At first sight the plant is inconspicuous, and to the untrained eye looks like something that would not be out of place in a run-of-the-mill garden center.
But scientists in Indonesia have detected within its leaves something that could potentially have far-reaching implications for population control and family planning efforts across the globe: an ingredient that could form the basis of a male contraceptive pill.
Clinical trials testing whether the medicinal qualities of the plant in question – known as gandarusa – can be harnessed for an effective male contraceptive pill. The trials are ongoing in Indonesia, the fourth-most populated country in the world, and scientists conducting the tests say that preliminary results are promising.
Aside from vasectomies or condoms, there are few reliable contraceptive options for men, with success in bringing a male contraceptive pill to market to date proving elusive.
“Gandarusa has been used for years by people in the provinces of West Papua and Papua as a traditional form of male contraception,” says Dr Bambang Prajogo of Airlangga University in Surabaya, East Java, who is leading the clinical trials.
“But today Indonesia faces a big problem in terms of the size of its population, so it needs something like gandarusa to help limit the population and improve the lives of future generations.”
According to the World Bank, Indonesia’s population has grown from 145 million in 1980 to 246 million in 2012. The country has by far the largest population in Southeast Asia and if its current rate of growth persists, it will reach 289 million by 2050, says the Bank.
“But Indonesia is also very rich in biodiversity, with over 30,000 flowers and 7,000 medicinal plants,” Prajogo tells The Diplomat. “There are a lot of opportunities here to explore the potential of these plants for medicine.”
With this in mind, Prajogo’s team in Surabaya has been testing one such plant – gandarusa – for more than 20 years.
They have taken gandarusa samples from the Indonesian islands of Papua, Java and Kalimantan, drying leaves from the plant and then grinding them into powder form so they can extract the substance required for the contraceptive, which Prajogo says is known as “Gandarusin A.”
“The mechanism of sperm penetration is done through three enzymes,” he explains. “Gandarusin A slows down these enzymes, resulting in their inability to penetrate the ovum.”
Since clinical trials of gandarusa began in 2008, Prajogo says he has tested over 500 males and has found almost no side effects from using the drug.
“All organs functioned normally, but we also found that the pill acted as an aphrodisiac,” he says. “After one month of not taking the pill, fertility levels returned to normal in all users.”
The team also found the pill largely did its job, with only one pregnancy reported throughout the clinical trials to date.
Prajogo is uncertain when gandarusa would be available in pharmacies, as the third phase of the clinical trials was incomplete and the drug had to be registered with the Indonesian National Food and Drugs Monitoring Agency (BPOM) before it could proceed to market.
But he points out that while he is testing gandarusa samples from different regions in Indonesia to identify which region had the strongest concentration of Gandarusin A, he is also keen to test the drug further afield in North America and Africa, to gain a greater understanding of its effects on different ethnicities.
Indonesian Health Ministry data suggests male participation in family planning in Indonesia is very low, with 1.8 percent using condoms and 0.2 percent using vasectomies.
“It could be years before we have the results on gandarusa, but [if it works] this could be a key breakthrough in terms of increasing male participation in family planning and increasing male contraceptive options,” says Julianto Witjaksono, deputy of family planning and reproductive health at the National Population and Family Planning Agency (BKKBN).
Witijaksono adds that an injectable contraceptive for males was also being tested at another Indonesian university, with the results expected toward the end of the decade.
He notes that male use of contraceptives was partly low because existing methods such as condoms and vasectomies were not wholly accepted in society.
“Some religious leaders have rejected vasectomies because they think it can reduce male sex drive. We’ve invited health experts to speak to them to help them better understand this form of contraception,” he says.
Use of the other main contraceptive for males – condoms – is also limited because of stigma, explains Melania Hidayat, a reproductive health officer with the United Nations Population Fund (UNFPA) Indonesia.
“Condoms are easily available and have been around for so long, but they remain associated with casual sex,” she says.
For Hidayat, getting more men to use condoms is a big challenge, so other contraceptive options like gandarusa offer new hope in promoting male participation in family planning.
“But we must first ensure gandarusa’s efficacy before it goes to market,” she warns.
Gandarusa could also help balance out contraception options in Indonesia, which are heavily focused on female injectable methods.
“The trend of injectable use among females is getting higher and this is a problem. The drop out risk for this method is high as it requires frequent visits to health services for monthly shots,” says Hidayat.
According to Health Ministry data, the most common method of contraception is the use of injectibles by females, with 31 percent of females opting for this method, followed by the pill at 13 percent.
“We’re trying to balance this method out with other options,” Hidayat continues. “The important thing is to create more choices for men to get involved in family planning and maybe gandarusa could help with this.”
Mark Wilson is a freelance journalist based in Jakarta. More of his articles can be found on markwilsonjournal.com.