Towards shared responsibility for family planning

Fifty-seven years ago the drug Enovid was approved for use as a female contraceptive in the USA, and most other developed nations quickly introduced similar formulations. Although this method of contraception has had enormous social impacts, allowing modern women greater access to higher education and remunerative employment, it has largely shifted the previously shared responsibility for family planning to women. Globally female hormonal methods and female sterilization are the most frequent family planning strategies adopted, and women now bear most of the financial and health-related burdens of contraception. But have the many studies over half a century linked use of ‘the pill’ and female sterilization with adverse health effects?
It has been clearly demonstrated that hormonal contraceptives have an impact on periodontal health: there is a significant increase in the prevalence of severe periodontitis and sub-gingival Candida infections in pill users. And women perceived as high risk for cardiovascular disease or breast cancer have been advised to use another form of contraception. However, although there is a plethora of anecdotal evidence concerning the pill’s association with depression and reduced libido, studies did not adequately address this problem until a nationwide prospective cohort study of over a million women living in Denmark was carried out. Recently published results reported that use of hormonal contraception was associated with a first diagnosis of depression and antidepressant use, particularly amongst very young women.
Although sterilization is applicable to both genders, globally over 80% of such procedures are carried out on women. Yet male vasectomy is simple and straightforward and, according to the UK National Health Service, is 20 times less likely to have postoperative complications and 30 times less likely to fail than the more invasive female tubal occlusion. However, in EU countries where vasectomy had become a common family planning choice, the number of couples now relying on this method has decreased in recent years. The reason could well be that as relationship break-ups become more common, men realize that a potential new partner may want children – vasectomy reversal is technically challenging and usually unsuccessful – whereas sterilized women are normally content with the family they have.
A technical solution is on the horizon, however, namely Vasalgel. This non-hormonal polymer blocks sperm flow when injected into the vas deferens, and can be flushed out again if desired. A recent trial with male rhesus monkeys demonstrated its safety and efficacy, and clinical trials have now begun. But its success depends on family planning once again becoming a shared responsibility.