Emily Dorman; David Bishai

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2012;12(5):605-613. 

In This Article

Market Size for Male Contraception

Doubt over the existence of sufficient demand for male contraception has been expressed in a number of ways. First, given the variety of products already on the market, there is skepticism regarding whether additional methods are needed. Another argument is that men would not be willing to use novel male methods, nor that women would trust men to use contraception. Current usage patterns of contraceptives, however, indicate that dissatisfaction with current methods is high and that men all over the world are involved in family planning practices. Furthermore, a great deal of research has been carried out on male and female attitudes towards male contraception. The results of these studies indicate a healthy interest in male methods from both men and women even given regional variations in attitudes[17,29,33–35] Finally, the financial responsibility of child support required for men in certain countries provides an incentive for men in casual sexual relationships to take control of their own fertility.

The worldwide, unmet need for contraception has been estimated to be between 137 and 200 million women[36] and need is as high as 40% in certain African countries.[37] Data from the 2002 National Survey of Family Growth indicated that 25% of American women discontinue using their method of birth control within the first year. Importantly, the highest discontinuation rates were those for male methods: 57% discontinued using condoms and 54% discontinued using withdrawal within the first year.[38] These data indicate that there is plenty of room for improvement and innovation in current contraceptive methods, especially for couples that choose male methods.

The belief that women have always been the ones responsible for contraception is flawed. Until the advent of the oral contraceptive pill in the late 1950s, the only contraceptive options available were vasectomy, condoms, periodic abstinence and withdrawal, all of which are male-oriented methods.[7] Male participation in contraception played a large role in the demographic transition from high to low fertility in many countries.[17] Even now, in an era where women have many more options for fertility control than men, male-reliant contraception is used by 150 million couples, over a quarter of the couples using contraception.[39]

The sexual revolution that started after improvements in female contraception has also shifted the economic prospects for male contraception. Currently, 40% of births in the USA are nonmarital births.[40] These births have always had and continue to have economic consequences for single women. In bygone days, single men could easily dodge these costs. However, owing to rising rates of paternity establishment, nonmarital births can also impose high costs on men, often without the accompanying rewards of involved fatherhood. In 2000, the Offices of Child Support Enforcement established 1,555,581 paternities.[41] In 2010, after a steady annual increase, the number of established paternities reached 1.7 million.[42]

While established couples are able to make cooperative contraceptive choices and plan families, single men who want to have casual sexual relationships, where there is less trust and cooperation, have few options to reliably avoid the serious financial consequences of single fatherhood and a child support order. US trends show that single men are facing an increasing financial risk from child support orders. Condoms, which are the best reversible male option besides abstinence, are only 93% reliable.[43] An American worker earning US$36,000 per year would face a child support order worth US$400 per month. Therefore, an unmarried man who believes that his partner would not get an abortion is facing an undiscounted stream of payments until the child's 18th birthday amounting to US$86,400. This number is the product of US$400 per month for 18 years. If future installments of child support payments were discounted by 5%, the total drops to US$56,100. One year of unprotected sexual activity with his partner would expose him to an 85% chance of conceiving – a risk worth US$48,000 (= 0.85 × US$56,100). His best option to personally control this risk would be to comply perfectly with condom use but this could only reduce this risk by 90%, reducing expected risk from 1 year of sex with condoms and an unreliable partner to US$4800 (= 0.1 × US$48,000). A yet to be marketed male contraceptive that was safe and 99% effective could reduce his risk by US$4320 (= S$4800 − US$480).

This brief informal exercise suggests that the financial value of the prevention of a child support order from a 9-point gain in contraceptive efficacy would be worth US$4320 per year to a man of modest means who does not fully trust his sex partner to use contraception adequately or to abort an unwanted pregnancy. In theory, a pharmaceutical company could price their product at US$4319 per year (US$11.80 per day) and consumers would be better off purchasing it. How much revenue would be generated depends on how many single men are having sex with partners they do not trust. We shed light on this question below.

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