For 60 years birth control has largely been the responsibility of women with very few options for men.
And while the invention of the pill in the 1960s was a revolution for women, allowing them to stay in careers and choose when they had children, it also meant they were delegated the task of managing it.
Since the invention of the pill several other forms of female birth control have become available in New Zealand, and worldwide, most with varying side effects. For example, side effects for the pill include fatigue, headaches, blood clots, acne, low sex drive and weight gain.
Over the past 10 years a male birth control method has been inching closer to a reality. But do we even need one?
Associate Professor and director of the Public Health Program at Pittsburgh University Dr Martha Terry said developing a male contraceptive is important because women have been carrying the physical, mental and financial burdens of birth control for decades.
Terry, who is also a cultural anthropologist, said birth control was originally focused on women because they had very little control over their own fertility, with all the options being controlled by men such as condoms or withdrawal.
She said the downside to this is a view that contraception is a women's responsibility.
But she said as social norms change men and women both want more birth control options.
"Women want men to have a way to be a part of the process and if men have a birth control method they are able to have a more equitable conversation about what method to use," she said.
But Terry warned that even if a male birth control method is developed, women might be reluctant to completely allow men to take control of it because women "pay the price of pregnancy".
Non-scientific opinion polls back this theory up, with women expressing concern that their partner would forget to take a male birth control pill.
"Women will never be off the hook because women pay the real cost of having children, from the bodily toll of pregnancy, to the pain of childbirth and the struggles of breastfeeding," she said.
Professor of medicine at the Lundquist Institute at Harvard UCLA Medical Center Dr Christina Wang is heavily involved in the development of hormonal male birth control. Dr Wang is leading studies into a pill, gel and injection for men. She said the gel, which is rubbed onto the shoulders and upper arms daily, is showing a lot of promise.
The gel is a hormone-based treatment designed to reduce sperm production without affecting libido and with minimal other side effects. Its effectiveness is currently being tested in a year-long study.
Dr Wang told Newshub birth control for men is important because it would take some of the stress off women.
"It's about sharing. So the theory is the man will do it for a few years then the woman will for a few years. They will have a kid and do it again. It's about sharing the responsibility."
Dr Wang said while the current methods being trialled are mostly aimed at men in relationships, there is also interest from single men.
But unfortunately that option is still at least a decade away.
Why is it taking so long to develop a male birth control?
A male birth control pill has been in development for over 50 years. In contrast it took only 10 years for the female pill to be created and approved.
The eager development of the pill was out of necessity and that haste did come with some drawbacks, such as severe side effects including strokes. However, through development, the female pill is now a safe and accessible option for many women.
Over the years experts have given many reasons for the delay in male birth control. Lack of funding, increased difficulty in creating it, disinterest from both men and pharmaceutical companies, and unpleasant side effects are just some of the numerous setbacks.
Dr Wang said creating birth control for men is more difficult because men are constantly producing sperm.
"For women using hormones all we have to do is stop the ovulation at the time. In men they produce millions and millions of sperm… so we have to suppress the sperm production all the time," she said.
The pill, gel and injection will also help test the market for other non-hormonal methods, Dr Wang said.
"We know the hormones, we know what side effects to look for and we know how to deal with it. These hormones have been around for a long time so we know and can anticipate what will happen.
"We hope one of those methods can be launched and then once it is launched, it's about the uptake by the men."
Dr Wang said while they are looking into three different methods the principle is the same - "stop the hormones...and suppress the production of sperm".
Another issue they are facing is a delay in male contraceptives taking effect.
"Sperm production peaks around three months...so everything is delayed by about three months," Dr Wang said.
This means men need to be using contraceptives for roughly three months to ensure there is no more fertile sperm.
This is the same with vasectomy.
Dr Wang also stressed the importance of making sure the birth control has minimal side effects so men want to use it.
She said the best way to mitigate symptoms is to make sure the contraceptive has a very low dose of hormones, unlike the first pill for women which contained very high levels of hormones.
"We are more sophisticated than when we were when we developed the female pill where it was a very high dose of estrogen and progesterone. Nobody would even allow it now."
But despite all the progress, she said a male control method is still at least 10 years away.
"Our current phase two studies (of the gel) are going well, it's going slow and COVID-19 has slowed it down... but so far there are no pregnancies."
Dr Wang said if the long term study shows it's effective it will move to another testing phase before being approved for use.
"If that is good we are moving to a phase three study which would need 2000 couples for one year or 1000 couples for two years. So we think that [male birth control] will be [available] in 10 years optimistically."
Lack of interest holding it back
Other issues that have slowed down the development of male birth control is a lack of interest from pharmaceutical companies, Dr Wang said.
Negative media coverage about side effects from earlier studies of a male pill, coupled with a perceived lack of money to be made has meant pharmaceutical companies aren't very interested in supporting the development of any contraception.
"Companies that were previously supporting female studies are not anymore and they are not [even] supporting male studies," Dr Wang said.
She said companies are more focused on other drugs.
"They [pharmaceutical companies] are interested in cancer, obviously COVID-19... cholesterol, high blood pressure and cardiovascular disease."
Despite the lack of interest, Dr Wangs said there is clearly a market for male birth control.
"We have demonstrated that there is a market... of maybe $40 million or more a year, so big companies in theory should be interested but then there is the liability of pregnancies and giving drugs to healthy people not sick patients, so there are many deterrents to the development of a male birth control by pharmaceutical companies."
Another question hanging over its development is whether men will actually use it. While there haven't been any studies in years, Dr Wang said ones carried out in the 1990s and early 2000s actually showed most men were open to using some form of male birth control.
"Because the social structure… has changed so much in the past 10 years these studies have to be done again, but the studies that have been published show at least more than half of the men would be willing to try a new method other than a condom or vasectomy."
And women's interest is even more positive.
"Females support the method (male birth control) even more strongly than males. They would like the men to participate and share family planning responsibility," Dr Wang said.
So while it might take some time, it seems both men and women are eager for some more options.
