Walking On Egg Shells: Reproduction And Gender Equity

This blog post mostly addresses heterosexual, cisgender couples but it could include  genders and sexual identities among people concerned about personal fertility and unplanned pregnancy.    

Recently, a client  called me in a panic. “He was inside me without a condom. Is it too late to take Postinor (the morning after pill)?  His pre-cum could have sperm in it, right? How could I have let this happen? Where do I go if I’m pregnant and need an abortion? OMG -what am I going to do?”  

She was clearly upset, and could not stop beating herself up for being so reckless.  “I hear how stressful this is for you,” I told her calmly. “But based on everything you’ve told me about your secretions and the day of the cycle, I think there’s a very small chance that you could be pregnant.”  

When she regained her balance, I couldn’t resist asking, “Why is this just about you? What about your partner (of many years!)?  Is there a reason why 50% of the responsibility here doesn’t lie with him?” She went silent. Why is it so natural for women to assume blame and responsibility for non-use of condoms which prevent unplanned pregnancy? When it comes to so many reproductive issues,  why is it always the woman who is left “walking on eggs?”    

During my 35-year career as a reproductive health educator and Sympto-Thermal Method teacher, having counseled thousands of people and couples who truly want to be in control of their bodies, cycles, fertility, sexuality and relationships, I am sad to admit that so little seems to have changed in terms of shared roles and responsibility for birth control.   

Mutual Responsibility Between Couples

Why do learned gender roles still keep women from asserting themselves?  Why do I continue to hear stories about male partners who kvetch about condoms? Why do women continue to take on the role of the “enablers?” Why do they bend over backwards with only compassion for their whining partners who insist that condoms ruin spontaneity and diminish sexual pleasure? 

And we should never forget that the condom is the only method that can protect both partners against sexually transmitted infections! In over three decades of talking to people about sexual pleasure, shared responsibility and  reproductive decision-making, I do not recall even one client who ever reported her refusal to have sex with someone because he refused to wear a condom. In short, when will condom use be normalized- like wearing a seat belt while driving? 

Unfortunately, we see a similar pattern regarding our cultural and medical assumptions about male infertility. We likewise tend to put the onus on women, even though nearly half of all infertility problems reside with men! 

Ignoring the main cause of male infertility

More than forty years have passed since the first successful IVF milestone and it is still the women who have to bear the risks and dangers of infertility treatments.  The medical profession and society as a whole have no problem labeling “infertile” women in stigmatizing language. No one bats an eye when pronouncing they have hormonal deficiencies, dysfunctional bleeding, diminished ovarian reserve, hostile cervical mucus, repeated miscarriage and pregnancy loss, etc. Yet we have a paucity of comparable labeling for fertility inadequacies in men. Everybody tiptoes around men, as if acknowledging poor sperm quality is akin to emasculating someone’s gender identity. In Israel, for example, couples are routinely told that “everything’s OK.” Doctors rarely reveal the true picture about the man’s poor sperm quality because they can isolate one good sperm and inject it into the woman’s egg which will hopefully lead to a viable pregnancy. 

Finally, there is really no medical speciality focusing on the main cause of male fertility – poor sperm quality. Urologists diagnose and treat testicular and urinary tract disorders and genital issues (including prostate).  Andrologists treat hormonal imbalances and sexual dysfunction. But when it comes to poor sperm quality there are no real specialists. 

Rather, gynecologists tend to manage the situation by treating the women. Women are expected to sacrifice their physical and mental health, and often their careers, when pursuing costly and invasive high-tech fertility treatments. 

Conventional medicine knows how to bypass and create an artificial menstrual cycle with artificial hormones to increase the chances of pregnancy, but nobody is minding the store on male infertility, despite the fact that infertility problems are shared almost equally between men and women. 

We now know that the age of the father also affects the genetics of a child.  It is not just “her” issue. Sperm is not timeless. Older sperm are less successful at doing their job and more importantly, they may be associated with abnormal pregnancy and congenital defects.  

Bottom line

It is hard to dispute that these patterns reveal a blatant bias towards protecting men’s status and privilege. It is time to stop walking on eggs. Time to stop worrying about protecting male ego and masculinity by ignoring the importance of scientific research and treatment for poor sperm quality, and treating men with white gloves for fear of making them uncomfortable. Why should they be less vulnerable to reproductive harm than women? Because their fertility doesn’t affect pregnancy and children?  

In terms of contraception, it is time for women to put themselves first, and stop operating under the notion that a partner’s needs are more important than her own. Using contraception and navigating infertility is a mutual enterprise. Scientists, practitioners and the community at large should ensure that gender equity and equality, accountability and shared responsibility are the values which define our ethics and our sexual and reproductive decisions.