Mas­culin­ity, mod­ern equal­ity and mi­nor acts of hero­ism

The Monthly (Australia) - - FRONT PAGE - BY CERIDWEN DOVEY

Since word got out that my hus­band was con­sid­er­ing a va­sec­tomy – and I was plan­ning to write about it – a lot of men have sur­prised me by ea­gerly shar­ing their “va­sec­tomem­o­ries”. Some told me about their first ad­ven­tures in pu­bic hair re­moval. Oth­ers re­layed wry com­ments that their va­sec­tomist had made, loom­ing above the op­er­at­ing ta­ble (“you may feel a small prick”). There were re­peat ac­counts of ter­ri­fied men in re­cep­tion rooms, blanched and jit­tery, await­ing a com­mon fate, and of freez­ers stocked with bags of frozen peas in prepa­ra­tion for post-op ic­ing.

A few dug a lit­tle deeper and told me they’d been un­pre­pared for the psy­cho­log­i­cal im­pact of the pro­ce­dure. For most, that im­pact was pos­i­tive, as they rel­ished the prospect of wor­ryfree sex or basked in a part­ner’s grat­i­tude. Some strug­gled with mild de­pres­sion or loss of li­bido as they came to terms with the fact that they could no longer fa­ther chil­dren. Noth­ing very dra­matic had hap­pened to their bod­ies: “It’s not brain surgery,” Aus­tralian va­sec­tomy pi­o­neer Bar­bara Sim­cock says of the quick, mostly pain­less process of cut­ting or block­ing the vasa def­er­en­tia, the two tubes that ferry sperm from the testes. Yet, for all these men, hav­ing a va­sec­tomy threw up larger ques­tions about their iden­ti­ties as part­ners, lovers, fa­thers.

At first glance, the topic of va­sec­tomy might ap­pear to be of in­ter­est only to het­ero­sex­ual cou­ples with com­pleted fam­i­lies liv­ing in de­vel­oped coun­tries. But as an in­ter­ven­tion in the hu­man body (and, more cru­cially, in the male sex­ual and re­pro­duc­tive sys­tem), it can act as a wedge to open up re­flec­tion on is­sues of wider sig­nif­i­cance: shifts in gen­der iden­ti­ties, old anx­i­eties and new ideas sur­round­ing mas­culin­ity, and the cor­re­la­tion be­tween con­tra­cep­tive and gen­der equal­ity within so­ci­eties.

Just how stacked the cur­rent sys­tem is against men tak­ing re­spon­si­bil­ity for con­tra­cep­tion was brought home to me when my hus­band vis­ited his GP to en­quire about a va­sec­tomy. He was given a pam­phlet out­lin­ing con­tra­cep­tion op­tions, al­most all of which were de­signed for women and came with not in­signif­i­cant dis­com­fort or health risks. Only two of the listed meth­ods al­lowed for male agency or re­spon­si­bil­ity: con­doms, and a va­sec­tomy. The GP re­luc­tantly gave my hus­band the name of a va­sec­tomy clinic, but urged him to ex­er­cise ex­treme cau­tion about go­ing through with it given the per­ma­nence of the pro­ce­dure, his age (un­der 40), and the fact that our chil­dren are young. His part­ing warn­ing was that “in a year or two, your wife might get broody again”.

More use­ful was the GP’s ques­tion of what we would do if the un­think­able hap­pened and we lost a child. Would we then want to have another? This alone gave us pause. Sud­denly what had seemed a sim­ple sub­ject of male plumb­ing be­came meta­phys­i­cal. Like any cou­ple, we had imag­ined a cer­tain kind of fu­ture – ours had two chil­dren in it, and we had man­aged to cre­ate them. All fu­tures are pre­car­i­ous, and the ef­fects of grief un­known un­til they’re upon you. But to find our­selves preg­nant again with an un­wanted child was

for us the more ur­gent and imag­in­able fear. (We also felt re­as­sured that va­sec­tomies can some­times be re­versed, and there are new tech­niques for as­pi­rat­ing sperm di­rectly from the testes, for use in IVF.)

In spite of this ver­bal hoop-jump­ing with the GP, the process of get­ting a va­sec­tomy is fairly straight­for­ward – and pop­u­lar – in Aus­tralia, which has the sec­ond-high­est va­sec­tomy rate in the world, af­ter New Zealand. Ap­prox­i­mately one in four Aus­tralian men over the age of 40 has had a va­sec­tomy. Af­ter oral hor­monal con­tra­cep­tion (the pill) and con­doms, va­sec­tomy is Aus­tralia’s third pre­ferred con­tra­cep­tive op­tion. This is sig­nif­i­cant given that va­sec­tomies – un­like the for­mer two op­tions – aren’t pushed by phar­ma­ceu­ti­cal com­pa­nies stand­ing to make a huge profit. It also makes Aus­tralia one of the few coun­tries in the world where va­sec­tomy is more pop­u­lar than fe­male ster­il­i­sa­tion (glob­ally, fe­male ster­il­i­sa­tion is five times more preva­lent), which says a lot about how cul­tural norms sur­round­ing con­tra­cep­tive use have changed here over time.

