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. 2025 May;145:110811. doi: 10.1016/j.contraception.2025.110811

The impact of male contraception on global sexual and reproductive health and rights☆☆☆☆☆☆

Nancy Kidula a,⁎, Brian T Nguyen b, Ndema Habib a, James Kiarie a
PMCID: PMC7617376  EMSID: EMS202215  PMID: 39788344

Abstract

The right to health and other health-related human rights are legally binding commitments enshrined in international human rights instruments. While these positions are known and ratified by policy makers, little has been done to actualize men’s sexual and reproductive health (SRH) as an integral part of attaining these important global goals. Not addressing men’s SRH over and above supporting their female partners sustains the sexual and reproductive risks and burdens that women must bear. Advances in contraceptive technology with several male contraceptive candidates in advanced clinical trials bolsters expectations for a broader contraceptive method mix including greater choice of male contraceptives. This would potentially increase awareness and investments in the men’s SRH and promote health systems strengthening and gender equity including shared responsibility for prevention of pregnancy, sexually transmitted infections, and HIV. This paper is a review and synthesis of published literature including research publications, reports, global policies and commitments and technical documents available online and in organizational repositories such as the World Health Organization (WHO) Institutional repository for information sharing (IRIS) on male contraception and men’s SRH. We provide insights on the impact of male contraception including novel methods and the spillover effects on global SRH. We call on all stakeholders to invest in men’s SRH since the attainment of the Sustainable Development Goal (SDG) target 3.7 on Universal access to SRH cannot be met without addressing this neglected topic.

Keywords: Gender equity, Health systems, Integration, Male contraception, Monitoring, Reproductive health

1. Background

In 1994, the World Health Organization (WHO) and representatives from 179 countries convened, as part of the International Conference on Population and Development (ICPD), to advance global standards for sexual and reproductive health and develop strategies for their universal attainment [1]. This was reaffirmed in 2015 under the Sustainable Development Goal (SDG) target 3.7 that called on governments and stakeholders to ensure universal access to Sexual and Reproductive Health (SRH) services for all by 2030 [2]. They defined sexual and reproductive health as “a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity in all matters relating to the reproductive system and to its functions and processes;” with sexual and reproductive health care being “the constellation of methods, techniques and services that contribute to reproductive health and wellbeing by solving reproductive health problems.” [1]. Essential elements of SRH include sexual health, maternal and perinatal health, family planning/contraception, infertility, sexually transmitted infections (STIs), reproductive tract cancers, prevention of unsafe abortion, sexual and gender-based violence, and adolescent sexual and reproductive health among others [3], [4].

1.1. Rationale for investing in men’s sexual and reproductive health

A critical aspect of the ICPD’s Program of Action was its recognition that men have distinct SRH needs that should be addressed in parallel with those of women [1]. In many settings however, little attention is paid to men’s SRH needs beyond their role in supporting their female partners’ access and utilization of SRH services. A recent report by the Global Action on Men’s Health revealed significant under representation of men’s SRH issues in regional and global sexual and reproductive health policy [5]. The limited focus on men's SRH in public policy, programs, financing, advocacy, research, service provision, measurement, information, and education has resulted in the area being regarded as a women’s issue [6], [7]. Data to support the need to address men’s SRH alongside that of women includes: a high proportion of infertility (45%) attributable to male factors [8], higher age-standardized incidence rates of sexually transmitted infections in men compared to women [9], high prevalence of human papilloma virus (HPV) in men of -31% [10], increasing prostate cancer prevalence [11], and high prevalence of sexual dysfunction with >50% of men 40–70 years describing some degree of sexual dysfunction [12]. These findings amplify the need to address men’s SRH issues which are inextricably linked to women’s. Notwithstanding, the call to address men’s SRH “is in no way intended to detract from the sexual and reproductive health and rights, nor to divert resources from much-needed SRH services and programs for women and adolescent girls” [13]. Rather, addressing men’s SRH issues at the level of scrutiny as has been done for women is aimed at alleviating the inequitable burden of diagnosis, intervention, and prevention placed on women while affording men access to SRH information and services for themselves.

