MALE CONTRACEPTIVES

[Guest guest]

Dear members,Why do we need new contraceptives?   Abortion rates are still high. In the United States, about 2% of women get an abortion each year, and more than 20% of total pregnancies end in abortion. Furthermore, the United States has the highest adolescent birth rate in the industrialized world – about four times the European Union average, and more than 10 times the rate in Japan and Korea. In fact, one in five girls has a child by the time she turns 20. Nearly one million teenage girls become pregnant in the U.S. each year, and 78% of these pregnancies are unintended. With the United States disgraced with a teenage pregnancy rate more than twice that of its neighbor to the north, clearly the state of

contraceptive technology is not the only problem. Politics, pricing and culture have also limited access to contraceptives that already on the market. A 2004 report calls contraceptive availability in the United States an “unfinished revolutionâ€. Still, even with universal health coverage and consistent support for contraception, other prosperous nations have not completely eliminated the need for abortion – a sign that the search must continue for reliable, foolproof, long-term contraceptives free from frustrating side effects. Western Europe, where 1% of reproductive-age women get abortions each year, probably represents the limit of what can be accomplished with current contraceptives .Current contraceptives don’t meet everyone’s needs. The current contraceptive situation is far from ideal, and this remains true despite its recent improvement. For instance, in the United States, the

selection of contraceptives has become more similar to that in Europe with the recent introduction of three new hormonal methods for women: the contraceptive patch, the contraceptive ring, and the Mirena IUS (intrauterine system), the last of which has been in use in Europe for more than a decade. These methods can combine lower peak doses of hormones, more physiologically natural delivery systems, and greater reliability than the traditional Pill. Many hope that these new methods will be appealing to women and that their efficacy will soon bring lower rates of unwanted pregnancies.However, even at its best, this state of affairs leaves two major groups unserved by the “contraceptive supermarketâ€: (1) women who experience intolerable side effects from hormonal methods, and (2) men who are too young for vasectomy but want more reliable control over their fertility than condoms can provide. Unfortunately, these are both rather large groups. For

example, even among women who don’t have contraindications to the Pill (such as smoking, breastfeeding, or varicose veins), nearly every woman who has used the Pill has experienced weight gain, breast tenderness, or reduced libido. (As for condoms, although they are 98% reliable with perfect use, the real-world yearly pregnancy rate can be as high as 15%, leaving many men wishing for a viable backup method There is an even greater need in the developing world.For most women in the developing world, the contraceptive revolution is not unfinished. Rather, it has yet to arrive. Lack of adequate contraception is literally a life and death matter: one woman in seven (or even six) dies in pregnancy or childbirth in Afghanistan, Angola, Malawi, Niger, and Sierra Leone. Not only can access to contraception and birth-spacing determine whether a woman will live past her twenties, but a mother’s level of

education and her access to family planning services are the factors most strongly associated with the well-being of her children. Existing contraceptive options fall short. The existing contraceptive situation repre-sents a massive global burden of morbidity, mortality, and lost opportunities, both in developing and prosperous nations. Politics, war, tradition, and economics all play a role in perpetuating this situation. Despite the overwhelming nature of such forces, a large part of the problem remains a simple lack of effective, affordable, appropriate contraceptive options. A cheap, effective, and user-friendly option could make a tremendous difference even in such an inhospitable global environment. RegardsDr Sanjay Yallappa ChoudhariJR2,Dept of PharmacologyGMC, Nagpur

[Guest guest]

Interesting points.How can lack to access to contraceptives (point number three, even greater need in developing countries) be a reason for introduction of new contraceptives?/Arin

On Mon, Apr 12, 2010 at 6:04 AM, sanjay choudhari <sanjaych7@...> wrote:

 

Dear members,Why do we need new contraceptives? • Abortion rates are still high.

• Current contraceptives don’t meet everyone’s needs. • There is an even greater need in the developing world.• Existing contraceptive options fall short.  Regards

Dr Sanjay Yallappa Choudhari

JR2,Dept of PharmacologyGMC, Nagpur

[Guest guest]

Dear Sanjay,

Welcome to NetRUM as moderator again. Please ensure that you dont make all

postings in rich text and dont increase the font size.

When sexual pleasure is derived by both partners, why should only women use

contraceptives and also suffer from the ADRs of these? The men who also indulge

in risky behaviour should also be the target of contraceptives.

Vijay

>

> Dear members,

>

> Why do we need new contraceptives?

>

> Abortion rates are still high.

> In the United States, about 2% of women get an abortion each year, and more

than 20% of total pregnancies end in abortion. Furthermore, the United States

has the highest adolescent birth rate in the industrialized world †" about four

times the European Union average, and more than 10 times the rate in Japan and

Korea. In fact, one in five girls has a child by the time she turns 20. Nearly

one million teenage girls become pregnant in the U.S. each year, and 78% of

these pregnancies are unintended. With the United States disgraced with a

teenage pregnancy rate more than twice that of its neighbor to the north,

clearly the state of contraceptive technology is not the only problem. Politics,

pricing and culture have also limited access to contraceptives that already on

the market. A 2004 report calls contraceptive availability in the United States

an “unfinished revolutionâ€. Still, even with universal health coverage and

consistent support for

> contraception, other prosperous nations have not completely eliminated the

need for abortion †" a sign that the search must continue for reliable,

foolproof, long-term contraceptives free from frustrating side effects. Western

Europe, where 1% of reproductive-age women get abortions each year, probably

represents the limit of what can be accomplished with current contraceptives .