By com­par­i­son, in France, get­ting a va­sec­tomy for con­tra­cep­tive rea­sons was con­sid­ered il­le­gal un­til 2001 be­cause of an ob­scure pro­vi­sion in the Napoleonic Code out­law­ing self-mu­ti­la­tion. (In 2000, an in­ter­na­tional birth con­trol ad­vo­cacy group launched a “va­sec­tomy tourist” cam­paign, en­cour­ag­ing French men to pop over the Chan­nel to get the snip.) There is still an oblig­a­tory cooling-off pe­riod be­tween con­sul­ta­tion and pro­ce­dure for prospec­tive va­sec­tomy pa­tients in France, as there is in some US states. Many coun­tries re­strict ac­cess to va­sec­tomy: in Fin­land, for ex­am­ple, you must have had three chil­dren or be over 30; in Rus­sia, you must have had two chil­dren or be over 35. In some places, such as Iran, va­sec­tomy is il­le­gal, and in dozens of coun­tries the le­gal sta­tus of va­sec­tomy is still un­clear.

Even in Aus­tralia, the right for a man to openly re­quest a va­sec­tomy for con­tra­cep­tive pur­poses has only been won fairly re­cently. While some in­di­vid­ual doc­tors were dis­creetly car­ry­ing out vol­un­tary va­sec­tomies from the 1930s, the Aus­tralian Med­i­cal As­so­ci­a­tion (AMA) con­sid­ered the pro­ce­dure il­le­gal and un­eth­i­cal un­til 1971. It took its lead from Bri­tain, where va­sec­tomies were only of­fi­cially al­lowed for con­tra­cep­tive pur­poses from 1972.

This wari­ness was in part a re­sponse to the hor­ri­fy­ing his­tory of forced ster­il­i­sa­tions in many coun­tries. Harry Sharp, the Amer­i­can doctor cred­ited with per­form­ing the first va­sec­tomy on a hu­man, used the pro­ce­dure in 1899 to ster­ilise in­mates at the In­di­ana Re­for­ma­tory.

In Aus­tralia, many of the ear­li­est va­sec­tomists were also of­ten mixed up in the eu­gen­ics move­ment, such as Nor­man Haire from Syd­ney, who worked as a birth con­trol ad­vo­cate and eu­geni­cist in Bri­tain in the 1920s and ’30s. There he pro­moted “Steinach op­er­a­tions”, a one-sided, open-ended va­sec­tomy for the pur­poses not of con­tra­cep­tion but sex­ual re­ju­ve­na­tion. (Eu­gen Steinach, an Aus­trian doctor, had from 1918 falsely claimed that the re­ab­sorp­tion of sperm would in­crease li­bido and de­lay age­ing: Sig­mund Freud and WB Yeats both had the pro­ce­dure done in their late 60s, and Yeats later claimed “it re­vived my cre­ative power [and] sex­ual de­sire”.) Vic­tor Wal­lace, a Mel­bourne doctor, sex­ual coun­sel­lor and found­ing mem­ber of the Eu­gen­ics So­ci­ety of Vic­to­ria, gave hun­dreds of male pa­tients vol­un­tary va­sec­tomies for con­tra­cep­tive pur­poses in his pri­vate prac­tice from 1934 to 1976.

Tiarne Bar­ratt, who re­searched the 20th-cen­tury his­tory of tubal lig­a­tion (fe­male ster­il­i­sa­tion) and va­sec­tomy in Aus­tralia for her masters the­sis at the Univer­sity of Syd­ney, con­tends that the aw­ful ev­i­dence of forced ster­il­i­sa­tion still over­shad­ows the record of sub­stan­tial pub­lic de­mand for ster­il­i­sa­tion as a form of re­li­able con­tra­cep­tion. In spite of the fact that, glob­ally, ster­il­i­sa­tion (mostly fe­male) is still the most used method of birth con­trol, Bar­ratt says it is of­ten miss­ing from his­tor­i­cal ac­counts. Cana­dian his­to­rian Ian Dow­big­gin agrees, writ­ing in his 2008 book, The Ster­il­iza­tion Move­ment and Global Fer­til­ity in the Twen­ti­eth Cen­tury, that the “his­tory of the ster­il­iza­tion move­ment is … more im­por­tant than the his­tory of the Pill and ri­valling the sig­nif­i­cance of the his­tory of abor­tion”. He, too, be­lieves that his­to­ri­ans have failed to ac­knowl­edge ster­il­i­sa­tion’s “for­mi­da­ble im­pact on birth rates and mores re­gard­ing sex and gen­der”.