1.2. Concerns around male contraception and SRH

To date there are three male-directed contraceptive methods available for use: withdrawal, male or external condoms, and vasectomy–all with unique problems that impact their acceptability, accessibility, and effectiveness. The development of novel male contraceptive methods seeks to address some of these gaps by providing a wider range of male directed methods and increasing choice of contraception. The introduction of novel male contraceptives however raises several issues that warrant further reflection by developers, funders, policy makers, program managers, rights groups, implementation partners and other stakeholders at global regional and country level.

  • •

    Are additional male directed methods a ‘‘good buy’’ for the global SRH landscape?

  • •

    With society’s attention to raising awareness about and ensuring access primarily to the range of female-controlled contraceptive methods, resources for men have been comparatively limited. How will education and healthcare have to change to ensure the inclusion of men and new male contraceptive options?

  • •

    As men have historically not needed to interact with the healthcare system for contraceptive care because of the widespread availability of condoms, the healthcare system may be unprepared to deliver new male contraceptives and by extension men’s reproductive health services in primary care settings. How will the healthcare system need to change to ensure availability, accessibility, and affordability?

  • •

    With the physical burden of carrying pregnancy falling on women, men do not directly benefit from using contraceptives that would otherwise only cause side effects or risk adverse events. As such, what, (if any), additional benefits would men need to perceive for them to ‘risk’ taking novel male contraceptives?

  • •

    As the development of female hormonal contraceptives contributed significantly to women’s empowerment and agency, might the availability of new male contraceptives affect women’s reproductive autonomy and social progress towards gender equity?

  • •

    Metrics on men’s SRH are generally limited to those relevant to infertility and impotence. With the development of new male contraceptives, how might broader SRH metrics be influenced? Which relevant metrics should be collected?

We anticipate that introducing new male contraceptive will do more than just prevent pregnancy. In this paper, we present areas of broad additional value for SRH, including fostering integrated health services, strengthening health systems, enhancing health information and education, strengthening SRH metrics, and ensuring universal access to SRH for all within a gender transformative and human rights environment.

1.3. Male contraception as an entry point for integrated SRH services for men and boys

For many individuals, the pursuit of family planning services is their first independent entry point into the healthcare system [14]. Contraception services for women are traditionally provided in tandem with other SRH services, such as screening and management of sexually transmitted infections and reproductive tract cancers. With time more services have been added, including blood pressure measurement, HIV testing, smoking cessation, mental health screening, among others. Men also need these services however, their poor health seeking behavior hinders their engagement with the health system [7]. Failure to access all-inclusive and integrated quality services has been cited as one of the most important reasons for men’s poor involvement in reproductive health services [15]. Introduction of novel male contraceptive methods affords a reason for men to visit a health facility and potentially receive comprehensive SRH services [16]. Availing integrated health services where other SRH and medical comorbidities for men can be diagnosed and managed in tandem with contraception is more efficient and enhances the client experience, which may consequently incentivise men to seek health services. Moreover, interventions that need partner testing and treatment such as HIV testing and STI treatment often expect affected women to either take the prescription to their partners or inform the partner to come for testing as part of curbing the transmission cycle. Rather than accruing the positive spillover effects of partner testing and treatment, this often triggers gender-based violence [17]. Enhanced male engagement and partner support may be attained by strengthening communication and education around SRH issues as part of the integrated service delivery.

