Hey fellas, consider yourself an ally to women? Consider a vasectomy
American men have come a long way, baby. They spend more time with their kids than ever before. Most of them say they want egalitarian marriages and better work-life balance. Two-thirds of married fathers have a wife who works outside the home and contributes to the family income, and about four in 10 of those men have a wife who outearns them. So why, when it comes to family planning, are women doing all the work and men doing so little? To put a finer point on it: why don’t more American men get vasectomies?
The contraception gap is one of the most striking and persistent gender inequities. While close to 100% of American women take steps, at some point in their lives, to prevent pregnancy, the vast majority of them shoulder that burden alone. Fewer than one in 10 relied on condom use – a contraceptive method that requires men to take action. And only about one in 10 married or coupled men have had a vasectomy – the rate for single men is far lower.
It’s difficult to understand why. Vasectomies are typically covered by insurance, so cost isn’t the primary factor. Neither is risk, given that vasectomies are overwhelmingly safe. Neither is time or even pain: vasectomies are simple outpatient procedures. The recovery so minimal that urologists have deemed the month of March to be “vasectomy season”: men schedule the procedures to coincide with March Madness, so they can sit on the couch with a bag of frozen peas on their crotch, watching basketball.
For men who have already had children or know they don’t want children, vasectomy is the safest, easiest and most effective method of contraception. It’s also safer and easier to reverse than tubal ligation. It allows men more control over their own fertility. And it gives men with female partners an opportunity to more equally share in the work of planning their families. But for too many men – and even in conversations about family planning and reproductive rights – vasectomy remains an afterthought. There is a builtin presumption that women will bear nearly all of the reproductive burdens, even though reproducing (at least the old-fashioned way) always takes two.
The question of why women are the ones doing nearly all of the work to prevent unintended pregnancy – when an accidental pregnancy requires as much involvement from men as women – is newly salient thanks to questions about whether the Johnson & Johnson Covid vaccine in the US, and the AstraZeneca vaccine in the UK and Europe, elevate risks of blood clots. After a pause to evaluate the evidence, the CDC deemed the Johnson & Johnson vaccine safe, but noted that in a very tiny handful of cases, there was a slightly elevated risk of blood clotting for women under 50. The European Medicines Agency has recommended that the AstraZeneca shot not be given to young people.
Which led a lot of women to ask: what about the pill?
The birth control pill remains very safe, but it also comes with elevated blood clot risk – a higher risk than that of the Covid vaccine. That said, the two aren’t necessarily comparable. Pill-related blood clots tend to be in the legs and sometimes the lungs, not the brain, and are generally treatable.
And no contraception method is without its flaws. Hormonal methods, including the pill, the Depo-Provera shot and the hormonal IUD, among others, come with side effects that can include weight gain, mood changes, nausea and – perhaps most offensively – decreased sex drive, which kind of defeats the purpose of using contraception, so you can have sex for pleasure without risking pregnancy. Anecdotally, a great many women I know are diehard pro-choice advocates for a wide range of contraceptive options, but personally forgo hormonal contraception because of the side effects. And non-hormonal methods aren’t necessarily a solution: The copper IUD, which does not contain hormones, can cause heavy bleeding and severe menstrual pain. (When I asked my own doctor about the copper IUD years ago, she told me to get it only if I was okay with bleeding and being in pain for the next year.)
One answer to the question of why men don’t bear their fair share of the contraception burden is obvious: men also don’t bear the burden of pregnancy, and so there is far less incentive for them to take the lead in preventing it. And it’s certainly a good thing that women have the ability to control their own reproductive capacities without relying on male partners.
Another answer is obvious enough from the list above: there simply aren’t any hormonal or otherwise medical and impermanent contraception options for men. Condoms, unlike hormonal contraception, can prevent the spread of infections. But they require perfect use every time, kind of like the contraceptive sponge and the diaphragm, neither of which is exactly a popular method of birth control in 2021. Many people find they experience decreased sensation with condoms, and they require the interruption of what lots of couples want to be a spontaneous and sensuous moment; they’re not a method where the burden is borne only by the male partner in a heterosexual pairing. While there are multiple drugs on the market that allow men to continue getting erections well into old age, there’s no male pill or male IUD, which tells you a lot about what men demand and what drug companies believe they will use.
But the relative lack of medical options for men wanting fertility control isn’t the whole story. The most popular form of contraception for American women isn’t any of the hormonal options; it’s tubal ligation. And there’s a male corollary: vasectomy.
Yet women are about twice as likely to get their tubes tied than men are to get the snip, even though tubal ligation is more invasive, riskier and harder to reverse.
At the heart of this divide isn’t money or opportunity or anything logical. It’s sexism: the expectation that women will not only bear the work of reproduction, often permanently damaging our health and always risking our lives, but that we will also take on 100% of the pain and risk of preventing it, too. As for men, well, they just join for the fun part.
This divide has existed in our intimate relationships for millennia, so no wonder a lot of men haven’t budged and a lot of women don’t give it a second thought. But concerns about the (overwhelmingly safe) Covid vaccine have opened up a new line of conversation about who takes on which risks and why when it comes to contraception. That conversation should extend beyond concerns about the (also overwhelmingly safe, if not 100% beloved) birth control pill. Men should be asking why they aren’t up in arms about their lack of contraceptive options. More of them should get vasectomies. And the women who expect equality at home should ask whether they’re getting it if the physical toll of planning their families falls on them alone.
Jill Filipovic is the author of OK Boomer, Let’s Talk: How My Generation Got Left Behind