>

> Current contraceptives don’t meet everyone’s needs.

> The current contraceptive situation is far from ideal, and this remains true

despite its recent improvement. For instance, in the United States, the

selection of contraceptives has become more similar to that in Europe with the

recent introduction of three new hormonal methods for women: the contraceptive

patch, the contraceptive ring, and the Mirena IUS (intrauterine system), the

last of which has been in use in Europe for more than a decade. These methods

can combine lower peak doses of hormones, more physiologically natural delivery

systems, and greater reliability than the traditional Pill. Many hope that these

new methods will be appealing to women and that their efficacy will soon bring

lower rates of unwanted pregnancies.

> However, even at its best, this state of affairs leaves two major groups

unserved by the “contraceptive supermarketâ€: (1) women who experience

intolerable side effects from hormonal methods, and (2) men who are too young

for vasectomy but want more reliable control over their fertility than condoms

can provide. Unfortunately, these are both rather large groups. For example,

even among women who don’t have contraindications to the Pill (such as

smoking, breastfeeding, or varicose veins), nearly every woman who has used the

Pill has experienced weight gain, breast tenderness, or reduced libido. (As for

condoms, although they are 98% reliable with perfect use, the real-world yearly

pregnancy rate can be as high as 15%, leaving many men wishing for a viable

backup method

>

> There is an even greater need in the developing world.

> For most women in the developing world, the contraceptive revolution is not

unfinished. Rather, it has yet to arrive.

> Lack of adequate contraception is literally a life and death matter: one woman

in seven (or even six) dies in pregnancy or childbirth in Afghanistan, Angola,

Malawi, Niger, and Sierra Leone. Not only can access to contraception and

birth-spacing determine whether a woman will live past her twenties, but a

mother’s level of education and her access to family planning services are the

factors most strongly associated with the well-being of her children.

>

> Existing contraceptive options fall short.

> The existing contraceptive situation repre-sents a massive global burden of

morbidity, mortality, and lost opportunities, both in developing and prosperous

nations. Politics, war, tradition, and economics all play a role in perpetuating

this situation. Despite the overwhelming nature of such forces, a large part of

the problem remains a simple lack of effective, affordable, appropriate

contraceptive options. A cheap, effective, and user-friendly option could make a

tremendous difference even in such an inhospitable global environment.

>

>

>

>

> Regards

> Dr Sanjay Yallappa Choudhari

> JR2,Dept of Pharmacology

> GMC, Nagpur

>

[Guest guest]

Dear Members,It could have been better if we can discuss my view on the topic as follows:

Male Behavior towards Reproductive

Responsibilities

Failure

to assess impact men’s perceptions in reproductive health decisions has

weakened the impact of reproductive health care programmes. We had to evaluate male

sexual partner’s knowledge and practice (in stable and trusted relations only husbands’

knowledge and practice) towards conventional contraceptives as manifested through reproductive health and

sexual decisions. 1

Men

play an essential role in reproduction. They should be encouraged to involve

themselves in birth control, particularly in developing countries, where

contraceptive goals have not been reached 2.

Reproduction

is a dual commitment, but so often in much of the world, it is seen as wholly

the woman's responsibility. Failure to target men in reproductive health

interventions has weakened the impact of reproductive health care programmes.

Men's perceptions, as well as determinants of sexual behavioural change and the

socioeconomic context should be reviewed. There is a need to study and foster

change to reduce or prevent poor reproductive health outcomes; to identify

behaviours which could be adversely affecting women's reproductive health.

Issues of gender, identity and tolerance as expressed through sexuality and

procreation need to be amplified followed up by well-developed causal models of

the determinants of positive reproductive health-promoting behaviours. Preventive

reproductive health initiatives & information should move from the female

alone to both sexes. Women need men as partners in reproductive health who

understand the risks they might be exposed to and strategies for their

prevention3.

The

Brazilian couples did not, in

general, know any effective contraceptive options for use by men and/or

participating in their use, except for vasectomy. The few methods with male

participation that they knew of were perceived to interfere in spontaneity and

in pleasure of intercourse. Men accepted that condom use in extra-conjugal

relations offered them protection from sexually transmitted diseases; that

their wives might also participate in extra-marital relationships was not

considered. The few contraceptive options with male participation lead to

difficulty in sharing responsibilities between men and women. On the basis of

perceived gender roles, women took the responsibility for contraception until

the moment when the situation became untenable, and they faced the unavoidable

necessity of sterilization. Specific actions are necessary for men to achieve

integral participation in relation to reproductive sexual health. These include

education and discussions on gender roles, leading to greater awareness in men

of the realities of sexual and reproductive health4.

