval by the researchers working on the project.

These injections were reported to be effective for 13 years, following which they would lose potency, according to a Hindustan Timesreport. Four years and a pandemic later, the country is still waiting for the magic panacea one hopes will relieve cis-women from bearing the major brunt of contraception in a society where condoms are still the most commonly used male contraceptives

“My partner and I keep reading reports of this male contraceptive pill every now and then. I think it was last year when I again read about a non-hormonal pill being made for men, but I doubt anything concrete has happened on that front,” says 28-year-old Tanuj (name changed on request), a Hyderabad-based psychologist. Tanuj is referring to the scientific formulation titled “GPHR-529” or “YCT529” developed by Md. Abdullah al Noman, PhD candidate at the University of Minessota, and Gunda Georg, Director of the Institute of Therapeutics and Discovery, who, in 2022, claimed that their compound successfully induced sterility in mice with no adverse effects. Four weeks after the mice were weaned off the drug, their fertility and sterility resumed normal levels, enabling them to reproduce again.

“I think a big part of why people, especially men, are still skeptical about even considering such a contraceptive is because they are afraid they’ll lose their fertility,” says Tanuj. Literature around such research is also scanty at present. “You see, men have always been the conventional decision-makers in our homes, so they always put the onus of contraception on the women, because with women, one only needs to stop that one egg every month from fertilising in order to avoid pregnancy. But men can produce up to 200 million sperms each day, and it’s a daunting task to stop all 200 million, because it takes only one to cause pregnancy,” says Mumbai-based Dr. Ishwar Gilada, President-Emeritus of the AIDS Society of India, and Governing Council Member, International AIDS Society, Geneva. According to Gilada, the emphasis should be on formulating male contraception with reversible effects in order to make them more widely acceptable. “But that will take time to research,” he says.

Gilada, who was one of the pioneers in raising awareness about AIDS in India back in 1985, started the country's first AIDS clinic, the Unison Medicare and Research Centre, at the government-run J.J. Hospital in Mumbai the following year. He recalls the initial ordeal of spreading awareness about the benefits of using condoms. "We told people and sex workers how condoms can save lives by not only preventing unwanted pregnancies, but only that one small object can even prevent life-threatening STDs. This was in the '80s and '90s, after which conversations on other male contraceptives just stopped. It ended with condoms," he says.

The science behind male contraception

At present, the two most popular methods of contraception for cis-men are condoms and vasectomy, of which the latter, according to Gilada, is still less favoured than a tubectomy or tubal sterilisation, which is a permanent method of contraception for women. While in theory, both tubectomy and vasectomy are reversible, in practice, not all of them are successful, especially when carried out after a significant amount of time has elapsed since the procedure was performed. “This has led men to assume that a vasectomy will take away their ‘manhood’,” says Dr. Amal Cruz, who is currently based in London, and is associated with the Basildon and Thurrock University Hospital, Essex. “Indian men never consider contraceptives because firstly, they are unaware, and secondly, it’s still considered taboo for them to use contraception, which means the demand for a male contraceptive pill is way too less. This makes their production less viable,” she says.

So what actually goes into the making of these formulations? The answer to that lies, of course, in the male anatomy and their endocrinology, or the study of hormones. The pituitary glands are responsible for the production and termination of said hormones, or gonadotropins (GnRH), which release the sex hormones testosterone, estrogen and progesterone. “The GnRH regulates the Luteinizing hormone (LH) and Follicle Stimulating Hormone (FSH) (stimulating follicular growth and ovulation), which determine spermatogenesis in the male body, and egg production in the female body. These hormones are present in both male and female bodies, but their functions differ. So we need to control those hormones or, alternatively, control the vas deferens (or sperm duct), which transports semen from the testicles to the penis during ejaculation,” says Gilada, who adds that the option of blocking the vas deferens with an “intra-vas deferens device (IVD),” or the counterpart of the “intrauterine device (IUD)” for women should be made available.

There’s also research being carried out for testosterone injectables, which prevent the release of the pituitary hormone to prevent spermatogenesis. “There are hormonal contraceptive gels as well, like a combination of nestorone—which is a female equivalent of progesterone—and testosterone, but everything is still largely being researched because we live in a male-dominated society even today,” mentions Gilada.

And the proof for that lies in the pudding. There is a battery of options for female contraception, far outnumbering those for men. From short-acting hormonal measures like the pill, mini-pill, patch, shot, and vaginal rings that prevent your ovaries from releasing eggs or block sperm from reaching the egg, to barrier methods like diaphragms, sponges and cervical caps prevent sperm from getting to the egg. Besides, IUDs, contraceptive implants, tubectomy and contraceptive injections exist too.

“It’s ridiculous, because it’s almost as if I, being a woman, am the only one responsible for not getting pregnant,” says Mohini Mandal (name changed on request), a 53-year-old homemaker living in Siliguri. Mandal separated from her husband five years ago, when he refused to get a vasectomy after she suffered adverse reaction from long-term usage of birth control pills.

The social cost of a lack of male contraceptives

When Mandal walked out of her 15-year-long marriage, she did so over a breach of trust she faced at the hands of her partner of 20 years. It baffled her when she realised that her husband perhaps did not care for her physical and emotional wellbeing over his perceived notions of sexual pleasure and “manhood,” corroborating what Cruz says on the subject. “I developed a latex allergy some years ago, which meant that the widely available condoms—mostly made of latex—stopped being an option for me. We already have a 13-year-old son and do not wish to have another child, so I could not understand why a vasectomy was a problem. He insisted I either continue to let him use condoms, or the pull-out method, which I do not trust at all, or that I get a tubectomy, and that was out of the question because I was already quite unwell from the side-effects of using the birth control pill. The morning-after pill was also a no-no for me, the doctor had said,” she says.

Mandal’s husband was against seeking medical counsel either, and, evidently, he is not alone in this regard. According to Cruz, she has “not met a single male patient asking about male contraception so far,” and this can only be attributed to a glaring lack of sensitivity and knowledge towards the subject of sexual health, or even gender equality. “As a cis-man, I am ashamed to admit that most men around me still look at women’s bodies as more dispensable than their own. They believe it’s a woman’s duty to carry a child, which is why abortion is still so taboo,” says Tanuj. “Our societies, especially Indian societies, are designed in ways that encourage women to still be domesticated, raise children, and not attend to their own needs. A lack of options for male contraception or safe abortions are only more ways for men to control women’s bodies,” he adds. 

But all hope is not lost, Gilada says, as the tides are turning, no matter how slowly. “These days, whenever I visit medical colleges, I can see more and more women getting into the field. Sometimes, there are classrooms with 60 per cent women [students], so I am expecting research, too, to start reflecting this change,” he says. So until then, one can certainly “hope for our men to at least try and be more sensitive,” as Tanuj says.

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