Without financial investments from the pharmaceutical industry, many experts believe it is unlikely that a novel, male contraceptive will be brought to market. If one has an economists' faith that the market will never leave big bills on the sidewalk, the absence of significant private pharmaceutical investment in male contraceptives is ipso-facto evidence that this market has been judged to be unprofitable. However, there are new social developments that might contribute to a rosier future for male contraceptives.
Unwanted fertility is in transitioning from being primarily a couples' concern to a singles' concern, which bodes well for male contraceptives. Our examination of national data on patterns of sexual behavior suggests that over 9% of men in the USA are never married but have fathered children, an unknown fraction of which started as unintended pregnancies. A drug company that used a more effective contraceptive to compete against the condom could charge US$480 per year for every 1% reduction in pregnancy risk. With today's genotyping methods for establishing paternity and the legal requirement that fathers pay child support, it is possible that men will demand more choices in contraception. Indeed, men in the WHO 12-year follow-up study indicated interest in relying on themselves to ensure they did not unwillingly or unknowingly impregnate a partner. Overtime, men may come to view having control over their own fertility to be a right just as women have done.
A male contraceptive should appeal not only to single males but also to couples in stable relationships. A small survey of 47 couples showed modest support for the idea that egalitarian sex-role preferences are related to a belief that contraception is a shared responsibility. Analysis of the 1991 National Survey of Men indicates that 78% of men surveyed believe that men and women should share equal responsibility for decisions about contraception. In a stable relationship where trust is established, a male method would enable couples greater freedom and flexibility in their reproductive choices. Furthermore, if side effects are considered as something to be shared between partners, male methods would offer couples a 'gallantry option' by shifting a portfolio of tolerable side effects from contraception from females to males, thus halving the overall burden to each partner.
If a new male contraceptive could be marketed for dual purposes, for beneficial side effects, it could enjoy better user adherence and acceptability. Though not engineered or necessarily taken for its side effects, female oral contraception reduces the risk of endometrial and ovarian cancer. While no such formulation has yet emerged for the male, a male contraceptive that conferred an added benefit to the user might have much more success in attracting investment from pharmaceutical companies because of its higher potential revenue.
The authors are grateful for helpful comments by Barry Zirkin.
Expert Rev Pharmacoeconomics Outcomes Res. 2012;12(5):605-613. © 2012 Expert Reviews Ltd.