THROUGH THE GENDER LENS: RE-SEARCHING RESEARCH

THROUGH THE GENDER LENS: RE-SEARCHING RESEARCH

Newsletter May Aug 2003

Saheli has consistently raised issues of hazardous contraceptives and of medical ethics in clinical trials of contraceptives. Our campaigns against unethical research and the coercive population policy have also led us to question the direction of contraceptive research itself. A closer look at subjects held to be ‘neutral’ and 'objective’ reveal biases of several kinds: gender, class, race and ethnic origin. And, science and technology development are not free from these biases.

If we accept that research work leads to the development of technologies, it should be obvious that the more the research in a particular field, the higher are the chances of technologies emerging out of these research endeavours.

We therefore set out to see whether or not this logic holds true in the field of women's health and to substantiate our experience and perspective that women bear the brunt of contraceptive techniques. Our survey of papers and reviews published in scientific journals over the past 35-40 years was revealing.

Gender bias in research on reproduction

Over a 35+ year period, a large body of research work has been published in scientific journals. We compiled the numbers of scientific and technological publications related to the male and female reproductive system and then categorised them. Not surprisingly, we found that the number of papers on women's reproduction were much higher than that on man's reproduction. Out of more than 6,60,000 papers published, nearly 62% were focussed on women and their bodies rather than men's bodies.

Next, we looked specifically at contraceptive research. Here a more dramatic picture was in store. Of about 32,000 reports published over 35+ years, about 77% focussed on contraceptives for women and only 23% on contraceptives for men. This finding confirmed that women are viewed as bearing the major responsibility for reproduction, and hence as target users of contraceptives. Moreover, since women being the main subjects for research and development of contraception, issues of safety, and side-effects have not been given the priority they deserve. (Remember the sudden disappearance of vasectomy - male sterilisation ~ from the scene post Emergency due the erroneous notion that it caused loss of virility?).

Many of these papers reported work on contraceptives at an experimental stage. Only when such experiments in the laboratory show concrete evidence that the given contraceptive is not dangerous if used by ordinary human beings, but show promise to provide the desired contraceptive effect, are they tested in clinical trials. The World Health Organisation's (WHO) guidelines are used as a yardstick to develop each country's own guidelines for clinical trials. The Indian Council for Medical Research (ICMR) has recommended guidelines for conducting clinical trials in India. These clinical trials occur in different phases (Phase I to IV). We estimated the number of papers reporting information on clinical trials pertaining to contraceptives for men as well as women. There were about 2,200 of them in all. We discovered that 86% of these clinical trials were conducted for contraceptives for women! Why is this so?

The primary attempt in scientific research is to make a model of mechanisms involved, based on the current state of understanding, and to continue refining the model to increase the predictive value and hence ‘reliability’ of the model. Individual scientific researchers working in the same broad field may work as if they are separately trying to solve the same jigsaw puzzle. However, there is no clear idea what the ultimate puzzle picture looks like, and by the time a fit is achieved between two adjoining pieces, the size of the puzzle might have increased manifold, thus increasing the complexity. In contrast, development of products, or technological research, progresses on a relatively less complex and better defined path with a clearer understanding of tangible ‘success’ and ‘progress’. The impact of the social context is likely ‘to be larger and more direct on the directions taken for product development than for mechanistic model-building.

Research in the field of reproduction and contraception can also be separated to some degree into ‘science’ and ‘technology’. Scientific research in the broad field of reproduction would include many areas of pursuit that are likely to add to the understanding of the development, structure and functioning of the process of reproduction. The information gathered during these efforts may or may not be useful for any product development. Research on contraception, on the other hand, is more technological research. It focuses on a specific aspect of reproduction with the explicit aim of developing products - contraceptives - for use.

What is the outcome of a bias in contraceptive research?

There are many more methods for spacing of children available for a woman than for a man. The same is true for the terminal methods too (Table 1).

Table 1. Commonly available methods of contraception

For men

- Reversible method - condom

-Permanent method - vasectomy

For women

- Reversible methods – [UD Copper T] oral pills, hormonal injectable contraceptives, hormonal implant morning after pill, abortion

- Permanent methods - tubal occlusion or ligation hysterectomy.

We sought information about the normal functioning of the male and female body, in order to find an explanation for the skewed figures for research on contraceptives for men and for women. We considered the hormones necessary for the functioning of the male and the female reproductive systems and the various parts of the body where ‘control’ in the form of a drug or a device can be exercised in order to achieve efficient contraception. We were still at a loss as to find any substantial reason for the discrepancy. We listed the potential ways in which contraception can be achieved in men and in women. Table 2 lists these to provide a clearer picture.

Table 2. Approaches to develop contraceptives for men and women

In men

In women

- prevent sperm production

- decrease sperm production

- decrease/inhibit sperm maturation

- prevent transport of sperms

- prevent ejaculation of sperms

- decrease motility of sperms

- inhibit egg penetrating properties of sperms

- make essential sperm nutrients unavailable

- prevent egg maturation

- prevent egg fertilisation

- prevent egg implantation

- prevent egg transport to uterus

- increase motility of the uterus to cause expulsion of the fertilised egg

- prevent deposition of sperms

- destroy deposited sperms

Why is it then that both contraception research and contraceptives are more in number for the female body? The issue boils down to societal attitudes towards men and women or in other words the impact of patriarchy. Here again we see a projection of the glorified submissive womanhood — a sacrificing and loving mother, an obedient and tolerant wife – this time being taken as a basis for something so apparently ‘neutral’ as technology development. The other reason for this bias could lie in the fact that this field is still a male-dominated one. (See Table 3)

Table 3. Disparity in sexes at higher echelons in academia

[Number of women (F) vs men (M): Undergraduate to Faculty in the school of science, MIT 1994. Source: the MIT faculty Newsletter, vol 11 issue 4, march 1999]

Impact of gender bias in contraceptive research

Time and again we have written about and protested against the gender bias in contraceptive research. Male responsibility in reproduction, while it has become a buzzword of late, finds little reflection in the direction of contraceptive research. Long-acting injectable hormonal contraceptives, hormonal implants, anti-fertility vaccines and quinacrine are illustrative of this bias. We have consistently raised issues of health hazards, both short and long term, the ethics of informed consent, lack of follow up, etc. Thus, despite not having any biological or scientific reasons for offering a larger basket of contraceptive choices to women, gender biases continue to skew research and technology development in this direction. Socio-cultural upbringing moulds the psyche of the policy makers who give directions, researchers implement them to deliver the products, and pharmaceutical companies, especially the large multinationals, reap the benefit. With women as primary targets of contraceptive development, it is not surprising that risk-benefit assessment is weighted in favour of 'benefit’, i.e. effective contraception, with little regard to the ‘risks’ for women's health.