By: Shoshana Boardman, Jack Fertility microintern, and MSt student studying Asian and Middle Eastern Studies at The Queen's College, University of Oxford. All views expressed are her own.
Women’s health is a dramatically under-funded research area. Of diseases specific to males (like prostate cancer), almost three quarters are funded far more than warranted by their effect on the population, while female diseases are almost universally underfunded. For example, PMS dramatically affects the quality of life of up to 90% of women, causing significant pain and disruption; nevertheless, it receives a fifth of the funding allocated to erectile dysfunction, which affects only 20% of men.
Outside of cancers, only two percent of all healthcare funding is allocated to women’s health conditions; of venture capital investment in digital health startups, female-focused companies receive only 5% of the funding.
In fact, from the 1960s to the 1990s, the U.S. Food and Drug Administration actively excluded women of childbearing age from drug trials of any kind—just in case they were secretly pregnant. They feared a repetition of the disastrous thalidomide scandal, where they had authorised the use of a drug that ultimately caused up to 10,000 birth defects in children of mothers who had taken it. When women were not included in drug trials, of course researchers could not learn about the effects of the drugs on their bodies.
…because men are considered default.
Part of this funding imbalance comes from an ancient idea that the male body is a “default.” Because of hormones, cycles, and stigma, women’s bodies are often considered variable, difficult to test, and imperfect. Researchers seem to see female bodies as “baby-making machines,” worth studying solely for fertility purposes, as though they are simply male bodies with uteruses grafted on.
But when it comes to fertility, women are considered the default.
As a result, when it comes to male fertility, the situation is almost perfectly reversed. Female bodies are the default fertile bodies. Ancient stigma framing women as imperfect men because of their variability has, as a side effect, framed male bodies as stable, almost inert, and therefore reproductively irrelevant.
Men, too, have hormone cycles, and their fertility waxes and wanes—but research into these elements is lacking, and does not receive much funding.
Of the over $800 million invested in fertility startups globally last year, the vast majority of the funding went to established, uterus-focused treatments like egg-freezing; almost none went to sperm research. Although there isn’t much publicly available data on the amount of funding accorded to male fertility, one study suggests that leading up to 2019, UK agencies funded female reproductive health research with two and a half times more money than male.
When fertility is a “women’s issue,” male health suffers. Men do not receive information about their own bodies or about how to maximize their chances of having children. Sperm can serve as a window into a person’s overall health, and neglecting to study it deprives men of this chance to receive treatment for other health conditions, too.
Women’s health also suffers. Male infertility or poor sperm health increases the chances of birth defects and pregnancy conditions, which cause direct physical repercussions for pregnant people. Women bear the burden of invasive fertility treatments, even though they might be perfectly fertile while their male partner might not be: the NHS “infertility” page suggests treating lack of regular ovulation or endometrial scarring, but does not mention treatments for men.
Inclusion of males in fertility treatment is a microcosm of the women’s health fight.
At this time, sex-disaggregated data is not required for research trials in the UK. As with all other areas of gender equity, devoting more funding to this sex-specific research is good for everyone—is, in fact, crucial for everyone.
The female body is not the “default” fertile body: male bodies contribute 50% of a heterosexual couple’s fertility. The fight for research into women’s health has framed the issue in ways that directly address these imbalances. Efforts to push for funding into male fertility can make use of these frameworks so that everyone can receive the treatment they deserve.
We need to disaggregate data. We need to focus on sex-specific research. Male reproductive health research can seek funding from bodies which have been receptive to female reproductive health research. Male fertility startups can contribute to and invoke feminist theory to emphasize their importance. Women’s health organizations can support male fertility. Fertility is a joint journey. Let’s stop thinking of certain groups as “default.”
So what is more invisible than women in clinical trials?
Mention and study of male [in]fertility.
We at Jack are here to change that.
(For more research on these topics, see Invisible Women: Exposing Data Bias in a World Designed for Men, by Caroline Criado-Perez.)