1.4. Male contraception as trigger for health systems strengthening

1.4.1. Policy and financing

The WHO Human Reproduction Program has elucidated ‘Critical considerations and actions for achieving universal SRH access in the context of Universal Health Coverage (UHC). Among them is the inclusion of SRH services in national health policies and plans [18]. While women’s SRH is well articulated in global and regional policy and has dedicated strategies to spur investments, a recent review of global and regional SRH related policies revealed very limited inclusion of men, with only 16% specifically addressing men’s inherent need for SRH services [5]. This paucity of men’s SRH in global policy has far reaching implications on regional and national policy, guidance, research, and programming, including resource allocation by governments and partners.

In many countries, female contraceptives and male condoms are part of the essential health service package and included in the UHC compendium and benefit package. The concept of financial risk protection within UHC is intended to improve access while mitigating out-of-pocket expenditures for essential health services [18]. Notwithstanding, contraceptive programs in many countries rely heavily on stagnating donor funds [19], [20]. Further, a UNAIDS report noted decreasing investments in condom procurement and distribution between 2010 and 2022 [21] adversely impacting access and utilization of one of the few male methods available. The introduction of novel male contraceptives warrants a review of global and national SRH policies and strategies to include men’s SRH in the essential health benefit package to ensure that all contraceptive methods (male and female) are covered equitably and assure financial risk protection without which uptake of novel male contraceptives in development will not be possible.

1.4.2. Health workforce

Limited access and availability of SRH services, perceptions that SRH facilities are not male friendly spaces, and lack of focus on men’s SRH contribute to poor SRH service uptake among men in low- and middle-income countries (LMICs) [22], [23]. Sadly, the health systems’ capacity to deliver the essential package of SRH services in many countries is weak. This gap is grossly evident with vasectomy where weak infrastructure, insufficient numbers, and weak competencies of health workers hamper the provision of services [23]. Furthermore, there is inadequate medical training to deal with SRH issues, especially for men [24]. Specialists in male SRH are few as compared to the need [25], and often inaccessible given that they are commonly based in tertiary health care facilities. While almost all female contraceptives and male condoms may be provided by nurse midwives and other advanced practice clinicians, the WHO guidelines on task shifting recommend that vasectomy and tubal ligation be offered by physicians and physician associates [26]. However, few doctors seem to have vasectomy competencies [27], and training opportunities and resources are becoming scarcer [28]. This has gross implications especially for vaso-occlusive novel male contraceptives that will heavily rely on the expertise of vasectomy providers. Moreover, ensuring universal access to male contraception requires that these services are available in primary care facilities, which are not traditionally staffed by physicians. Considering the very limited workforce for vasectomies and the insufficient competencies in male SRH that will be encountered when novel male contraceptives reach the market, it will be imperative to focus on infrastructure for training in and offering men's SRH which requires changes in policy, regulations, scope of practice, and training curricula.

1.4.3. Infrastructure

The entry of novel male contraceptives into the contraceptive method mix demands a review of the health systems capacity to support introduction and scale up. The current health facility infrastructure in many places does not cater for men’s SRH and would need to be reworked to ensure male-friendly service delivery spaces or dedicated service areas where men can obtain SRH services, with privacy, confidentiality and dignity, appropriate equipment, and supplies, the lack of which has been found discourage men’s participation in SRH services [7].

1.4.4. Service delivery

The Essential Package of Healthcare Services (EPHS) comprises health services that individual governments designate to be provided free of charge or at a minimum cost to everyone accessing them through public facilities at the point of receiving the service [29]. Nonetheless, some of these services may for a variety of reasons be unavailable in public health facilities forcing those needing them to go to private health facilities and thus incur out of pocket expenditures. The UHC has provided for a “Health Benefit Package’’ (HBP) that denotes a selection of services linked to a financing mechanism and therefore more likely to be available without financial risk to the user [29]. Generally, family planning methods including male methods are in the EPHS, however services like vasectomy are consistently missing from the HBPs [30]. Including novel male contraception in both the EPHS and HBP is critical to guarantee availability and access in contexts where vasectomy and other male directed methods might be cost prohibitive. New male contraceptive methods need to be added to the list of essential medicines and devices- to do otherwise essentially negates investments in male contraceptive development.