Another rea­son that vol­un­tary ster­il­i­sa­tion as a pop­u­lar con­tra­cep­tive is un­der-rep­re­sented in his­to­ries of con­tra­cep­tion is be­cause the pill has had such an enor­mous im­pact, so­cially and sex­u­ally, and it con­tin­ues to dom­i­nate the nar­ra­tive of birth con­trol. The pill was im­mensely lib­er­at­ing for women, pre­cisely be­cause it marked a shift in con­tra­cep­tive re­spon­si­bil­ity: once “con­signed to the pub­lic, male world”, Bar­ratt writes, con­tra­cep­tion “was re­con­fig­ured as a fe­male re­spon­si­bil­ity”.

Yet, as a re­sult of this new per­cep­tion – that con­tra­cep­tion should be a wo­man’s ques­tion rather than a man’s duty – men and their re­pro­duc­tive choices, and the gen­dered in­ter­ac­tions sur­round­ing con­tra­cep­tive de­ci­sion-mak­ing, have of­ten been over­looked. This per­cep­tion is now so en­trenched it is easy to for­get that un­til the 1960s, for bet­ter or worse, men “shoul­dered a large share of the re­spon­si­bil­ity for birth con­trol”, as his­to­rian Frank Bon­giorno doc­u­ments in The Sex Lives of Australians. By the late 1930s, for ex­am­ple, al­most two-thirds of cou­ples prac­tis­ing birth con­trol in Aus­tralia were us­ing with­drawal, con­doms and the rhythm method.

Once the pill burst onto the scene here in 1961, the dom­i­nant con­ser­va­tive forces within Aus­tralian so­ci­ety – the Catholic Church, and a gov­ern­ment with a pro-na­tal­ist at­ti­tude and reg­u­lar pan­ics over white Aus­tralian birthrates drop­ping – were threat­ened by its abil­ity to change for­ever the mean­ing of sex for women “from pro­cre­ation to recre­ation”,

as Bon­giorno puts it. Ster­il­i­sa­tion (still il­le­gal at the time) was seen to be even more threat­en­ing, for it sig­nalled the per­ma­nent end to fu­ture par­ent­hood, and the be­gin­ning of a life­time of sex for no other pur­pose but en­joy­ment. The Med­i­cal Jour­nal of Aus­tralia’s edi­to­rial re­sponse in 1963 to a pe­ti­tion ask­ing it to re­con­sider its po­si­tion on the il­le­gal­ity of ster­il­i­sa­tion is re­veal­ing: “in­dis­crim­i­nate ster­il­i­sa­tion can­not ben­e­fit the State, and if widely per­formed at in­di­vid­ual whims would ul­ti­mately be detri­men­tal to the na­tion.”

So it is no sur­prise that ster­il­i­sa­tion was still of­fi­cially con­sid­ered il­le­gal in Aus­tralia un­til 1971. What is sur­pris­ing, ac­cord­ing to Bar­ratt, is that ster­il­i­sa­tion’s tran­si­tion by the mid 1970s to be­com­ing an ac­cepted, un­con­tro­ver­sial and pop­u­lar pro­ce­dure was not based on any changes to leg­is­la­tion. In­stead, this shift in the per­ceived ac­cept­abil­ity of the pro­ce­dure was mostly driven by the ef­forts and ac­tivism of a tightknit net­work of doc­tors around the coun­try, who dur­ing the 1960s were pre­pared to per­form va­sec­tomies covertly. Some of them in­ad­ver­tently be­came ex­perts in the field, as word-of­mouth re­fer­rals drove many pa­tients to the same few doc­tors.

Syd­ney-based doctor Ian Ed­wards, who died ear­lier this year, was one of these va­sec­tomy pi­o­neers. In an in­ter­view late last year, he told me about his first va­sec­tomy pa­tient, who also hap­pened to be his neigh­bour in Cronulla, in 1961. This man and his wife al­ready had three kids, and his wife had re­cently had an abor­tion on their kitchen ta­ble. Ed­wards re­called him say­ing, “I’ve heard that in Amer­ica there’s this op­er­a­tion called a va­sec­tomy – could you do this for me?” Ed­wards’ sur­gi­cal part­ner had done a few of them, so Ed­wards said to his neigh­bour, “Well, you know, if you don’t mind be­ing my first va­sec­tomy pa­tient, we’ll give it a go.”

