In 2016, a two-hormone birth control method for men made headlines. The injection showed promise, but Stage II trial was stopped after an independent review panel found the drug had “too many side effects”, including mood swings and depression.
However, what those headlines didn’t include was that, out of the 420ish participating men, 85% said they would still use that contraception method: side effects and all.
Access to birth control has unquestionable benefits. For one example, estimates for the economic impact of family planning have found that $3.6 billion a year spent on providing contraception to all those who want them has an annual return potential of $432 billion – or a $120 dollar return for every $1 invested.
And yet, despite birth control’s positive effects, the current methods are lacking for both women and men – to such an extent that men still expressed interest in the two-hormone shot, regardless of its side effects. After all, men have limited contraception options at their disposal: abstinence, condoms, withdrawal (also known as the pull-out method), and vasectomies. In contrast, women, who tend to carry the responsibility of birth control in heterosexual couples, have a variety of options including abstinence, condoms, emergency contraceptives, implants, injections, intrauterine devices (IUDs), patches, pills, shots, spermicide, and vaginal rings. But they, in turn, can face the emotional, financial, mental, and physical burdens with side effects that can include depression, hair loss, headaches, micronutrient deficiencies, mood swings, nausea, suicide, heavier periods, lighter periods, early periods, late periods, shorter periods, longer periods, or no periods — among others. A 2012 study found that 91% of women believed that no currently available contraception method had all the features they thought to be significant: affordability, effectiveness, and lack of side effects.
“I’ve believed for the past decade that there are not enough good contraception options, period,” says Kevin Eisenfrats, CEO and founder of Contraline. Founded in 2015, Contraline is focused on male contraception specifically; its first product, ADAM™ is a non-hormonal hydrogel that is inserted in the vas deferens, the pair of tubes that transport sperm. ADAM™ blocks the sperm without affecting sensation or ejaculation. Unlike vasectomies, which can be challenging and expensive to reverse, ADAM™ is a birth control option that can be removed if needed or can last until it dissipates. The Contraline team’s first goal is to create a gel that lasts about one to two years before it dissolves but may develop one in the future that lasts three to five years.
Contraline’s first in-human trial only reinforced the demand for a novel birth control method for men. The company’s trial includes 25 patients – but almost 1,000 filled out Contraline’s survey to express their interest in participating in the first place. These men, on average, were 34 years old, haven’t had kids before, didn’t want to use condoms and were too young to have a vasectomy. Collectively, this group expressed interest in both having control over their own contraception and sharing the responsibility of birth control with their partners.
While Contraline is developing a new birth control option for men, Twentyeight Health is ensuring that women have access to and education around existing birth control options. More than 19 million women of reproductive age in the United States live in “contraceptive deserts”: places with an insufficient numbers of health clinics offering the full range of birth control options to meet the needs of the number of women eligible for publicly funded contraception – or fewer than one health clinic per 1,000 women in need. The closing of clinics, which included places such as Planned Parenthood, and the stigma on contraception only provides additional limits.
Founded in 2018 by Bruno Van Tuykom and Amy Fan, Twentyeight Health’s goal is to provide affordable access and convenience for the reproductive and sexual health needs of women, especially those who are underserved; they may be low-income, uninsured, on Medicaid, in rural areas, or even simply lacking high-speed Internet access. “We identified a gap in care for underserved women, especially those on Medicaid, and over 63% of the company’s patients didn’t have access to birth control before they came to Twentyeight Health”, Mr. Van Tuykom, Co-Founder and CEO of Twentyeight Health, shares.
In turn, Twentyeight Health help address the challenges around affordability, effectiveness, and side effects of women’s birth control. For example, the cost of a pack of oral contraception pills, one of the most popular contraception options, can cost up to $50 per pack for the uninsured. Through Twentyeight Health, the cost can be as low as $18 per pack for the uninsured while the company’s network of culturally competent doctors help patients find the best method.
The company is also partnering with major payers to increase access and to be a women’s digital healthcare solution for more than just contraceptives. Twentyeight Health can provide abortion pills, herpes treatment, prenatal vitamins, and COVID-19 tests –as well as education around those products. Patients have access to Twentyeight Health’s doctor network, the company’s content is all doctor-approved, the platform is in English and Spanish, and the content is at no more than a sixth-grade reading level so that race, ethnicity, language, and/or education level are not barriers to care.
And demand for those services has only increased since June 2022. Following the overturning of Roe v. Wade, “We saw a 3x increase in the demand for birth control, and the demand hasn’t slowed down since,” said Livia Kesemen, Twentyeight Health’s Director of Strategy & Product. Permanent birth control options are seeing a spike in interest as well. Nationwide, vasectomy procedures increased by 30% from July through September 2022 compared with the same time period in 2021. Some urologists now have waiting lists for vasectomies.
As Mr. Eisenfrats believes, improving contraception is not a winner-takes-all game; rather, the ultimate goal should be to serve customers by giving them options such as ADAM™, vasectomies, or one of the 100+ birth control brands that Twentyeight Health offers. The Twentyeight Health team agrees that there should be as many birth control options as possible for women and men. While both Twentyeight Health and Contraline are both for-profit organizations, Christina Azimi, Director of Marketing at Twentyeight Health, notes, “It’s powerful how health equity is built into our business model”. In other words, the company and its customers can benefit together; the customer has access to education around and options for birth control, and the company can stay in business to provide those services.
Birth control dropped off the list of medical research’s top 35 priorities in 1988 and men and women today still feel the repercussions with the number of contraception options available, their affordability, their accessibility, their costs, and their potential side effects. World Contraception Day, which has been observed on September 26 every year since 2007, aims to improve awareness of contraception and enable individuals, especially young people, to make informed choices around reproductive and sexual health. It can also, though, be a reminder that society needs continued improvement, investment, and innovation in birth control options for men and women alike – and a chance to spotlight companies like Contraline and Twentyeight Health who are making these options a reality.
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