In

a study in the Turkey it was found that, male university students who are

sexually active generally do not have enough knowledge about family planning

and family planning. They tend to engage in high-risk behavior. It is

imperative that education and counseling in reproductive and sexual health must

be offered to all young men. In addition, men's attitudes toward contraceptive

methods should be evaluated in other cultures and useful comparisons made with

Turkey 5.

The

study done in Bangladesh found association between men's reproductive health

knowledge, attitude and behaviour and their wives' subsequent reproductive

behaviour and there was also significant association between husbands'

fertility preferences and current use of any family planning method 6.

References:

Chankapa Y D, Tsering D, Pal R. Male Behavior

towards Reproductive Responsibilities

in Sikkim. Indian Journal of

Community Medicine 2010; 35(1):40-5.Pirinçci AF, Oguzöncül E.Knowledge and attitude of married Turkish

men regarding family planning. Eur J

Contracept Reprod Health Care. 2008 Mar;13(1):97-102. Mbizvo MT, Bassett MT. Reproductive health and AIDS prevention

in sub-Saharan Africa: the case for increased male participation.

Health

Policy Plan. 1996 Mar; 11(1):84-92. Marchi NM, de Alvarenga AT, Osis MJ, Bahamondes L.Contraceptive

methods with male participation: a perspective of Brazilian couples.

Int Nurs

Rev. 2008; 55(1):103-9. Sahin NH. Male university students' views,

attitudes and behaviors towards family planning and emergency

contraception in Turkey. J Obstet

Gynaecol Res. 2008; 34(3):392-8. Hossain MB, JF, Mozumder AB.The effect of husbands' fertility

preferences on couples' reproductive behaviour in rural Bangladesh.

J Biosoc

Sci. 2007;39(5):745-57.

"I know quite certainly that I myself have no special talent; curiosity, obsession and dogged endurance, combined with self-criticism, have brought me to my ideas." -Albert Einstein Thanks and regards Professor(Dr.) Ranabir Pal, M.D., D.C.H., M.B.A., FAIMER FELLOWProfessor, Community MedicineSikkim Manipal Institute of Medical Sciences (SMIMS) & Central Referral Hospital(CRH)Chairman,Board of Studies and Member, Research Advisory Committee5thMile,Tadong,Gangtok, Sikkim, India – 737 102Ph.No.+91-3592- 270534/270294/231137, ext Residence) 335, (Hospital) 150Fax:+91-3592-231496/231147/231162Mobile: +91-9433247676e-mail:ranabirmon@...From: sanjay choudhari <sanjaych7@...>Subject: MALE CONTRACEPTIVESnetrum Date: Sunday, 11 April, 2010, 11:36 PM

Dear members,Why do we need new contraceptives? Abortion rates are still high. In the United States, about 2% of women get an abortion each year, and more than 20% of total pregnancies end in abortion. Furthermore, the United States has the highest adolescent birth rate in the industrialized world – about four times the European Union average, and more than 10 times the rate in Japan and Korea. In fact, one in five girls has a child by the time she turns 20. Nearly one million teenage girls become pregnant in the U.S. each year, and 78% of these pregnancies are unintended. With the United States disgraced with a teenage pregnancy rate more than twice that of its neighbor to the north, clearly the state of

contraceptive technology is not the only problem. Politics, pricing and culture have also limited access to contraceptives that already on the market. A 2004 report calls contraceptive availability in the United States an “unfinished revolutionâ€. Still, even with universal health coverage and consistent support for contraception, other prosperous nations have not completely eliminated the need for abortion – a sign that the search must continue for reliable, foolproof, long-term contraceptives free from frustrating side effects. Western Europe, where 1% of reproductive- age women get abortions each year, probably represents the limit of what can be accomplished with current contraceptives .Current contraceptives don’t meet everyone’s needs. The current contraceptive situation is far from ideal, and this remains true despite its recent improvement. For instance, in the United States, the

selection of contraceptives has become more similar to that in Europe with the recent introduction of three new hormonal methods for women: the contraceptive patch, the contraceptive ring, and the Mirena IUS (intrauterine system), the last of which has been in use in Europe for more than a decade. These methods can combine lower peak doses of hormones, more physiologically natural delivery systems, and greater reliability than the traditional Pill. Many hope that these new methods will be appealing to women and that their efficacy will soon bring lower rates of unwanted pregnancies.However, even at its best, this state of affairs leaves two major groups unserved by the “contraceptive supermarketâ€: (1) women who experience intolerable side effects from hormonal methods, and (2) men who are too young for vasectomy but want more reliable control over their fertility than condoms can provide. Unfortunately, these are both rather large groups. For

example, even among women who don’t have contraindications to the Pill (such as smoking, breastfeeding, or varicose veins), nearly every woman who has used the Pill has experienced weight gain, breast tenderness, or reduced libido. (As for condoms, although they are 98% reliable with perfect use, the real-world yearly pregnancy rate can be as high as 15%, leaving many men wishing for a viable backup method There is an even greater need in the developing world.For most women in the developing world, the contraceptive revolution is not unfinished. Rather, it has yet to arrive. Lack of adequate contraception is literally a life and death matter: one woman in seven (or even six) dies in pregnancy or childbirth in Afghanistan, Angola, Malawi, Niger, and Sierra Leone. Not only can access to contraception and birth-spacing determine whether a woman will live past her twenties, but a mother’s

level of

education and her access to family planning services are the factors most strongly associated with the well-being of her children. Existing contraceptive options fall short. The existing contraceptive situation repre-sents a massive global burden of morbidity, mortality, and lost opportunities, both in developing and prosperous nations. Politics, war, tradition, and economics all play a role in perpetuating this situation. Despite the overwhelming nature of such forces, a large part of the problem remains a simple lack of effective, affordable, appropriate contraceptive options. A cheap, effective, and user-friendly option could make a tremendous difference even in such an inhospitable global environment. RegardsDr Sanjay Yallappa ChoudhariJR2,Dept of PharmacologyGMC, Nagpur