1.5. Male contraception as an opportunity for strengthening SRH education and stigma reduction

Education around SRH, including male contraception is critical for raising awareness, dispelling myths and misconceptions, promoting contraceptive uptake, and can facilitate early recognition, and management of various SRH conditions. Studies have linked men’s underutilization of SRH and misinformation about SRH interventions to lack of reliable information and knowledge gaps around SRH services [16], [22], [31], [32]. Addressing cultural perceptions that SRH is a women’s issue, negative norms and stigma surrounding contraception and men’s involvement can lead to better support for female partners and improve men’s SRH and health-seeking behaviors [32], [33]. Male contraception may serve as an entry point for providing information and education around other Male SRH issues in line with the integrated approach to health care, leveraging appropriate approaches for integrated SRH/ FP services in women [34]. As new male contraceptive methods emerge, key messages and communication strategies around method choice and decision-making among individuals and couples will need to be reworked. Digital strategies may be leveraged to reach adolescent populations and enhance their SRH literacy [35].

1.6. Male contraception as an opportunity to address gender-based inequities in SRH and contraceptive services

It is imperative that men are engaged not just as supporters but beneficiaries of SRH services and products if gender equity in SRH is to be fully realized [36]. However, global SRH efforts have focused on women, with male engagement often misconstrued as empowering, enabling, or in nominal support of their female partners to access and utilize family planning services, inclusive of contraception. Consequently, women continue to bear the burden not only of pregnancy and childbirth, but also pregnancy prevention and the management of an unwanted pregnancy. The burden of contraception for women is underscored by the disproportionate risks and side effect profiles of female-controlled contraceptives, as compared to available male contraceptives. The focus on female contraception has had wide repercussions on global commitments, funding, contraceptive research, training, and even national health systems. The absence of new male contraceptive alternatives has been termed ‘‘a matter of social justice’’ [6] in the face of numerous user perspective research consistently showing men’s willingness to use novel male contraceptives and women’s willingness to trust their partners to use male directed contraception [37].

The efficiencies subsumed in effective male contraception cannot be underrated in that in the period that a woman carries only one pregnancy to term, a man can impregnate several women. The introduction of new male contraceptives affords an opportunity for men to share the responsibility for pregnancy prevention, access SRH information and services, and support their partners better. It further fosters choice for men – a major determinant for uptake, and adherence [38]. This demands clear innovative, more comprehensive, integrated, and male friendly service delivery approaches that are complementary to existing women’s SRH services.

Additionally, availability of men’s SRH services has the potential to impact access and utilization of SRH services by special groups including adolescent boys, men who have sex with men, and gender diverse persons by destigmatizing SRH and male contraception, facilitating information and education, and creation of safe places for diverse populations to obtain SRH services. It is also relevant for different settings including incarceration, emergencies, and complex humanitarian situations.

1.7. Male contraception as a catalyst for updating SRH metrics

Data on male contraception and men’s SRH is scanty and most global policies and frameworks have minimal or no specific measurements targeting men [5]. This inadvertently limits the understanding of the magnitude and effects of men’s SRH issues and deters the designing and implementing of evidence-based solutions. The Demographic and Health Surveys is a program that supports countries to collect, analyse and disseminate accurate data on population and health including on family planning [39]. It includes the ‘‘Man’s questionnaire’’ which collects some data on contraceptive use, STIs and HIV, but which is nonetheless very lean on other aspects of men’s SRH. While these areas have been surveyed individually and valuable data obtained on men, there is need for inclusion of dedicated questions on men’s SRH in global instruments and survey tools, and for incorporation of specific indicators and targets into global policies and frameworks to highlight the need for investments and to monitor impact.

An understanding of factors that influence the uptake and use of male contraception such as educational initiatives, access to male contraception services and affordability may be obtained through evaluation of policies and programs that promote male contraception use and can be applied across the wider SRH [40]. Sales and prescription data for male contraception products is another good source of data on consumer behavior and market trends [41].