Ed­wards per­formed dozens of va­sec­tomies each year af­ter that, even­tu­ally tal­ly­ing up about 10,000 over his ca­reer. At first, it was mainly other doc­tors who came to him. (He and his sur­gi­cal part­ner did each other’s va­sec­tomies, as well as those of many other doc­tors in their so­cial net­work.) Over time, he would of­ten find clus­ters of men in male-only work­forces com­ing to see him. “You’d get the whole po­lice force in a cer­tain area, and fire brigades, huge num­bers of them,” Ed­wards said. “The men would talk about these things be­tween them­selves and say, ‘I’ve had it done – why don’t you?’”

Other doc­tors – among them Bruce Er­rey in Bris­bane and Barry Wal­ters in Mel­bourne – were do­ing the same, of­ten with huge num­bers of pa­tients. Er­rey was one of the most pro­lific, per­form­ing more than 30,000 va­sec­tomies over a four-decade ca­reer, and celebrating ev­ery 1000th op­er­a­tion with a cake for the pa­tient. Wal­ters used to keep a tally of the num­ber of va­sec­tomies he’d done on a sign on his fence, caus­ing passers-by much mirth (and a lit­tle dis­com­fort). He liked to say that peo­ple who knew him well called him Tchaikovsky, “be­cause I run the nut­cracker suite”.

When, in 1962, the New South Wales branch of the AMA firmly re­stated its po­si­tion that ster­il­i­sa­tion was not only il­le­gal but also un­eth­i­cal, Ed­wards was shocked. “I thought it was a load of bull and we just kept go­ing,” he said. “We were against this load of med­i­cal politi­cians telling us what we should do.” At the time, Ed­wards was a mem­ber of the NSW Hu­man­ist So­ci­ety. The Hu­man­ist Frame, a 1961 col­lec­tion of essays by well­known fig­ures (in­clud­ing both Ju­lian and Al­dous Hux­ley) about de­vel­op­ing a non-re­li­gious view of life, had a big im­pact on Ed­wards. He iden­ti­fied with the anti-au­thor­i­tar­ian be­lief that peo­ple are not cor­rupted by free­dom.

Ed­wards be­lieved the AMA’s state­ment was mis­lead­ing, given that “no law dealt di­rectly with ster­il­i­sa­tion, no cases had come to court, and there was a va­ri­ety of le­gal opin­ions from which to choose, most of them British”. In­spired by the Si­mon Pop­u­la­tion Trust, a pop­u­la­tion-con­trol ad­vo­cacy foun­da­tion in the United King­dom that from 1966 be­gan putting prospec­tive va­sec­tomy pa­tients in touch with sur­geons will­ing to do the op­er­a­tion, Ed­wards de­cided to try the same strat­egy in Aus­tralia. He con­tacted the Fam­ily Plan­ning As­so­ci­a­tion, but it de­clined to co-op­er­ate or run such a cam­paign. So he floated the idea with the NSW Hu­man­ist So­ci­ety, which was al­ready ac­tive in ad­vo­cat­ing for abor­tion law re­form. It agreed to take the lead on the cam­paign, and soon had the sup­port of Hu­man­ist so­ci­eties in other states.

In 1970, the Hu­man­ist So­ci­ety sent a let­ter to all doc­tors known to be work­ing in the field, ask­ing if they would be pre­pared to have their names added to a list of those will­ing to per­form va­sec­tomies in Aus­tralia. The let­ter stated that “no le­gal ac­tions have arisen” against doc­tors who were al­ready per­form­ing va­sec­tomies in Aus­tralia, “but most sur­geons re­main in­tim­i­dated by the law, and pa­tients still have great dif­fi­culty in find­ing a doctor who will do a va­sec­tomy for them”. A sec­ondary goal of the cam­paign was to per­suade doc­tors they could safely per­form va­sec­tomies with­out fear of le­gal con­se­quences.

The re­ac­tion from the med­i­cal com­mu­nity was mixed. The Med­i­cal Jour­nal of Aus­tralia re­ceived sev­eral hos­tile let­ters to the editor about the cam­paign, one of which ac­cused the Hu­man­ist So­ci­ety of be­ing “anx­ious to at­tack life at its very source by pro­mot­ing ster­il­iza­tion”. Even those doc­tors who were sym­pa­thetic to the cause of­ten re­sponded cau­tiously or neg­a­tively, re­fus­ing to have their names added to the list. One wrote, “I do va­sec­tomy op­er­a­tions, but … I am not for one mo­ment pre­pared to be­come a ‘va­sec­tomist’.” Another wrote, “Per­son­ally, al­though I may be bi­ased as a man, I think it prefer­able for a wo­man to be ster­il­ized … it would be an em­bar­rass­ment to me to have my prac­tice flooded with these pa­tients.”