[Guest guest]

Dear Friends,I would wish to bring some more issues to the table: -1. The large number of unsafe abortions - all of which could be avoided if contraceptives had been available/accessible/used. The morbidity and mortality is still unacceptably high.

2. The large number of women who get married very young (well before the legal age at marriage) and are expected to prove their fertility without a thought to their health and the outcome of their pregnancy. It is imperative that we increase access and use of contraceptives by couples where the  wife is not physically mature until such time that we can bring about an increase in the age at marriage.

3. The lack of knowledge of contraception among young men and the entire " conspiracy of silence and gender " that ensures that men do not know much about contraception since it is considered a " women's " issue.

Lt Col Anil Paranjape, MDPuneOn Mon, Apr 12, 2010 at 8:10 AM, ranabir pal <ranabirmon@...> wrote:

 

Dear Members,It could have been better if we can discuss my view on the topic as follows:

Male Behavior towards Reproductive

Responsibilities

Failure

to assess impact men’s perceptions in reproductive health decisions has

weakened the impact of reproductive health care programmes. We had to evaluate male

sexual partner’s knowledge and practice (in stable and trusted relations only husbands’

knowledge and practice) towards conventional contraceptives as manifested through reproductive health and

sexual decisions. 1

Men

play an essential role in reproduction. They should be encouraged to involve

themselves in birth control, particularly in developing countries, where

contraceptive goals have not been reached 2.

Reproduction

is a dual commitment, but so often in much of the world, it is seen as wholly

the woman's responsibility. Failure to target men in reproductive health

interventions has weakened the impact of reproductive health care programmes.

Men's perceptions, as well as determinants of sexual behavioural change and the

socioeconomic context should be reviewed. There is a need to study and foster

change to reduce or prevent poor reproductive health outcomes; to identify

behaviours which could be adversely affecting women's reproductive health.

Issues of gender, identity and tolerance as expressed through sexuality and

procreation need to be amplified followed up by well-developed causal models of

the determinants of positive reproductive health-promoting behaviours. Preventive

reproductive health initiatives & information should move from the female

alone to both sexes. Women need men as partners in reproductive health who

understand the risks they might be exposed to and strategies for their

prevention3.

The

Brazilian couples did not, in

general, know any effective contraceptive options for use by men and/or

participating in their use, except for vasectomy. The few methods with male

participation that they knew of were perceived to interfere in spontaneity and

in pleasure of intercourse. Men accepted that condom use in extra-conjugal

relations offered them protection from sexually transmitted diseases; that

their wives might also participate in extra-marital relationships was not

considered. The few contraceptive options with male participation lead to

difficulty in sharing responsibilities between men and women. On the basis of

perceived gender roles, women took the responsibility for contraception until

the moment when the situation became untenable, and they faced the unavoidable

necessity of sterilization. Specific actions are necessary for men to achieve

integral participation in relation to reproductive sexual health. These include

education and discussions on gender roles, leading to greater awareness in men

of the realities of sexual and reproductive health4.

In

a study in the Turkey it was found that, male university students who are

sexually active generally do not have enough knowledge about family planning

and family planning. They tend to engage in high-risk behavior. It is

imperative that education and counseling in reproductive and sexual health must

be offered to all young men. In addition, men's attitudes toward contraceptive

methods should be evaluated in other cultures and useful comparisons made with

Turkey 5.

The

study done in Bangladesh found association between men's reproductive health

knowledge, attitude and behaviour and their wives' subsequent reproductive

behaviour and there was also significant association between husbands'

fertility preferences and current use of any family planning method 6.

References:

Chankapa Y D, Tsering D, Pal R. Male Behavior

towards Reproductive Responsibilities

in Sikkim. Indian Journal of

Community Medicine 2010; 35(1):40-5.Pirinçci AF, Oguzöncül E.Knowledge and attitude of married Turkish

men regarding family planning. Eur J

Contracept Reprod Health Care. 2008 Mar;13(1):97-102. Mbizvo MT, Bassett MT. Reproductive health and AIDS prevention

in sub-Saharan Africa: the case for increased male participation.

Health

Policy Plan. 1996 Mar; 11(1):84-92. Marchi NM, de Alvarenga AT, Osis MJ, Bahamondes L.Contraceptive

methods with male participation: a perspective of Brazilian couples.

