The Death of Birth — Our Dismal Fertility Rates

This last week has seen a plethora of news about male birth control (MBC). A hormonal contraceptive, composed of testosterone and progestin — a synthetic form of progesterone, was reported in the Journal of Clinical Endocrinology & Metabolism. The pill, taken once a day, reportedly has a 98% efficacy, the same as female birth control pills. In addition, the effect is easily reversed.There is little certainty regarding possible side effects, due to a lack of long term studies. Early results, however, indicate that they may be minor (weight gain, for instance). An injectable form may be available in the US next year.Regarding its reliability, the article’s lead author, Peter Y. Liu, associate professor at the University of Sydney, states “The rate of suppression is comparable to that achieved after a vasectomy.”

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Fertility rates began a dramatic collapse following the development of female hormonal birth control. The average number of births per woman in many countries reached a peak in the late 1950s, just before the release of “the pill,” which was approved by the US Food and Drug Administration in 1960 and first entered the market as “Enovid” in August of that year. Further developments have included patches, implants, and injections. With development of safer, less expensive, and increasingly accepted abortion, women’s control over fertility became paramount.

A new player, however, may soon enter the field.

Male birth control has been relatively difficult to develop, and many have questioned men’s willingness to help shoulder the burden. Recent surveys, however, indicate that numerous men are more than willing to share this responsibility. Many are also quite concerned over becoming fathers when they don’t want to. According to Dr. Bill Bremner, chair and director, respectively, of the University of Washington Department of Medicine and the Male Contraception Research Center, “up to 80 percent of men surveyed worldwide claimed they would use a new male contraceptive.”

On September 27 and 28, 2007, Seattle, Washington, hosted the “Future of Male Contraception” conference. Sponsors of the gathering included the National Institute of Child Health and Human Development; the National Institutes of Health, DHHS; the University of Washington, Seattle; CONRAD; and the World Health Organization. One message in particular underlay talks on this developing bio-technology — male birth control, beyond condoms and vasectomies, may soon be widely available.

Women have gained far greater control over their lives through the use of birth control; men may soon enjoy a similar increase in control over their own lives. The National Marriage Project, based at the State University of New Jersey, Rutgers, has for years released annual reports, “The State of Our Unions.” In their 2002 publication, “Why Men Won’t Commit,” the authors told of many men choosing never to marry. Among the most common reasons for avoiding marriage was that “They want to avoid divorce and its financial risks.” To this might well be added a decision to forego fatherhood in order to avoid losing contact with children after the breakdown of a relationship with a woman. Many a man has come to fear that if things go bad with his children’s mother, the mother may prevent contact between him and his children. While men must pay child support (really household support) under penalty of imprisonment, women who deny contact between fathers and their children often face no consequences.

When male birth control becomes available, and especially after it has had time for bugs to be worked out, it’s likely that many men will avail themselves of the opportunity to have sex while avoiding the possible, devastating loss of contact with children whom they otherwise would have sired.

In any case, the whole purpose of birth control is to reduce the number of children. It will be interesting to see if male birth control has an impact on total fertility rates comparable to that of female birth control. A negligible effect is unlikely.

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