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Policy Engagement Manager, Metriarch
From research and development to the doctor's office, pregnancy prevention has long been understood as something best achieved by meddling with the female body. But in the wake of a seismic shift in reproductive healthcare access, this centuries-old belief feels especially out of touch with the difficult decisions women and men of reproductive age are being forced to make.
Indeed, the technological, clinical, and financial barriers to including men – and their bodies – in family planning interventions are real. The resulting disconnect is driving a confusing and unnecessary wedge between people who can become pregnant and people who can’t.
It’s high time we start trying to fix it.
I’m sitting in a small exam room next to my partner of 10 years, fighting off the special brand of headache LED lights always blast into my brain.
He begins to review the material a nurse handed him as we wait for the doctor, brow furrowed. I tilt my head to read the back of the brochure in his hands.
It lists the alternatives to a vasectomy. IUD, the pill, implant, shot, tubal ligation… most things we’ve not only tried but have wreaked havoc on my mental and physical health. I’m immediately annoyed, and I point it out.
“I appreciate what you’re saying,” he responds anxiously. “But today needs to be about my body.”
Though the technicalities have changed, humans have long understood that when semen enters the vaginal canal, you get pregnancy. It makes sense that withdrawal and barrier methods (condoms and diaphragms) were what most folks relied on for contraception until the last few centuries.
When people started getting more creative, however, the female body became the primary playground for new family planning technologies. From spermicides in antiquity through the development of “the pill” in the 1950s, more invasive forms of contraception were injected into, ingested by, and applied to women.
There’s been no shortage of ink spilled about why. But I want to talk about what that means for the way we think about family planning today and how it affects our health and relationships.
In short, within most heterosexual relationships, pregnancy prevention is the woman’s job and any side effects are simply occupational hazards. I had internalized it, somewhat resentfully, as follows: This sucks, but it’s better – and safer – than pregnancy!
As someone who can become pregnant, I have enjoyed (suffered?) many contraceptive options. My partner has been actively involved for most of that journey, sometimes out of curiosity but more often from a place of compassion.
He’s contributed to hours of pre-appointment research over the years and gently pointed out changes in behavior when a hormonal option isn’t jiving with my brain chemistry. During his tenure as a pharmacy tech, he even practiced injecting water into oranges until we were both confident in his ability to administer a Depo-Provera shot.1This isn’t medical advice. Talk to a medical provider about if, when, and how to take prescription medication.
As supportive as he was, I don’t think his participation was ever understood as a shared responsibility. How can it be when my bodily autonomy is so tied to the decision-making process? His contraception options are limited to barrier methods or sterilization. Mine are extensive but affect my lived experience. If it’s my body that will endure changes, I’m sure as hell going to be making that decision.
The best we could come up with is I carry the burden, he supports how he can, and we work through the occasional tension. It was an understanding that went both ways until June of 2022.
The Dobbs decision and my IUD’s rapidly-approaching expiration date raised the stakes.
We were pretty sure we didn’t want kids. I knew I didn’t want to go through the painful process of an IUD insertion again. As Oklahoma’s strict abortion bans went into effect, the consequences of an accidental, complicated pregnancy or a forced birth terrified us both.
He was the one who brought it up. “Why don’t I get a vasectomy?” It felt like a dramatic suggestion even though we’d also discussed tubal ligation. It was time to explore all our options.
Turns out, we weren’t alone in broadening our approach to family planning after Roe fell. A recent study found new vasectomy consultation requests increased by 35% in the two months following SCOTUS’s decision. Men seeking the procedure were also significantly younger and more likely to be childless.
As we began to research and discuss with our network, I was floored. We had friends who had undergone the procedure telling us it was quick and required minimal recovery time. While you shouldn’t count on them being reversible, they don’t affect sexual function.
It sounded like a better contraceptive option than almost any of mine, yet only 5% of American men of reproductive age are sterilized compared to 22% of women.
There are many reasons vasectomies aren’t popular. One that we ran into was that while most health plans are required to cover female sterilization, the same isn’t true of vasectomies.
For us, a lack of coverage meant over $600 for a procedure with the same desired outcome as the many contraceptives my insurance had covered for me through the years. What a bizarre business decision.
Another, more nuanced reason is the different ways male- and female-presenting people are treated in medical settings. My partner and I compared notes. I’m usually asked about family planning during visits with my primary care physician. He’s not. I’ve seen an OB/GYN annually for most of my adult life, and we always discuss contraception. He has no equivalent.
These are anecdotal observations, and I’m extremely privileged to have regular visits with thorough healthcare providers. Studies show, however, that family planning programming has always primarily focused on women, “operating from the perspective that women are contraception-users and men should support their partners.”
No wonder it seemed like a novel idea to us last year.
After the appointment, we’re silent and deep in thought as we make our way back to the car. I decide that I agree – today should be about his body. Our conversations about how to prevent a pregnancy should have always involved his body. And I’m excited for the day when family planning technology and conversations with our partners and at the doctor’s office make that easier for all of us to wrap our heads around.
Policy Engagement Manager at Metriarch
Caitlin is a connector and storyteller leveraging her training in research and background in public relations to expand awareness around and improve the health of Oklahomans. In her role as Policy Engagement Manager at Metriarch, she supports partnerships and research initiatives with a focus on trauma-informed, ethical storytelling and the power of compelling narratives in driving actionable empathy.
Hardee, Karen, Melanie Croce-Galis, and Jill Gay. “Are Men Well Served by Family Planning Programs?” Reproductive Health 14, no. 1 (January 23, 2017). https://doi.org/10.1186/s12978-017-0278-5.
“HHS, DOL, and Treasury Issue Guidance Regarding Birth Control Coverage” HHS.gov, July 28, 2022. https://www.hhs.gov/about/news/2022/07/28/hhs-dol-treasury-issue-guidance-regarding-birth-control-coverage.html.
Kaiser Family Foundation. “Sterilization as a Family Planning Method,” December 14, 2018. https://www.kff.org/womens-health-policy/fact-sheet/sterilization-as-a-family-planning-method/.
Kimport, Katrina. “More Than a Physical Burden: Women’s Mental and Emotional Work in Preventing Pregnancy,” The Journal of Sex Research. Vol. 55, No. 9 (April 18, 2017):1096-1105. https://www.tandfonline.com/doi/full/10.1080/00224499.2017.1311834.
Kimport, Katrina. “Talking about Male Body-Based Contraceptives: The Counseling Visit and the Feminization of Contraception,” Social Science & Medicine. Vol. 201 (March 1, 2018): 44–50. https://doi.org/10.1016/j.socscimed.2018.01.040.
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