Int Nurs

Rev. 2008; 55(1):103-9. Sahin NH. Male university students' views,

attitudes and behaviors towards family planning and emergency

contraception in Turkey. J Obstet

Gynaecol Res. 2008; 34(3):392-8. Hossain MB, JF, Mozumder AB.The effect of husbands' fertility

preferences on couples' reproductive behaviour in rural Bangladesh.

J Biosoc

Sci. 2007;39(5):745-57.

" I know quite certainly that I myself have no special talent; curiosity, obsession and dogged endurance, combined with self-criticism, have brought me to my ideas. " -Albert Einstein

Thanks and regards Professor(Dr.) Ranabir Pal, M.D., D.C.H., M.B.A., FAIMER FELLOW

Professor, Community MedicineSikkim Manipal Institute of Medical Sciences (SMIMS) & Central Referral Hospital(CRH)

Chairman,Board of Studies and Member, Research Advisory Committee5thMile,Tadong,Gangtok, Sikkim, India – 737 102

Ph.No.+91-3592- 270534/270294/231137, ext Residence) 335, (Hospital) 150Fax:+91-3592-231496/231147/231162

Mobile: +91-9433247676e-mail:ranabirmon@...

From: sanjay choudhari <sanjaych7@...>Subject: MALE CONTRACEPTIVESnetrum

Date: Sunday, 11 April, 2010, 11:36 PM

 

Dear members,Why do we need new contraceptives?   Abortion rates are still high. 

In the United States, about 2% of women get an abortion each year, and more than 20% of total pregnancies end in abortion. Furthermore, the United States has the highest adolescent birth rate in the industrialized world – about four times the European Union average, and more than 10 times the rate in Japan and Korea. In fact, one in five girls has a child by the time she turns 20. Nearly one million teenage girls become pregnant in the U.S. each year, and 78% of these pregnancies are unintended. With the United States disgraced with a teenage pregnancy rate more than twice that of its neighbor to the north, clearly the state of

contraceptive technology is not the only problem. Politics, pricing and culture have also limited access to contraceptives that already on the market. A 2004 report calls contraceptive availability in the United States an “unfinished revolution”. Still, even with universal health coverage and consistent support for contraception, other prosperous nations have not completely eliminated the need for abortion – a sign that the search must continue for reliable, foolproof, long-term contraceptives free from frustrating side effects. Western Europe, where 1% of reproductive- age women get abortions each year, probably represents the limit of what can be accomplished with current contraceptives .

Current contraceptives don’t meet everyone’s needs. The current contraceptive situation is far from ideal, and this remains true despite its recent improvement. For instance, in the United States, the

selection of contraceptives has become more similar to that in Europe with the recent introduction of three new hormonal methods for women: the contraceptive patch, the contraceptive ring, and the Mirena IUS (intrauterine system), the last of which has been in use in Europe for more than a decade. These methods can combine lower peak doses of hormones, more physiologically natural delivery systems, and greater reliability than the traditional Pill. Many hope that these new methods will be appealing to women and that their efficacy will soon bring lower rates of unwanted pregnancies.

However, even at its best, this state of affairs leaves two major groups unserved by the “contraceptive supermarket”: (1) women who experience intolerable side effects from hormonal methods, and (2) men who are too young for vasectomy but want more reliable control over their fertility than condoms can provide. Unfortunately, these are both rather large groups. For

example, even among women who don’t have contraindications to the Pill (such as smoking, breastfeeding, or varicose veins), nearly every woman who has used the Pill has experienced weight gain, breast tenderness, or reduced libido. (As for condoms, although they are 98% reliable with perfect use, the real-world yearly pregnancy rate can be as high as 15%, leaving many men wishing for a viable backup method 

There is an even greater need in the developing world.For most women in the developing world, the contraceptive revolution is not unfinished. Rather, it has yet to arrive. Lack of adequate contraception is literally a life and death matter: one woman in seven (or even six) dies in pregnancy or childbirth in Afghanistan, Angola, Malawi, Niger, and Sierra Leone. Not only can access to contraception and birth-spacing determine whether a woman will live past her twenties, but a mother’s

level of

education and her access to family planning services are the factors most strongly associated with the well-being of her children. Existing contraceptive options fall short. The existing contraceptive situation repre-sents a massive global burden of morbidity, mortality, and lost opportunities, both in developing and prosperous nations. Politics, war, tradition, and economics all play a role in perpetuating this situation. Despite the overwhelming nature of such forces, a large part of the problem remains a simple lack of effective, affordable, appropriate contraceptive options. A cheap, effective, and user-friendly option could make a tremendous difference even in such an inhospitable global environment.

 RegardsDr Sanjay Yallappa ChoudhariJR2,Dept of PharmacologyGMC, Nagpur

[Guest guest]

Hi All,

Once again, like problem based learning, this is turning out to be an

extremely interesting discussion.

Excellent points raised.

Another issue that Vijay briefly touched earlier today was about

sexuality and reproduction. In a commentary about sexuality, pleasure,

and contraception (Pleasure deficit [1]), Higgins and Hirsch (2007)

has written about Ruth Dixon-Mueller's (1993) notion about sanitzation

of sexual intercourse by the health community. They wrote, " ... ways

in which the positive aspects of sexual experience contribute to

women's sexual health and risk are little understood. Despite a few

notable exceptions, the public health research community has largely

failed to explore the factors that contribute to optimal sexual

functioning for women or the ways in which sexual pleasure-seeking (as

opposed to love-seeking or money-seeking) influences women's risk for

unintended pregnancy and disease.  " .