How­ever, enough doc­tors put for­ward their names that Ed­wards was able to cre­ate a to­ken list in sev­eral states. One

doctor was so en­thu­si­as­tic about the pro­ce­dure that he ad­mit­ted to hav­ing done his own va­sec­tomy five years pre­vi­ously, “the best thing I ever did for my­self”. Another wrote, “Count me in on your list of va­sec­tomis­ing doc­tors. I am al­ready do­ing them, and don’t mind risk­ing the wrath of the Es­tab­lish­ment.” In Septem­ber 1970, a story in Ade­laide’s Sun­day Mail about the list be­ing made pub­lic re­sulted in the South Aus­tralian AMA and Med­i­cal De­fence Union ask­ing the state at­tor­ney-gen­eral, Len King, for a rul­ing. A month later, King made the fol­low­ing state­ment in the AMA Gazette:

What­ever may be thought as to the moral­ity or wis­dom of a per­son un­der­go­ing such an op­er­a­tion with­out grave rea­son, I am sat­is­fied that the op­er­a­tion of ster­il­i­sa­tion on man or wo­man is not pro­hib­ited by the crim­i­nal law of South Aus­tralia if per­formed with the con­sent of the pa­tient.

King’s state­ment had a flow-on ef­fect. In 1971, the AMA Fed­eral Coun­cil deleted the clause for­bid­ding ster­il­i­sa­tion from its Code of Ethics, a change ac­cepted by all AMA state branches ex­cept Queensland’s. This means per­form­ing a va­sec­tomy could still tech­ni­cally be con­sid­ered un­eth­i­cal in that state, which is laugh­able if you’ve ever seen the mas­sive bill­boards on the Sun­shine Coast ad­ver­tis­ing Nick Demediuk, aka Dr Snip, and his boom­ing va­sec­tomy prac­tice.

Na­tional va­sec­tomy data was first col­lected in Aus­tralia be­tween 1973 and 1974, and it showed that around 25,000 Aus­tralian men had been swept up in what was dubbed “va­sec­to­ma­nia”. By 1980, ster­il­i­sa­tion (tubal lig­a­tion or va­sec­tomy) had be­come the most widely used method of birth con­trol in Aus­tralia for peo­ple older than 35. In spite of the re­newed pa­pal ban on birth con­trol in 1968, ster­il­i­sa­tion be­came a pop­u­lar choice even for Catholics: as a on­ce­off pro­ce­dure, it meant they could avoid “re­peat sin­ning”.

Since the 1994 United Na­tions In­ter­na­tional Con­fer­ence on Pop­u­la­tion and De­vel­op­ment, it has been glob­ally recog­nised that men’s in­volve­ment in con­tra­cep­tive prac­tices is cru­cial – not only in terms of pop­u­la­tion con­trol but also to ad­dress the un­fair con­tra­cep­tive bur­den on women. And that bur­den is heavy: as Holly Grigg-Spall claims in her 2013 book, Sweet­en­ing the Pill, we’ve been forced into an ad­dic­tion to oral birth con­trol for women be­cause of its prof­itabil­ity. This in turn has re­in­forced cul­tural as­sump­tions that con­tra­cep­tion is and should re­main a wo­man’s is­sue.

Yet once women in the de­vel­oped world are fin­ished hav­ing chil­dren, they are re­luc­tant to re­sume drink­ing big pharma’s Kool-Aid. Gen­er­a­tions of women, from the late 1960s through to to­day, on reach­ing their 30s or 40s and hav­ing com­pleted their fam­i­lies, have cho­sen to re­place the pill with ster­il­i­sa­tion. In Aus­tralia, that in­creas­ingly means male ster­il­i­sa­tion; the pop­u­lar­ity of fe­male ster­il­i­sa­tion has de­creased here since the 1980s. (No won­der: a 1999 Amer­i­can study showed that, if com­pared with va­sec­tomy, tubal lig­a­tion has 20 times the risk of ma­jor com­pli­ca­tions, and a death rate 12 times higher.)

A col­league whose hus­band had a va­sec­tomy told me that, af­ter hav­ing kids, she chose not to go back on hor­monal con­tra­cep­tion be­cause she wanted to know what “nor­mal” felt like: her own, base­line self unadul­ter­ated by the ar­ti­fi­cial hor­mones she’d been on since the age of 15, which had con­sis­tently made her de­pressed. She is not alone. In a 2015 sur­vey of over 1000 British women, more than a quar­ter of re­spon­dents re­ported feel­ing “wor­ried” and “ner­vous” about tak­ing the pill, and a third said they felt women are sim­ply ex­pected to “put up” with its side ef­fects.

