The male pill and the inseparable nature of science and society

Over a decade since the publication of “The Male Pill” by Nelly Oudshoorn, there is still no male equivalent of the contraceptive pill. Astonishingly, four decades since the feminist movement and the Governments of China and India (an unusual menage a trios) called for the male pill, there is still no existence of this revolutionary technology. In her book, Oudshoorn set out to analyse the social, technological, cultural and political reasons as to why the male pill was taking so long to make. This book is a challenging read, partly because Oudshoorn explains in great depth the role of the many actors involved in development of the male pill and because the book spans many research fields from science & technology studies to gender & feminist studies, medicine, science, pharmaceutical innovation & industry, to the politics of the west and the developing world. I first read this book a few years ago when I became increasingly interested in the sociology of the life sciences and I recently decided to read the book again, to see if my understanding of the issues have broadened in any way.

The book is organised in two parts. Part 1 discusses how alternative socio-technical networks have been constructed in order to overcome resistance to the male pill. Part 2 focuses on the role of encouraging the necessary social and cultural change so that men accept the male pill. The chapters could be read as stand-alone and felt like a collection of review papers, each with their own introduction and conclusions section. In her acknowledgements, Oudshoorn states that some of the chapters are based on previous publications. This provides an explanation as to why some of the book seems very repetitive; although, as a relative newcomer to the field(s), I did find this repetition useful at times.

Chapter 1 is devoted to explaining that “a new technology will succeed only when it is able to attract a network of sociotechnical relationships” (p11). A critique of the construction of these sociotechnical networks forms part 1 of the book and the pace of construction of these networks is partly to blame for the slow pace of the development.

Oudshoorn states that condoms only account for only 17% of contraceptive method(p14) and that “female sterilization, oral contraceptives, and IUDs account for the majority of methods currently in use” (p14). Oudshoorn concludes that both men and women are disciplined to believe that contraception is a woman’s responsibility (p14) and argues that this is part of a culture of hegemonic masculinity where men (and thus society) delegate the responsibility for contraception to women. It is not until later (p127) that Outshoorn discusses a different opinion within the feminist movement, that women should maintain reproductive control and that including men in family planning as equal partners was a threat to women. I was surprised that this difference of opinion within the feminist movement was not discussed earlier, particularly when it appeared that Oudshoorn was arguing from a feminist-movement point of view for family planning responsibilities to be shared equally between men and women.

Chapter 2 analyses how men became included in research efforts into the male pill. Although there was (and as far as I’m aware, that’s still the case) no male movement calling for a male pill, innovations were taking place during the 1970s. Oudshoorn excellently describes the barriers to the new technology, including a lack of scientists specifically researching the male reproductive system, which was perceived as an “illegitimate line of research” (p31). Pharmaceuticals were largely disinterested in developing the male pill, and in chapter 3, Oudshoorn describes how the World Health Organisation (WHO) became a powerful actor in promoting research and creating networks of university scientists in both developed and developing countries in developing male hormonal contraceptives.

Chapter 4 describes the problems in attracting men to clinical trials and looks at China which had “tested a contraceptive agent (Gossypol) among ten thousand men” (p78). Oudshoorn plays down the role of the authoritarian Chinese Communist Party in ensuring men participated in the clinical trials and instead explains the participation of Chinese men as part of the one-child policy. Surprisingly, Oudshoorn makes no criticism of the statement “In the factories, men were addressed by megaphone to remind them to attend the clinics for Gossypol trial… factory workers made up the majority of trial participants” (p78). She fails to discuss the ethics of compulsory participation in clinical trials under an authoritarian regime.

The co-construction of technologies and risks are described in chapter 5. Oudshoorn powerfully puts the message across that men have a lower tolerance of risk than women when it comes to contraception and it is clear that hegemonic masculinity prevailed throughout (and still prevails in) the development of the male pill. Men’s low tolerance for risk means that this risk is delegated to women (risk of pregnancy).

Part 2 of the book looks at social and cultural changes that were (and still are) essential to promote the male pill to men (and society). Chapter 6 analyses male involvement in family planning and the social and cultural barriers to men being involved, including language. Oudshoorn rightly makes the point that “Technological change requires the mutual adjustment of technologies and identities” (p113). She looks at the link between birth control and masculinity and dispels myths such as men wanting large families to demonstrate virility, thus masculinity. Chapter 7 follows nicely and describes the physical, social and cultural changes (and associated controversies) to family planning clinics that were essential to encourage men to attend.

Chapter 8 describes the clinical trials and emphasises the importance of redefining masculine identity towards a non-hedgemonic masculity. In Chapter 9, Oudshoorn describes how the media perceived the new technology as culturally unacceptable. It certainly holds true today that the media is a powerful actor in the development of new technologies. Chapter 10 continues in the theme of acceptability and describes the role of social scientists performing acceptability studies becoming actors in the development of the male pill.

‘The Male Pill’ is a stimulating read and excellently describes how technological innovation can be achieved by breaking down social and cultural barriers and by creating sociotechnical networks. The book articulates the social, technological, political and cultural issues in the development of this new technology. Having had some time between first reading this book and my recent second reading of the book, I think there are broader issues that the book raises. It indirectly raises questions about the relationship between science, technology and society. Specifically, it’s interesting to think about how the reluctance of society to adopt the male pill is related to the reluctance of science to accept the male pill. The book is a powerful example of how science, society and culture and inseparable and it is difficult to talk about society without talking about science, and vice versa. Science really is at the heart of society and culture, and society and culture really is at the heart of science. Another important issue raised is on the democratisation of science and knowledge, and the powerful role of society in democratising these entities. This book provides an unfortunate example of a case where society gets to decide that scientific research doesn’t go on to become innovative technologies because this new technology would never be accepted as part of our culture.

What a huge disappointment that a decade since publication, barriers still prevent the development of the male pill. Hopefully societal attitudes change so that we can expect a second edition in the near future…?

Nelly Oudshoorn, The Male Pill: A Biography of a Technology in the Making, Duke University Press, 2003, ISBN 0-8223-3195-0, 306 pp.