This issue on " pleasure deficit " is not trivial and I think any

discussion on contraception needs to discuss these issues as well,

both for men and women alike. As we discuss these issues, for male

contraception related discussion, other issues that might be worth

keeping in mind are issues around men's health, cultural norms of

masculinity, and related issues. All of these in turn, influence

uptake of contraception.

Look forward to discussions.

[1]jenny A. Higgins and S. Hirsch. The Pleasure Deficit:

Revisiting the " Sexuality Connection " in Reproductive Health.

International Family Planning Perspectives. Volume 33, Number 3,

September 2007, available at

http://sparky.guttmacher.org/pubs/journals/3313307.html

On Mon, Apr 12, 2010 at 7:02 PM, Dr Anil Paranjape

<anilvparanjape@...> wrote:

>

>

>

> Dear Friends,

> I would wish to bring some more issues to the table: -

> 1. The large number of unsafe abortions - all of which could be avoided if

contraceptives had been available/accessible/used. The morbidity and mortality

is still unacceptably high.

> 2. The large number of women who get married very young (well before the legal

age at marriage) and are expected to prove their fertility without a thought to

their health and the outcome of their pregnancy. It is imperative that we

increase access and use of contraceptives by couples where the  wife is not

physically mature until such time that we can bring about an increase in the age

at marriage.

> 3. The lack of knowledge of contraception among young men and the entire

" conspiracy of silence and gender " that ensures that men do not know much about

contraception since it is considered a " women's " issue.

>

> Lt Col Anil Paranjape, MD

> Pune

>

>

> On Mon, Apr 12, 2010 at 8:10 AM, ranabir pal <ranabirmon@...> wrote:

>>

>>

>>

>> Dear Members,

>>

>> It could have been better if we can discuss my view on the topic as follows:

>>

>> Male Behavior towards Reproductive Responsibilities

>>

>> Failure to assess impact men’s perceptions in reproductive health decisions

has weakened the impact of reproductive health care programmes. We had to

evaluate male sexual partner’s knowledge and practice (in stable and trusted

relations only husbands’ knowledge and practice) towards conventional

contraceptives as manifested through reproductive health and sexual decisions. 1

>>

>> Men play an essential role in reproduction. They should be encouraged to

involve themselves in birth control, particularly in developing countries, where

contraceptive goals have not been reached 2.

>>

>> Reproduction is a dual commitment, but so often in much of the world, it is

seen as wholly the woman's responsibility. Failure to target men in reproductive

health interventions has weakened the impact of reproductive health care

programmes. Men's perceptions, as well as determinants of sexual behavioural

change and the socioeconomic context should be reviewed. There is a need to

study and foster change to reduce or prevent poor reproductive health outcomes;

to identify behaviours which could be adversely affecting women's reproductive

health. Issues of gender, identity and tolerance as expressed through sexuality

and procreation need to be amplified followed up by well-developed causal models

of the determinants of positive reproductive health-promoting behaviours.

Preventive reproductive health initiatives & information should move from the

female alone to both sexes. Women need men as partners in reproductive health

who understand the risks they might be exposed to and strategies for their

prevention3.

>>

>> The Brazilian couples did not, in general, know any effective contraceptive

options for use by men and/or participating in their use, except for vasectomy.

The few methods with male participation that they knew of were perceived to

interfere in spontaneity and in pleasure of intercourse. Men accepted that

condom use in extra-conjugal relations offered them protection from sexually

transmitted diseases; that their wives might also participate in extra-marital

relationships was not considered. The few contraceptive options with male

participation lead to difficulty in sharing responsibilities between men and

women. On the basis of perceived gender roles, women took the responsibility for

contraception until the moment when the situation became untenable, and they

faced the unavoidable necessity of sterilization. Specific actions are necessary

for men to achieve integral participation in relation to reproductive sexual

health. These include education and discussions on gender roles, leading to

greater awareness in men of the realities of sexual and reproductive health4.

>>

>> In a study in the Turkey it was found that, male university students who are

sexually active generally do not have enough knowledge about family planning and

family planning. They tend to engage in high-risk behavior. It is imperative

that education and counseling in reproductive and sexual health must be offered

to all young men. In addition, men's attitudes toward contraceptive methods

should be evaluated in other cultures and useful comparisons made with Turkey 5.

>>

>> The study done in Bangladesh found association between men's reproductive

health knowledge, attitude and behaviour and their wives' subsequent

reproductive behaviour and there was also significant association between

husbands' fertility preferences and current use of any family planning method 6.

>>

>> References:

>>

>> Chankapa Y D, Tsering D, Pal R. Male Behavior towards Reproductive

Responsibilities in Sikkim. Indian Journal of Community Medicine 2010;

35(1):40-5.

