At present, people assigned male at birth have extremely limited means by which to control their reproductive health. While medical advancements have yielded numerous modern contraceptives, nurses still have few modalities to recommend for male patients (Kanakis & Goulis, 2015; Davidson, London, & Ladewig, 2016). Hence, men, who represent over half the world’s population, experience stunted reproductive autonomy (Campo-Engelstein, 2011), the physical and economic burdens of pregnancy prevention are disproportionately relegated to women (Guttmacher Institute, 2011), and opportunities to expand the valuable individual and societal outcomes of family planning are missed (Waller, Bolick, Lissner, Premanandan, & Gamerman, 2016; Davidson et al., 2016). Although some posit that gender norms around birth control would impede male involvement (Brown, 2015), further investigation is warranted given that international studies have suggested that men are willing to assume increased contraceptive responsibility (Kanakis & Goulis, 2015) and that women would trust male partners to use contraception (Campo-Engelstein, 2013). Concerns have also been raised about the impact alternative male contraception could have on sexually transmitted infection (STI) rates by potentially lowering the usage of protective barrier methods (i.e., condoms, dams, gloves) as seen with female hormonal methods (Smith et al., 2012; Brown, 2015; Milhausen et al., 2013). To date, researchers have primarily tested male hormonal approaches which have been inconsistently effective (Oduwole & Huhtaniemi, 2014), associated with undesirable side effects (Kanakis & Goulis, 2015), and have prompted pharmaceutical companies to prioritize more lucrative investments (Campo-Engelstein, 2011). In response to this global sexual health deficit, development of a promising new form of long-acting and reversible contraception for males has emerged: non-hormonal injectable gel (NHIG). NHIG is bilaterally injected into each vas deferens and different polymer types work to degrade or obstruct the passage of spermatozoa while allowing the ejaculation of other seminal fluid that contains either functionally disabled sperm or no sperm at all (Kanakis & Goulis, 2015; Waller et al., 2016). With a characteristic period of sexual vulnerability accompanying the transition from adolescence to adulthood (Milhausen et al., 2013; Cheney et al., 2014), members of this demographic would be prime recipients of such innovative contraception; yet there is a dearth of research on how the NHIG option will be received within this subgroup.
The purpose of this study was to explore young adults’ perceptions regarding NHIG while addressing the following question. In undergraduate college students, is there a difference between attitudes and perceived behaviors related to NHIG contraception amongst potential users (i.e., people with testicles) compared to non-users (i.e., people lacking testicles and/or who do not intend to have partnerships that could lead to pregnancy)?
Methods:
A questionnaire for data collection was designed and modelled after relevant sections from the American College Health Association’s (2015) National College Health Assessment IIc (ACHA-NCHA IIc). Question generation was informed by a literature review and a theoretical framework that extended the theory of planned behavior (TPB). Focus was given to the constructs of control beliefs, intentions, and moral norms in relation to sexual interactions (Turchik & Gidycz, 2012). Eight variables were measured pertaining to NHIG: (a) eligibility for use, (b) likelihood of use or encouraged use, (c) factors influencing use, (d) behaviors across different sex acts (i.e., vaginal, anal, and oral sex), (e) concurrent use of multiple contraceptives, (f) attitudes toward contraceptive responsibility, (g) attitudes towards contraceptive trust, and (h) previous knowledge of the NHIG method. Demographic information was obtained as well. Logic pathways were set up to direct respondents to appropriate questions based on previous answers. Surveys were distributed via an online platform (SurveyMonkey®) to the student body at a small, Midwestern, liberal arts college. Respondents self-selected to participate and students 18 years or older, of all genders, sexes, and sexual orientations were invited to submit.
Results:
The sample (N = 474) was 67.6% female, 84.6% heterosexual, and 89.2% white with ages ranging from 18 to 24 years old. There were fewer potential users (n = 133, 34.2%) than non-users (n = 254, 65.3%). Preliminary results revealed that a greater portion of potential users reported that it would be unlikely (n = 58, 43.61%) for them to use NHIG, whereas non-users were more likely (n = 128, 51.41%) to encourage its use. Over a quarter of respondents in both user groups replied to the likelihood of use question neutrally. For users and non-users alike, low cost, reversibility, and infrequent administration were the top three options indicated as factors that would increase the likelihood of NHIG use. High cost was the most frequently selected deterrent, uncertainty arising from the newness of the new product was second, and the third diverged respectively between administration route or lack of STI protection for users and non-users. In the context of hypothetical NHIG use, users and non-users at risk for pregnancy were most likely to incorporate protective barrier methods during vaginal intercourse, followed by progressive decreases for anal and oral intercourse. Users were less likely than non-users to intend to utilize protective barrier methods or hormonal methods simultaneously with NHIG. The majority of respondents (n = 374, 95.9%) agreed or strongly agreed that all sexual partners should be equally responsible for contraception and that both men and women could be trusted to use contraceptives. However, more trusted women (n = 303, 79.4%) than men (n = 221, 56.8%). Additional statistical tests are scheduled to be completed to further analyze the results.
Conclusion:
As NHIG contraceptives enter the pharmaceutical marketplace, it will be vital for nurses to be knowledgeable about the products and the behavioral implications they may bring. For young adults in the foundational stage of forging lifelong sexual practices, nursing will play a critical role in anticipating patients’ needs and providing education that will enable fully informed decisions about NHIG. Nurses must serve as advocates to eliminate financial barriers to contraception and proactively promote the simultaneous use of protective barrier methods with NHIG for STI prevention. Guiding male patients in the safe and effective use of NHIG will have the potential to benefit both men and women, thus advancing the Global Health Initiative’s (2012) principle of gender equality in the realm of reproductive health.