opinion | According to Roe v. calf required

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More than 40 percent of the 6 million annual pregnancies in the United States are unplanned, according to the latest available data, and about one in five pregnancies ends in abortion. With the Supreme Court’s decision in Roe v. Wade, and the resulting loss of access to safe abortion treatment for millions of Americans, it is more important than ever to prevent unplanned pregnancies. Using an effective method of birth control is the best way to do this.

As researchers developing male hormonal contraceptives, we believe men need to be more committed to contraception to reduce unplanned pregnancies and the need for an abortion. Men are involved in 100 percent of unwanted pregnancies, and most men remain fertile for much of their lives.

Male contraceptives have been used for hundreds of years. Condoms made from animal intestines were used in Renaissance Europe. Condoms are a useful tool to prevent pregnancy and sexually transmitted infections, although they have significant failure and abandonment rates over time. A lot of men and women just don’t like them. Vasectomies have long been performed in the US, but are not always reversible and therefore only appeal to men who have no interest in future fatherhood. Despite these disadvantages, condoms and vasectomy currently account for about 21 percent of monthly contraception in the United States.

While there are numerous female contraceptives available, including implants, pills, IUDs, and vaginal rings, a significant proportion of women do not have a method that they can use safely or without significant side effects. For example, the pill may not be recommended for women with a history of blood clots or women over 35 who smoke. Many women suffer from side effects of birth control, such as abnormal bleeding, weight gain, acne and low libido. In addition, access to contraception, even for these imperfect options, remains a challenge in many situations. Now that the ability to terminate an unplanned pregnancy will not be available to many, the United States needs innovative solutions to make a major impact on unplanned pregnancy rates, which have been relatively high despite the introduction of new women’s methods over the past two decades are stagnant. Novel contraceptives for men keep this promise.

Would men use birth control if there were more choices? Multinational survey data suggests that between 29 and 71 percent of men would use a male hormonal contraceptive. Recent market research by the Male Contraceptive Initiative shows that 82 percent of US men ages 18 to 44 whose partners have had a past pregnancy are interested in new methods of male contraception, with the majority saying they are feel they share responsibility for contraception with their partner. Importantly, one study found that just two percent of women surveyed said they wouldn’t trust their partners to use a male hormonal contraceptive. More work is needed to corroborate this survey data with real-world experiences from men and to educate men about contraceptive options.

Reversible male hormonal contraception has been tested for around 50 years. We know from our research and that of others that these methods work well for most men. Various injections and implants have been tested in over 2,000 couples worldwide and together have shown reversibility and around 95 percent effectiveness in preventing pregnancy, rates comparable to the pill for women and better than condoms.

The Eunice Kennedy Shriver National Institute of Child Health and Development and the Population Council, along with 15 centers around the world, including sites in the Americas, Europe and Africa, are currently conducting a study of over 400 couples using a hormonal contraceptive gel Apply to shoulders once a day for men for 18 to 24 months. As investigators involved in conducting this study, we know that men are interested and committed to using these methods. Our male participants often express a desire to continue using the method of contraception after the end of the study period, and their partners are often disappointed to return to their previous methods.

Non-hormonal male contraceptives are less well developed, but show promise in laboratory tests. A prototype “reversible vasectomy” is being tested in countries like India and the United States. It includes an injected gel that forms a plug to prevent the passage of sperm; The connector may break or deteriorate to allow reversal. In the longer term, scientists are working to develop molecules that prevent sperm from swimming or from maturing; However, those “second generation” male contraceptives are likely more than a decade away.

As clinicians and developers, we are constantly asked about side effects. A minority of men who try male hormonal birth control pills experience side effects that some women who have used hormonal birth control pills are familiar with (eg, weight gain, acne, and increase or decrease in libido). Nonetheless, men say they are willing to share the burden of side effects with women, and the concept of ‘shared risk’ has been proposed to reformulate risk analysis in this situation. In this paradigm, men accept the risk of side effects from contraceptive use in order to protect their partners from the risk of adverse effects from their contraceptive or an unwanted pregnancy. With a number of states now further restricting access to safe abortions, the risk of unplanned pregnancy has risen sharply for many women, reinforcing the need to consider shared risk within a couple when evaluating potential contraceptive side effects.

As developers of male contraceptives, we are asked the most frequently: What is taking so long? Investment in male contraceptive development has declined compared to previous decades when large pharmaceutical companies and NGOs were investors. Today, the National Institutes of Child Health and Development and science provide the vast majority of funding for male contraceptive development. A lack of funding slows progress in both the innovation and clinical testing phases.

Why the loss of commitment? It is possible that the novelty of male contraception will be viewed as too risky for profit and that the market for a pharmaceutical holding is underestimated. Additionally, developers suffer from a lack of regulatory guidance from the Food and Drug Administration on how effective these products need to be to go to market. Consensus recommendations from the research community have been published proposing metrics for evaluating novel male hormonal contraceptives and establishing levels of effectiveness and safety, but whether these will be adopted by regulatory agencies is unknown. Greater advocacy is needed to move the field forward and convince funders and the pharmaceutical industry that there is a demand for this technology.

We do not develop male contraceptives to replace female contraceptives. Access to contraception and safe abortion are basic human rights for all people and a necessary part of public health. However, many men want to share the burden of birth control with their partners; others want their own reproductive autonomy. Men are ready, but their birth control options are sparse. Education will be important when products come to market.

Now that the US Supreme Court has issued a decision that will severely limit people’s choices when it comes to having an unplanned pregnancy – a decision that will have a disproportionate impact on poor women – we need more than ever to accelerate the development of male birth control options . Lives are at stake.

Stephanie Page and John Amory are medical professors at the University of Washington School of Medicine, where they develop hormonal and non-hormonal male contraceptives.

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