>> Pirinçci AF, Oguzöncül E.Knowledge and attitude of married Turkish men

regarding family planning. Eur J Contracept Reprod Health Care. 2008

Mar;13(1):97-102.

>> Mbizvo MT, Bassett MT. Reproductive health and AIDS prevention in sub-Saharan

Africa: the case for increased male participation. Health Policy Plan. 1996 Mar;

11(1):84-92.

>> Marchi NM, de Alvarenga AT, Osis MJ, Bahamondes L.Contraceptive methods with

male participation: a perspective of Brazilian couples. Int Nurs Rev. 2008;

55(1):103-9.

>> Sahin NH. Male university students' views, attitudes and behaviors towards

family planning and emergency contraception in Turkey. J Obstet Gynaecol Res.

2008; 34(3):392-8.

>> Hossain MB, JF, Mozumder AB.The effect of husbands' fertility

preferences on couples' reproductive behaviour in rural Bangladesh. J Biosoc

Sci. 2007;39(5):745-57.

>>

>> " I know quite certainly that I myself have no special talent; curiosity,

obsession and dogged endurance, combined with self-criticism, have brought me to

my ideas. " -Albert Einstein

>>

>> Thanks and regards

>>

>> Professor(Dr.) Ranabir Pal, M.D., D.C.H., M.B.A., FAIMER FELLOW

>>

>> Professor, Community Medicine

>>

>> Sikkim Manipal Institute of Medical Sciences (SMIMS) & Central Referral

Hospital(CRH)

>>

>> Chairman,Board of Studies and Member, Research Advisory Committee

>>

>> 5thMile,Tadong,Gangtok, Sikkim, India – 737 102

>>

>> Ph.No.+91-3592- 270534/270294/231137, ext Residence) 335, (Hospital) 150

>>

>> Fax:+91-3592-231496/231147/231162

>>

>> Mobile: +91-9433247676

>>

>> e-mail:ranabirmon@...

>>

>>

>>

>> From: sanjay choudhari <sanjaych7@...>

>> Subject: MALE CONTRACEPTIVES

>> netrum

>> Date: Sunday, 11 April, 2010, 11:36 PM

>>

>>

>>

>> Dear members,

>>

>> Why do we need new contraceptives?

>>

>>

>>

>>   Abortion rates are still high.

>> In the United States, about 2% of women get an abortion each year, and more

than 20% of total pregnancies end in abortion. Furthermore, the United States

has the highest adolescent birth rate in the industrialized world – about four

times the European Union average, and more than 10 times the rate in Japan and

Korea. In fact, one in five girls has a child by the time she turns 20. Nearly

one million teenage girls become pregnant in the U.S. each year, and 78% of

these pregnancies are unintended. With the United States disgraced with a

teenage pregnancy rate more than twice that of its neighbor to the north,

clearly the state of contraceptive technology is not the only problem. Politics,

pricing and culture have also limited access to contraceptives that already on

the market. A 2004 report calls contraceptive availability in the United States

an “unfinished revolution”. Still, even with universal health coverage and

consistent support for contraception, other prosperous nations have not

completely eliminated the need for abortion – a sign that the search must

continue for reliable, foolproof, long-term contraceptives free from frustrating

side effects. Western Europe, where 1% of reproductive- age women get abortions

each year, probably represents the limit of what can be accomplished with

current contraceptives .

>>

>> Current contraceptives don’t meet everyone’s needs.

>> The current contraceptive situation is far from ideal, and this remains true

despite its recent improvement. For instance, in the United States, the

selection of contraceptives has become more similar to that in Europe with the

recent introduction of three new hormonal methods for women: the contraceptive

patch, the contraceptive ring, and the Mirena IUS (intrauterine system), the

last of which has been in use in Europe for more than a decade. These methods

can combine lower peak doses of hormones, more physiologically natural delivery

systems, and greater reliability than the traditional Pill. Many hope that these

new methods will be appealing to women and that their efficacy will soon bring

lower rates of unwanted pregnancies.

>> However, even at its best, this state of affairs leaves two major groups

unserved by the “contraceptive supermarket”: (1) women who experience

intolerable side effects from hormonal methods, and (2) men who are too young

for vasectomy but want more reliable control over their fertility than condoms

can provide. Unfortunately, these are both rather large groups. For example,

even among women who don’t have contraindications to the Pill (such as smoking,

breastfeeding, or varicose veins), nearly every woman who has used the Pill has

experienced weight gain, breast tenderness, or reduced libido. (As for condoms,

although they are 98% reliable with perfect use, the real-world yearly pregnancy

rate can be as high as 15%, leaving many men wishing for a viable backup method

>>

>> There is an even greater need in the developing world.

>> For most women in the developing world, the contraceptive revolution is not

unfinished. Rather, it has yet to arrive.

>> Lack of adequate contraception is literally a life and death matter: one

woman in seven (or even six) dies in pregnancy or childbirth in Afghanistan,

Angola, Malawi, Niger, and Sierra Leone. Not only can access to contraception

and birth-spacing determine whether a woman will live past her twenties, but a

mother’s level of education and her access to family planning services are the

factors most strongly associated with the well-being of her children.

>>

>> Existing contraceptive options fall short.