And then there’s the ques­tion of fi­nan­cial fair­ness. Women pay more for health care be­cause they pre­dom­i­nantly take on the cost of con­tra­cep­tion, some­thing that the US 2010 Af­ford­able Care Act tried to ad­dress by re­quir­ing em­ploy­ers to pro­vide con­tra­cep­tive cov­er­age (with no out-of-pocket costs) in their em­ploy­ees’ health plans. A 2016 op-ed in the New York Times sup­port­ing this re­quire­ment said it “rep­re­sents an im­por­tant leg­isla­tive link be­tween sex equal­ity and re­pro­duc­tive rights”. Un­der the Trump ad­min­is­tra­tion, the Act it­self is un­der at­tack. The pro­posed word­ing of which con­tra­cep­tives are cov­ered with­out a pa­tient co-pay has al­ready been changed, so that va­sec­tomies, con­doms and any fu­ture male-fo­cused con­tra­cep­tives are not in­cluded.

The un­com­fort­able truth is that, in the five decades since the pill was re­leased, there have been al­most no ad­vances in male con­tra­cep­tion. Re­ports of re­search break­throughs pop up reg­u­larly – in­jectable hor­monal shots, “clean sheets” pills that could cre­ate ejac­u­late-free or­gasms, poly­mer gel in­jec­tions to dam­age sperm – but the prod­ucts never seem to make it to mar­ket. There was out­rage late last year when an oth­er­wise suc­cess­ful trial of a male in­jectable con­tra­cep­tive was stopped early due to sup­pos­edly se­ri­ous ad­verse ef­fects such as “acne, in­jec­tion site pain, in­creased li­bido, and mood dis­or­ders” (all of which are con­sid­ered to be ac­cept­able, run-of-the-mill risks of fe­male con­tra­cep­tives – well, ex­cept for in­creased li­bido).

“The joke in the field is we’re five to ten years away, and it’s been like that since the 1970s,” re­pro­duc­tive bioethi­cist Lisa Campo-En­gel­stein said in a 2014 in­ter­view. “The phar­ma­ceu­ti­cal com­pa­nies have de­cided it’s not a good busi­ness, and so there just isn’t the money to make the jump from re­search to mar­ket.” This is a view that chemist Carl Djerassi, known as the fa­ther of the pill, also sup­ported un­til his death in 2015. In a 2014 in­ter­view he said of the male pill’s prospects, “there’s not a sin­gle phar­ma­ceu­ti­cal com­pany who will touch it – for eco­nomic and so­ciopo­lit­i­cal, rather than sci­en­tific, rea­sons”.

This is all the more frus­trat­ing given the ev­i­dence that men are in­creas­ingly sup­port­ive of hav­ing more op­tions and

tak­ing equal re­spon­si­bil­ity for birth con­trol. In a 2015 poll of more than 80,000 British men con­ducted as part of the UK Tele­graph’s #TakeBack­BirthCon­trol cam­paign, 52% of re­spon­dents said they couldn’t wait to take the male pill. A 2005 study of more than 9000 men (from Ar­gentina, Brazil, Ger­many, In­done­sia, Mex­ico, Spain, Swe­den, the US and France) found that 55% of re­spon­dents would be will­ing to use male con­tra­cep­tives ca­pa­ble of pre­vent­ing sperm pro­duc­tion, if they were avail­able.

Men may be open to the idea of new male con­tra­cep­tives, but the re­al­ity is that many re­main ig­no­rant about their own bod­ies, which means some of the be­liefs about ba­sic con­tra­cep­tive pro­cesses or con­se­quences are illinformed. Take, for ex­am­ple, the en­dur­ing fear that va­sec­tomy is a ver­sion of cas­tra­tion. This has been a male ter­ror since the 1820s, when the first va­sec­tomy ex­per­i­ments were per­formed on dogs by a British doctor whose main goal was to demon­strate that va­sec­tomy did not have the same ef­fects as cas­tra­tion. In the NSW Hu­man­ist So­ci­ety’s 1963 “Re­port on Ster­il­iza­tion”, one of the first points made is that “ster­il­iza­tion is not the same as cas­tra­tion”, a mat­ter which “can­not be too strongly in­sisted upon, be­cause [it is] not gen­er­ally un­der­stood, and a grasp of the phys­i­o­log­i­cal facts is nec­es­sary if the so­cial and per­sonal im­por­tance of ster­il­iza­tion is to be ap­pre­ci­ated”.

This cas­tra­tion anx­i­ety still per­sists. In the “Va­sec­tomy Pack” my hus­band was given a few months ago (on its front page, rather re­as­sur­ingly, was a pho­to­graph of New Year’s Eve fire­works ex­plod­ing across the Syd­ney Har­bour Bridge) the first en­try un­der FAQs in­cluded the em­phatic re­sponse “Va­sec­tomy is NOT cas­tra­tion.”

