When the Supreme Court ended a woman’s right to abortion in 2022, it was hard to believe access to contraceptives could follow. And yet, even before the election, legislative initiatives had begun to limit access to certain contraceptives. A Trump administration could continue this regressive path, which could suggest a slippery slope to 1960s back-alley brutality.
It’s time for men to do their part. After 70 years of research, several new male birth control options are succeeding in clinical studies. Accelerating their development could slow the ongoing assault on women’s reproductive health. But this requires a new regulatory perspective, more research funding, and a commitment to prioritizing innovation in a market that’s been stagnant for more than half a century.
Following the election, demand for birth control, abortion pills, long-term contraception, permanent contraception, and requests to replace still-effective IUDs exploded. A similar surge followed the Dobbs v. Jackson Women’s Health Organization decision, overturning Roe v. Wade. This time, fear seems more palpable. The Trump-Vance campaign’s rhetoric on abortion and contraceptive access has been inconsistent, fueling pre-existing fears. Is this fear based on facts? Is contraceptive access truly at risk? Does increased demand for vasectomies suggest men want a larger role in pregnancy prevention? Yes. Yes. And yes.
Contraceptives are under attack
Early signs show contraceptive access is indeed at risk. An archaic interpretation of the dormant Comstock Act seems blameworthy. The so-called “sexual purity” law of 1873 prohibited sending obscene materials, contraceptives, and anything that could induce abortion through the mail. (It had previously been used to stop sales of diaphragms in the 1920s. To overcome this, activist Katharine McCormick had diaphragms sewn into fur coats in France for resale in America).
Following the Dobbs case, anti-abortion activists and conservative states began reinterpreting the Act to restrict access to “the abortion pill,” (mifepristone and misoprostol), even in states where abortion is legal. Importantly, this medication accounts for safe, early pregnancy termination for two-thirds of abortion-seekers. The Justice Department under President Biden saw the Act as applying to drugs used illegally. The FDA expanded who could prescribe the abortion pill and adjusted the requirement for in-person visits to support easier access via telehealth. A Trump-Vance administration could repeal these protections and/or enforce the Comstock Act. A few local ordinances already uphold the Act, making it illegal to receive the abortion pill through the mail.
If Comstock can be used to restrict the abortion pill, could it also be used to restrict contraceptives? Unfortunately, yes. Its enforcement would let states and local jurisdictions determine whether women could have access to contraceptives. This is already underway in Indiana and Oklahoma, where new laws reduce access to certain methods of female contraceptives based on false claims and conflations of their potential use in abortions. Reflecting a similar theme, Justice Clarence Thomas urged the Supreme Court to reconsider the 1965 decision that established the right of married couples to use contraception in his concurring opinion for the Dobbs case.
There’s also the question of Medicaid coverage for birth control and Medicaid funding for Planned Parenthood. Reductions or restrictions could make it harder for vulnerable populations to access contraceptives. The Affordable Care Act (ACA) requires insurance plans to cover birth control without out-of-pocket costs. Changes could impact contraceptive access for tens of millions.
Men must play their part
How these potential attacks on female contraceptives play out over time is unclear. What is clear is that 46% of all pregnancies in the U.S. are unintended. Pregnancy termination is never a desirable option but if it becomes harder to access birth control, women have few alternatives. The growing scarcity of safe abortion forces unwanted parenthood or unsafe pregnancy termination. This future is already edging closer. A July 2024 JAMA study showed that self-managed abortions are increasing with women trying to end their pregnancy by using drugs or alcohol, lifting heavy objects, taking a hot bath, hitting themselves in the stomach, or inserting an object into their body.
Against this backdrop, we need a novel perspective on a problem as old as humanity. One innovation could help change things: male contraceptives. For the first time in 70 years, new male contraceptives are succeeding. And it’s about time. The female pill turns 65 next year, marking more than a half-century of the same thing: every patch, injectable, implant, and ring introduced in the past 65 years prevents pregnancy with hormones. Women are complaining, and not unfairly. Innovation in male contraception is even worse: it’s been 169 years since Charles Goodyear commercialized the modern condom.
Government, women’s health advocates, investors and anyone who’s dissatisfied with their birth control method must prioritize innovation in contraception. Men have just three options: condoms, vasectomy and withdrawal. Researchers are testing three new male options in human studies: a hormone-free birth control pill, a “male IUD”, and a hormonal gel for dermal application. Data show there’s high demand for new contraceptives among women and men, but meeting this demand requires funding to accelerate them and promote future research. Prioritizing women beyond their ability to give birth not only means investing in reproductive health but also including men: the FDA should examine how it views risk so that men–even without the risk of childbirth–can participate in clinical studies for male contraceptives.
Finally, consider this: if men had more birth control options, would restricting access to contraceptives be a thing? Curiously, recent anti-contraceptive rhetoric hasn’t mentioned condoms. Perhaps contraceptives would be viewed more favorably if birth control weren’t perceived as “a woman’s job.” This won’t be clear until men have more options.
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