>> The existing contraceptive situation repre-sents a massive global burden of

morbidity, mortality, and lost opportunities, both in developing and prosperous

nations. Politics, war, tradition, and economics all play a role in perpetuating

this situation. Despite the overwhelming nature of such forces, a large part of

the problem remains a simple lack of effective, affordable, appropriate

contraceptive options. A cheap, effective, and user-friendly option could make a

tremendous difference even in such an inhospitable global environment.

>>

>>

>>

>>

>> Regards

>> Dr Sanjay Yallappa Choudhari

>> JR2,Dept of Pharmacology

>> GMC, Nagpur

>>

>>

>

>

[Guest guest]

I think there is a huge unmet need for an

effective,inexpensive,reliable,safe and reversible male contraceptive.

Alternatives that are available today are hardly used and raise serious

concerns about reversibility of fertility. But then as pointed out we

cannot dissociate love from reproduction and an effective male

contraceptive answers only the second part of the entire package.. A

very important and prime function of the only effective and widely used

male contraceptive method (if it may be called so) - the condom - is

protection from infection. So any male contraceptive that is developed

needs to be developed with the implicit understanding of its limited

role in the love & reproduction process....Efforts to develop an

effective male contraceptive should not lead to fostering of a behavior

where the condom is discarded because protection is no longer needed

from unwanted pregnancy...

sanjay choudhari wrote:

 

Dear members,

Why do we need new contraceptives?

 

  Abortion rates are still high. 

In the United States, about 2% of women get an abortion each year, and

more than 20% of total pregnancies end in abortion. Furthermore, the

United States has the highest adolescent birth rate in the

industrialized world – about four times the European Union average, and

more than 10 times the rate in Japan and Korea. In fact, one in five

girls has a child by the time she turns 20. Nearly one million teenage

girls become pregnant in the U.S. each year, and 78% of these

pregnancies are unintended. With the United States disgraced with a

teenage pregnancy rate more than twice that of its neighbor to the

north, clearly the state of contraceptive technology is not the only

problem. Politics, pricing and culture have also limited access to

contraceptives that already on the market. A 2004 report calls

contraceptive availability in the United States an “unfinished

revolutionâ€. Still, even with universal health coverage and consistent

support for contraception, other prosperous nations have not completely

eliminated the need for abortion – a sign that the search must continue

for reliable, foolproof, long-term contraceptives free from frustrating

side effects. Western Europe, where 1% of reproductive-age women

get abortions each year, probably represents the limit of what can be

accomplished with current contraceptives .

Current contraceptives don’t meet everyone’s

needs. 

The current contraceptive situation is far from ideal, and this remains

true despite its recent improvement. For instance, in the United

States, the selection of contraceptives has become more similar to that

in Europe with the recent introduction of three new hormonal methods

for women: the contraceptive patch, the contraceptive ring, and the

Mirena IUS (intrauterine system), the last of which has been in use in

Europe for more than a decade. These methods can combine lower peak

doses of hormones, more physiologically natural delivery systems, and

greater reliability than the traditional Pill. Many hope that these new

methods will be appealing to women and that their efficacy will soon

bring lower rates of unwanted pregnancies.

However, even at its best, this state of affairs leaves two major

groups unserved by the “contraceptive supermarketâ€: (1) women who

experience intolerable side effects from hormonal methods, and (2) men

who are too young for vasectomy but want more reliable control over

their fertility than condoms can provide. Unfortunately, these are both

rather large groups. For example, even among women who don’t have

contraindications to the Pill (such as smoking, breastfeeding, or

varicose veins), nearly every woman who has used the Pill has

experienced weight gain, breast tenderness, or reduced libido. (As for

condoms, although they are 98% reliable with perfect use, the

real-world yearly pregnancy rate can be as high as 15%, leaving many

men wishing for a viable backup method 

There is an even greater need in the

developing world.

For most women in the developing world, the contraceptive revolution is

not unfinished. Rather, it has yet to arrive. 

Lack of adequate contraception is literally a life and death matter:

one woman in seven (or even six) dies in pregnancy or childbirth in

Afghanistan, Angola, Malawi, Niger, and Sierra Leone. Not only can

access to contraception and birth-spacing determine whether a woman

will live past her twenties, but a mother’s level of education and her

access to family planning services are the factors most strongly

associated with the well-being of her children. 

Existing contraceptive options fall short. 

The existing contraceptive situation repre-sents a massive global

burden of morbidity, mortality, and lost opportunities, both in

developing and prosperous nations. Politics, war, tradition, and

economics all play a role in perpetuating this situation. Despite the

overwhelming nature of such forces, a large part of the problem remains

a simple lack of effective, affordable, appropriate contraceptive

options. A cheap, effective, and user-friendly option could make a

tremendous difference even in such an inhospitable global environment.

 

Regards

Dr Sanjay Yallappa Choudhari

JR2,Dept of Pharmacology

GMC, Nagpur

--

Dr. Arif Hashmi

Junior Resident - 1,

Dept. of Pharmacology,

Govt. Medical College & Rajindra Hospital,

Patiala, Punjab.

0-956-904-7686

email:drarifhashmi@...