What about the men? We need to better engage men in SRH discussions

Dr Bola Grace presented at this year’s FSRH Annual Scientific Meeting in Edinburgh was awarded the best poster presentation. Sexual and Reproductive Health research typically focuses on women and there is a paucity of data on the male perspective. Some of the reasons for this include poor engagement, poor provision of education on reproductive health, poor awareness and the perception that fertility is a woman’s issue. This article examines these issues, highlights the importance of engaging and educating men, and provides recommendations on how to address these issues.

Why engage men in sexual and reproductive health discussions?

Global health policies recommend that men should be included in reproductive health discussions since their involvement is beneficial for healthy pregnancies, reduction of unwanted pregnancies and in promoting positive outcomes for mother, father and child.

Furthermore, the WHO recommends increasing the active participation of men as well as their responsibility in the process of informed decision making on sexual and reproductive health issues. However, from a public health perspective, little attention is given to men in this area. The evidence relating to the importance of optimal paternal preconception health for the health of the offspring is growing, as demonstrated in the recent lancet series on preconception health.

Majority of the studies in this area are carried out on women since reproductive health is often seen as the woman’s territory. The under-representation of men in fertility and reproductive health research studies impedes the implementation and promotion of effective, male-friendly reproductive healthcare practices and policies. While there are many hypotheses for the lack of inclusion of men in studies on fertility and reproductive health, few studies actually include men.

Fertility issues only affect women – a myth.

It is often perceived that infertility mainly affects women. However, data shows that men and women are equally affected by infertility. Research shows that that approximately 40–50% of all cases of infertility are due to male factor infertility. Another key misconception in this area is that age-related fertility decline only affects women. Whilst extensive research has defined the impact of advanced maternal age on fecundity and reproductive outcomes for couples trying to get pregnant, less research has been focused on understanding the impact of advanced paternal age. However, available evidence suggest that advanced paternal age can be associated with decreased serum androgen concentration, decreased sexual activity, alterations of testicular morphology, deterioration of semen quality and reduced DNA integrity of sperm. Advanced paternal age is also implicated in pregnancy associated complications as well as a variety of adverse outcomes in offspring, including genetic defects and corresponding morbidity.

So what do men think of this?

In our recent study at the UCL EGA Institute for Women’s Health, we actually took the time to speak to men to get their views. We found that fertility tends to be seen as a private topic. Men wanted to be involved and engaged in the topic but felt that they did not have a voice because these discussions have traditionally focused on women.

Of course we spoke to women too! Interestingly, we found that both men and women largely saw reproductive health as a woman’s issue, but from different viewpoints. Women saw it from the perspective of societal stereotypes regarding male and female roles, whereas men tended to defer to the woman’s primacy in reproductive decisions.

It is also possible that we as researchers, healthcare providers, academics, policy makers, charity organisations, product developers etc. have succumbed to traditionally held beliefs around male interest in this area. Generally, men feel that involvement has not generally been encouraged because fertility and reproductive health is traditionally viewed as the woman’s domain.

What can we do better?

Changes in societal attitudes towards men’s reproductive health are required if men are to play a more informed role in sexual and reproductive health. We therefore suggest that additional concerted effort is required by educators, researchers, charities, healthcare service providers and policy makers to proactively encourage male involvement in fertility and reproductive health.

We recommend that reproductive health service provision and research studies in this area should be more inclusive of men and support the implementation of health policies that recognise men’s reproductive health needs. Additionally, educational programmes on sexual and reproductive health should be engaging and structured with age-appropriate information to include boys from a young age.

Word of caution!
Of course, we strongly advocate for necessary safeguards by healthcare providers to avoid discrimination or marginalisation of women without partners, or those who chose not to include partners in their reproductive journey. When encouraging partner involvement, we must carefully consider issues such as autonomy, reproductive cohesion and domestic violence.

You can read our full publication here: https://doi.org/10.1093/hropen/hoz014

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