What can contraceptive justice teach us about coronavirus?

By Arianne Shahvisi

A disease sweeps through the population, and is transmitted between people through ordinary social interaction. One group of people are particularly vulnerable, and infection has very serious consequences for them. Another group is able to transmit the disease, but has little risk of being harmed by it. Measures can be taken by individuals to stem the spread of the disease, but they are burdensome, and most people would rather not undertake them. Which group should be required to take measures to minimise harm?

My moral intuition is that the group that has little or no risk of being harmed—the “transmitters”—should be solely or chiefly responsible for undertaking measures to protect those most at risk—the potential “sufferers.” While one might argue that this puts an unfair burden on the transmitters, the potential cost to the sufferers is so high that it is justifiable to impose such a burden. Further, potential sufferers should not have to shoulder both the risk of infection and the burden of protecting against it.

That is the gist of my most recent research article. You’d be forgiven for assuming it’s about coronavirus. It isn’t. (I’m not so quick at thinking or writing as to have got around to that yet.) No, it’s a paper about contraceptive responsibility, but there are some uncanny parallels that are worth noting. In what follows, I’ll first summarise a couple of the arguments I make in this research article, and then reflect on what this might teach us about coronavirus.

Unwanted pregnancy is a lot like an infectious disease. It’s transmitted through a normal social activity—penis-in-vagina sex—and causes nine months of serious physical disruption to a woman’s life, including risks of diabetes, bleeding, back pain, cramp, tiredness, digestive issues, urinary incontinence, deep vein thrombosis, headaches, high blood pressure, indigestion, nausea, haemorrhoids, varicose veins, sleeplessness, mental health issues, and mortality. In short, unwanted pregnancy is harmful. Further, it only affects one population group (women) but is transmitted by another group (men).

Contraceptive methods can be used to protect against unwanted pregnancy, but they are burdensome and sex-asymmetric. Contraception is burdensome because it’s costly, since in many contexts it isn’t free, and the associated medical appointments take time and planning, and can be uncomfortable. Most forms of contraception also come with serious side effects, and abortions can be medically serious and are still widely stigmatised. These costs are particularly morally concerning because they’re sex-asymmetric. As a society, we tend to think that taking responsibility for the consequences of sex is a woman’s job. Eleven contraceptives act on the female body, while just two act on the male body, and women take the lead in acquiring contraception and ensuring it is used in 91% of cases.

The central claim of my paper is that since women are at risk of unwanted pregnancy when they engage in penis-in-vagina sex, men should be the ones to take measures to ensure that they cannot cause unwanted pregnancies. That way, the risks and burdens of sex are more evenly shared between partners. Instead of thinking of women as being vulnerable to pregnancy, we should think of men as carrying serious risks that they must act to minimise.

To see why this makes sense, imagine that you’re about to join a hypothetical society, but you don’t know whether you’ll end up as a man or a woman, or what kind of sex you’ll prefer. In our current society, if you end up as a woman who prefers penis-in-vagina sex, you not only face the risk of unwanted pregnancy, you’re also expected to shoulder the burden of protecting against it. If you end up as a man who prefers penis-in-vagina sex, you face no risk of pregnancy, and there’s no expectation that you contracept. Ending up as a man seems like a much better option. Instead, consider a society in which women are still at risk of unwanted pregnancy, but don’t have to worry about protecting against it, while men are not at risk of pregnancy, but are expected to take on the burden of protecting against it.  In such a society, your odds are better: it wouldn’t matter quite so much if you ended up as a man or a woman. Things seem fairer.

In the present context, this means that men should acquire and use condoms, or offer to contribute to the costs of their partners’ birth control method. Many men prefer not to use condoms, and rely on their partners to have taken care of contraception. This has to change.

In the near future, it’s quite likely that long-acting reversible contraceptives will be developed which operate on the male body to render semen harmless. These methods look set to be highly effective, and once they’re approved, men should use them to ensure that PIV sex is optimally unlikely to harm women. Ultimately, this should become the standard form of contraception.

The arguments made within my paper focus on contraception and unwanted pregnancy, but ultimately they’re arguments about the fairest way to share health-related burdens. What might they teach us about coronavirus?

Let’s return to the initial example of the transmitters and the potential sufferers. In this case, the transmitters are young people and those with no underlying medical conditions; the potential sufferers are older people and those with particular underlying medical conditions. Taking protective measures is onerous. Just as some people don’t like wearing condoms, others don’t like having to stay at home and limit their social lives. Tough.

The arguments just made indicate that living with the risk of being harmed or killed by coronavirus is burden enough. Older people and those with underlying medical conditions should be asked to give up as little as possible. They should not be made to feel faulty or deficient; others should think of themselves as dangerous, and should be following the latest public health advice as to how to avoid causing harm. These measures should fall disproportionately on one group because the risks fall disproportionately on the other. It will be burdensome, but that’s what justice demands.

 

Paper title:  Towards responsible ejaculations: the moral imperative for male contraceptive responsibility

Author(s): Arianne Shahvisi

Affiliations: Senior Lecturer in Ethics, Brighton and Sussex Medical School

Competing interests: None declared

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