The year 2024 is expected to usher in a new era of birth control. While an exact date has yet to be announced, an oral contraceptive named Opill is likely to be available over-the-counter, without a prescription, some time this year. Approved by the FDA in 2023, the manufacturer said to expect the pill to be readily available in stores and online at leading retailers across the U.S. in “early 2024.”
Not only will this be a historic moment in reproductive rights in America, one that is long overdue, but the so-called mini pill is progestin-only. Compared to combination oestrogen-progestin pills, progestin-only pills carry fewer risks like blood clots and can be accessible to more people. Experts see this pill as not only a win for reproductive rights, but as a celebratory moment of innovation in contraceptives.
Experts tell Salon they’re seeing more innovation in the contraceptive science field than before. The future, they say, looks bright and even more equitable as abortion care restrictions sweep across the country.
“I think there is a shift towards more gender equity, you can see more men getting comfortable taking on and sharing that burden,” Dr. Brian Nguyen, an assistant professor in the obstetrics and gynecology department at the University of Southern California, told Salon. “And more female partners who are expressing that their male partners should take on the burden.”
Male partners have had no options to prevent pregnancy that fall between condoms and vasectomies. But Nguyen sees firsthand the “paradigm shift” that’s happening because he helps run clinical trials for two potential male contraceptive options. One, which he says is closest going to market as it’s currently in a phase 2b trial, is a male hormonal gel. The other is a once-a-day pill.
The idea is that men would rub the gel on their shoulders once a day. Over the course of several weeks, it would gradually reduce their sperm count to less than one million. A “normal” sperm count is 15 million to one million per millimeter, so the idea is that by dropping that to less than one million is quite dramatic and can make the possibility of pregnancy less likely. While he couldn’t share specific details, the results are “very promising,” he said.
The daily pills are only in the first phase of their research and development. They work by suppressing hormones that initiate sperm production, not unlike the hormone suppression that is key to some forms of female birth control.
But this really only scratches the surface of what could be on the horizon. One option, that Nguyen isn’t directly involved with, is a non-hormonal pill that targets a protein that would produce Vitamin A. Previous research has shown that mice deprived of Vitamin A are infertile. In December 2023, a small clinical trial kicked off for this non-hormonal option in the U.K. including 16 participants. Improved reversible vasectomies could also be something that becomes more common in the future, Nguyen said.
“There's really no limit to the diversity of methods that could and should come out for men in the same way that we created diverse methods for females,” Nguyen said, pointing out that most innovation that’s happened in birth control has focused on female bodies.
Humans have been controlling their reproduction for all of recorded history, from ancient Egyptian vaginal suppositories made of animal dung to spermicidal ointments made with cedar and olive oil employed by 4th Century Greeks. Modern birth control is a little more sophisticated (and effective.) In 1916, a nurse named Margaret Sanger opened the Brownsville Clinic, the first birth control clinic in America — which was quickly scrutinized and rapidly shut down. The story goes that despite moments of progress, female contraception has historically been hard to innovate and access for over a century now.
“Issues specific to women, girls, and pregnant-capable individuals have always been understudied and underfunded,” Dr. Alison Edelman, professor and OB/GYN at Oregon Health and Science University, told Salon via email. “However, contraception comes with its own challenges — it is an area of high risk but potentially high reward.”
Edelman elaborated that it’s difficult to create something for a diverse and healthy population. Plus, the stakes are pretty high: a majority of reproductive-aged females will use a contraceptive method in their lifetime. It must work to prevent pregnancy, be safe and have few side effects, for a big population.
“Given this high bar, Big Pharma has decreased their footprint in contraceptive research and development over the years and now,” she said. “Much of the current innovations are being pushed forward by nonprofits, small startups, the NIH NICHD [National Institute of Child Health and Human Development] and individual researchers.”
This month, the CDC released a report on popular contraceptive choices for teenagers between 2015 and 2019. Condoms were the first most common method of contraception for females between the ages of 15 and 19. The withdrawal method was second on the list, and the pill ranked third. The fourth most popular method was the Depo-Provera injectable, which surpassed an intrauterine device (IUD) device. Another method on the list was a hormonal implant called Nexplanon. Just as it sounds, this birth control is a matchstick-sized implant that physicians insert into a person’s arm. It releases hormones to prevent pregnancy.
While it sounds a bit like science fiction, similar implants could be the future of birth control, too. Nguyen said to even expect neuro-modulating switches, which turn signals on and off in the brain — but that right now it’s “baby steps” with the first one to finally get a male contraceptive other than condoms on the market.
How far are we away from that? "Hopefully in next five years," he said.
