RI men still lackluster about contraception

By Injil Abu Bakar

DENPASAR, Bali (JP): On June 29, in honor of National Family Day, State Minister of the Empowerment of Women Khofifah Indar Parawansa spoke up for Indonesian women by decrying abuses that occurred during the Soeharto era family planning campaigns.

Referring to practices like the infamous "safaris", which rounded up women and persuaded them to use contraceptives, and the heavy pressure tactics sometimes used by local family planning officials, she argued that no woman should be coerced into using birth control.

But what Khofifah failed to mention was that in Indonesia women are still shouldering the heavy burden of family planning, virtually alone. Men constitute less than 6 percent of the nation's contraceptive acceptors.

Why do Indonesian men seem so reluctant to take reproductive responsibility? It certainly cannot be explained as a fear of the doctor or an unwillingness to have their sexuality scrutinized.

After all, recent reports from America that attributed 16 deaths to the "magic pill" Viagra have hardly dimmed Indonesian men's bright-eyed enthusiasm for the famed impotency medicine.

But at the same time as men are grateful for the "medicine of the gods", other startling medical research reports claiming that a number of common compounds may be effective and safe as male contraceptives have been all but ignored by the local media.

Drawbacks

There are a number of reasons men offer for their reluctance to take part in family planning. The two methods of male contraception currently available in Indonesia, vasectomy and condoms, are perceived to have too many drawbacks.

Vasectomy is irreversible and is thought to affect one's "manhood", making a man weak or effeminate. There is a widespread misconception that the operation is similar to castrating a bull or a dog, even though it is only the vas deferens, the tiny tube that brings the sperm from the testicles to the tip of the penis, that is cut.

Condoms are also thought to interfere with male sexuality by diminishing sensations and causing intimate relations to lose their "spontaneity". Few men realize that condoms may actually increase sexual pleasure for both partners by prolonging intercourse and preventing premature ejaculation in a way that is much safer than medications like Viagra.

But there are sound medical reasons why it may, in many cases, make more sense for men to practice family planning. Many women experience side effects -- ranging from the relatively mild to the very serious -- when using such contraceptive methods as the birth control pill, the IUD or spiral, or the contraceptive injection.

In such cases, condoms, which have few side effects -- with the exception of an occasional allergy to the latex brands -- may be a sensible choice. When used properly, especially in combination with a spermicide, condoms are quite effective, preventing pregnancy in 96 percent of cases.

For new mothers who are breastfeeding their babies, male contraceptives are an especially good alternative, as they do not risk interfering with milk production, as female contraceptives such as the birth control pill do. Condoms also have the important advantage of protecting against sexually transmitted diseases like gonorrhea, syphilis and chlamydia, and conditions like AIDS, which can cause death or damage to the reproductive organs.

There are also a number of social reasons why men should play a more active role in family planning. In a society struggling toward democracy and equal rights for women, it should be recognized that both husband and wife hold responsibility for pregnancy.

Placing the weight of family planning on women alone serves to reinforce the ideology that limits the role of women in society to the domestic realm of the household and family, and that frees men from family responsibilities to take the lead in political and economic affairs. By taking more responsibility for contraception, men express their commitment to the health and wellbeing of their families, and challenge stereotypes that hold a woman's natural role as the sole caretaker of the home and children.

Luckily, a number of recent reports indicate that it may soon become easier for Indonesian men to contribute their fair share to family planning. A possible male birth control pill might be a variation on the ordinary Aspirin pill.

Several years ago, the German medical journal Praxis Kurier reported that the popular headache reliever appeared to create sterility in men. According to the report, when Aspirin was taken in doses to relieve headaches over the course of a week, male fertility dropped drastically. The research, carried out in America, the world's number one consumer of Aspirin, may help explain why male sterility has been on the rise in recent years.

There are still major questions about the potential use of these findings, however, for Aspirin can have serious side effects, interfering with the body's blood clotting mechanism and creating changes in blood vessel walls. Because of these concerns, it is not yet recommended as a male contraceptive.

Researchers have also discovered that an extract of the vegetable known as pare (bitter momordica) has a contraceptive effect in men, lowering the quantity and quality of sperm produced. This finding has many in the medical community excited, for the vegetable is inexpensive and widely available, and the extract has a low toxicity and relatively few side effects. For men who fear taking the final step of vasectomy, the good news is that a pare extract contraceptive is reversible.

Although more research still needs to be done, preliminary findings point positively toward the birth of a new choice for male birth control.

The question, however, still remains as to whether drug companies will invest the large sums necessary to bring a new male contraceptive to the market if they believe community interest is low.

Although there is public opinion research that suggests many men believe family planning to be the responsibility of both husband and wife, too many in the birth control business seem to assume that women are the natural targets for their products.

But as we wait for a new safe, effective and high quality male contraceptive, we can all educate ourselves about available birth control alternatives and commit to making sexuality, reproduction and family matters a shared responsibility.

The writer is a general practitioner, based in Denpasar, Bali.