These fears, no mat­ter how ir­ra­tional, are valid. They re­veal the psy­cho­log­i­cal im­pact that a va­sec­tomy can have, and how bound up the pro­ce­dure is with male iden­tity, vul­ner­a­bil­ity, and ques­tions of self-worth and man­hood. It is only re­cently that men have started open­ing up about the anx­i­eties and emo­tions re­lated to get­ting the snip. A writer for GQ mag­a­zine de­scribed feel­ing “strangely emp­tied, gen­tled, sad … curled into a ques­tion mark” af­ter his va­sec­tomy, and wrote that he still feels a twinge each time he sees a child’s aban­doned dummy in a gro­cery store, “won­der­ing about all those might-have-beens”.

For more than five years, Auck­land-based psy­chol­o­gists Gareth Terry and Vir­ginia Braun have been in­ter­view­ing New Zealan­ders about what ef­fects a va­sec­tomy has on the pa­tients’ emo­tions and re­la­tion­ships. In one of their first ar­ti­cles, many of the men in­ter­viewed in­ter­preted their va­sec­tomy ex­pe­ri­ence pos­i­tively, as a mi­nor act of hero­ism un­der­taken out of love for their part­ners and a de­sire to take con­tra­cep­tive re­spon­si­bil­ity within a re­la­tion­ship. This was an im­por­tant in­ter­ven­tion in what Terry and Braun de­scribe as the “largely neg­a­tive pic­ture around va­sec­tomy, em­pha­sis­ing fears, side ef­fects, and men be­ing pres­sured into hav­ing the op­er­a­tion”.

In a fol­low-up study, Terry and Braun slightly tem­pered this fram­ing of va­sec­tomy as a form of hero­ism. Just as Annabel Crabb took is­sue in The Wife Drought with the per­ceived hero­ism of men who do even small amounts of house­work or child care (while their wives do the bulk of this work with­out credit), Terry and Braun asked if this per­cep­tion of va­sec­tomy – and the ex­treme grat­i­tude of­ten ex­pressed by the men’s part­ners – was a symp­tom of deeper in­equal­i­ties within the house­hold econ­omy.

That said, for a grow­ing num­ber of men around the world, get­ting a va­sec­tomy is not only a con­tra­cep­tive pro­ce­dure but also an op­por­tu­nity to rad­i­cally re­think mas­culin­ity. Some­times this takes the form of Trump­isms from men in the of­ten alt-right-lean­ing “men’s rights ac­tivists” com­mu­nity, about the de­sire to con­trol their own fer­til­ity to avoid be­ing duped into par­ent­hood by schem­ing women. More of­ten it marks an au­then­tic shift in how men, such as self-de­scribed “male fem­i­nist” Ash­ley Thom­son (founder of the Homer web­site, which he hopes will “act as a bridge be­tween the gen­derequal world I want to live in and the men who have yet to see the virtues of that world”), are pars­ing the new rights and re­spon­si­bil­i­ties of dif­fer­ent vi­sions of mas­culin­ity. Another male friend, who iden­ti­fies as a fem­i­nist, told me that he and his wife de­cided on a va­sec­tomy be­cause it’s his way of “smash­ing the pa­tri­archy”.

In 2013, Amer­i­can film­maker Jonathan Stack co-di­rected The Va­sec­tomist, a doc­u­men­tary about Florida-based sur­geon Doug Stein. Soon af­ter­wards, Stack and Stein co-founded World Va­sec­tomy Day, a cam­paign of­fer­ing ed­u­ca­tion about, and ac­cess to, va­sec­tomies for men around the world. There is now a net­work of more than 1000 par­tic­i­pat­ing doc­tors in more than 40 coun­tries, and Stack says the an­nual event, which in­cludes live demon­stra­tions of va­sec­tomies streamed glob­ally, is “the largest male-fo­cused fam­ily plan­ning event in his­tory”.

For Stack, the mo­ti­va­tion for the cam­paign is twofold. One goal is to over­turn of­ten well-founded fears that it is pa­ter­nal­is­tic and hyp­o­crit­i­cal for de­vel­oped coun­tries to en­cour­age birth con­trol in de­vel­op­ing coun­tries. In­deed, some in­ter­na­tion­ally funded pop­u­la­tion-con­trol pro­grams have been ap­pallingly co­er­cive, such as the mass ster­il­i­sa­tion cam­paign car­ried out in In­dia in the 1970s. Mil­lions of In­dian men were ster­ilised, of­ten against their will.