Recognizing advancements in male contraceptive development, male reproductive health indicators should be included in the Health Management Information Systems (HMIS) [42], [43]. Incomplete standardization of contraception indicators, inclusive of male contraception, is a major gap [44] and consensus is needed on specific data points to be collected including prevalence of use, method choice, discontinuation rates, and reasons for non-use, to ensure consistency in reporting of these indicators across different regions and countries. Moreover, many countries need continuous advocacy and support to integrate male SRH indicators, inclusive of male contraception, into existing national health monitoring frameworks.

While efforts have been made to develop data collection tools, there is a need for ongoing refinement and validation to ensure that they accurately capture male SRH/contraception data. Additionally, innovative data collection methodologies, including the use of digital health technologies, could enhance the accuracy and timeliness of male contraception data. Training programs and resources focused on male reproductive health data collection and management can help to strengthen the capacity of healthcare workers and data managers to effectively collect, record, and report male contraception data [45], [46], [47] and improve the quality and completeness of the data.

Enhanced coordination and collaboration among international organizations, governments, and non-governmental organizations is essential to drive progress in setting global indicators and inclusion in HMIS for male contraception and SRH. This includes sharing best practices, harmonizing data collection efforts, and aligning strategies for data reporting.

2. Conclusions and recommendations

The potential impact of new male contraceptive products on global sexual and reproductive health goes beyond its impact on men alone, extending to women and girls via its promotion and facilitation of a more gender equitable society. Indeed, studies have demonstrated positive impact of male engagement in SRH on reproductive maternal and child health [48], [49]. With selected novel male contraceptive in advanced clinical trials, time is ripe for instituting systems to facilitate introduction, scale up and sustainability of male contraception programs which can serve as a nidus for integrated SRH care for men. This will entail ramping up advocacy for recognition of men’s SRH as a public health concern and therefore an area for investments, strengthening health systems to deliver men’s SRH services, increasing public information and awareness around men’s SRH including the value addition for women’s health and gender equity, and strengthening data and metrics for men’s SRH. In this way we shall have contributed to the SDG 3.7 target ‘‘By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies’’ [2].

Author contributions

N.K.: Writing – original draft, Visualization, Project administration, Conceptualization. J.K.: Writing – review & editing, Validation, Supervision, Conceptualization. N.H.: Writing – review & editing, Visualization, Conceptualization. B.T.N.: Writing – review & editing, Visualization, Conceptualization.

Acknowledgments

The authors would like to thank the International Consortium for Male Contraception (ICMC), for inviting them to present on this topic in the 4th International Congress on Male Contraception and to contribute to the Special issue on Male Contraception.

Limitations of the review

The authors recognize that some publications may have been missed during the review and note the formidable task to cite all available publications on this subject as this would go above the allowable reference limit. Notwithstanding the authors believe that the references are representative of the situation on ground.

Open access

This is an open access article distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Footnotes

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Conflicts of interest: Brian T. Nguyen (BTN) is a consultant for the ongoing WHO Global Study on men’s and women’s male contraceptive knowledge attitudes and behaviors using mixed methods. BTN reports a relationship with Sebela Pharmaceuticals Inc that includes consulting or advisory. BTN reports a relationship with Sumitomo Pharma America Inc that includes consulting or advisory. NK, NH, and JK are current staff of the World Health Organization, Geneva, Switzerland and have no competing interests to declare.

☆☆

Funding: The authors did not receive any specific grant from funding agencies in the public, commercial or not for profit sectors to support this publication.

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This is an Open Access article published under the CC BY NC ND 3.0 IGO license which permits users to download and share the article for non-commercial purposes, so long as the article is reproduced in the whole without changes, and provided the original source is properly cited. This article shall not be used or reproduced in association with the promotion of commercial products, services or any entity. There should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted.

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