Yet Stack and other fam­ily plan­ning ac­tivists be­lieve it’s another kind of first-world prej­u­dice to as­sume that men in de­vel­op­ing coun­tries – or men in low-in­come com­mu­ni­ties within de­vel­oped coun­tries – don’t want to be ac­tively in­volved in con­tra­cep­tive de­ci­sion-mak­ing, or that

they would re­ject the idea of a va­sec­tomy if it were cheap and eas­ily avail­able. Karen Hardee, a se­nior as­so­ciate at the US Pop­u­la­tion Coun­cil, says, “I think a lot of us are in this mind­set of, ‘Oh, men are “prob­lems” in fam­ily plan­ning.’ And I re­ally think we need to see men as part of the so­lu­tion.” Sarah Miller, a fam­ily plan­ning spe­cial­ist work­ing in the Bronx, New York, says, “we have a very di­verse pop­u­la­tion of peo­ple … and yet, we are see­ing men for va­sec­tomies, and that’s sort of ex­cit­ing be­cause … we are shift­ing the de­mo­graphic and di­ver­si­fy­ing, but also we’re show­ing that … the whole idea of ‘those men won’t do it’ is sim­ply not true.”

Stack’s sec­ond goal is to use va­sec­tomies as a way of un­ob­tru­sively but ef­fec­tively break­ing down wider taboos around men tak­ing re­spon­si­bil­ity when it comes to con­tra­cep­tion. In ar­ti­cles he has writ­ten about World Va­sec­tomy Day, Stack says, “It’s not just about get­ting men to par­tic­i­pate, but get­ting men to do so with more com­pas­sion, kind­ness and care.” The cam­paign em­pha­sises that a va­sec­tomy can be a chance for a man in any coun­try to com­mit an act of love for women, and in do­ing so aims to bun­dle up “in­di­vid­ual acts of kind­ness into a col­lec­tive move­ment for so­cial good”.

This may sound a lit­tle corny, but it is more than a sym­bolic ges­ture. Con­tra­cep­tive equal­ity is a use­ful in­di­ca­tor of gen­der equal­ity in a so­ci­ety. Va­sec­tomy is one of the few trace­able forms of male con­tra­cep­tion, and coun­tries with the high­est rates of va­sec­tomy (New Zealand, Aus­tralia, Canada, the UK, the US, the Nether­lands, Bel­gium, Spain, Den­mark, Switzer­land, South Korea) tend to rank well in the UN Gen­der In­equal­ity In­dex. As global health ex­pert Roy Ja­cob­stein wrote in the Lancet in 2015, “va­sec­tomy is widely cho­sen in re­gions and coun­tries with high so­cioe­co­nomic de­vel­op­ment and gen­der equal­ity”. This cor­re­la­tion doesn’t al­ways hold: Swe­den and France have quite low va­sec­tomy rates, while Bhutan’s is high, but the link is gen­er­ally strong.

In so­ci­eties with more gen­der equal­ity, it seems that men are hap­pier hav­ing con­ver­sa­tions about shar­ing con­tra­cep­tive re­spon­si­bil­ity, and putting those be­liefs into prac­tice by get­ting a va­sec­tomy. It’s pos­si­ble that it works the other way around too: by con­sid­er­ing get­ting a va­sec­tomy, a man is en­gaged in wider con­ver­sa­tions around gen­der equal­ity, as Stack hopes.

It was com­fort­ing to my hus­band and me to know that in mak­ing a pri­vate choice to go ahead with his va­sec­tomy we were also qui­etly as­sert­ing our mu­tual be­lief in con­tra­cep­tive and gen­der equal­ity. Our de­ci­sion, and my hus­band’s open­ness in talk­ing about it, has had a snow­ball ef­fect in his work and so­cial cir­cles, prompt­ing other men he knows who have been putting off tak­ing re­spon­si­bil­ity for con­tra­cep­tion within their own re­la­tion­ships to con­sider va­sec­tomy as an op­tion.

I went with him to his ap­point­ment, and the doctor was kind – or sadis­tic – enough to let me ob­serve the pro­ce­dure for re­search pur­poses. High on happy gas, my hus­band asked the va­sec­tomist the age of his old­est-ever pa­tient. “Eighty-three,” he dead­panned, “which means there’s still hope for the rest of us.” This set my hus­band off in a fit of gig­gling, which lasted pretty much the en­tire ten-minute pro­ce­dure, while I watched, sober and grim-faced, as his left vas def­er­ens (which looks like a thick white shoelace) was cut in two. I did feel a jolt of emo­tion: this was the tube through which the seeds that even­tu­ally be­came our sons had trav­elled. The mys­te­ri­ous act of gen­er­at­ing life was sud­denly laid bare.

It also struck me then that ster­il­i­sa­tion is such a hor­ri­ble, cold word, im­ply­ing a sort of death for both part­ners. Mourn­ing what we would lose was a nec­es­sary part of our de­ci­sion-mak­ing process, but so too was an­tic­i­pat­ing the free­dom of our fu­ture. We walked home to­gether, and both looked a lit­tle wist­fully at our youngest son’s minia­ture socks dry­ing on the line. Then we got set­tled on the couch with a pack of frozen peas and a bot­tle of bubbly. We didn’t have to pre­tend: it felt like a cel­e­bra­tion.

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