To Plan or Not to Plan : Gender Perspectives on Pregnancy Planning, Fertility Awareness and Preconception Health and Care

Abstract: The level of pregnancy planning is of importance to the well-being of parents and children. Unintended and/or unwanted pregnancies are often associated with less health promoting behavior during pregnancy, poorer health of the new born, and relationship dissatisfaction. Preconception care is a health service with the purpose to encourage people to become mindful about their reproductive intentions and raise fertility awareness, in order to maintain or improve reproductive health.Reproductive health is a highly gendered area, both due to biological conditions and social expectations on gender. In most cases, the focus of reproductive health and health promotion is on cis-women and their bodies. This thesis mainly focuses on persons self-identifying as men. The aim is to scrutinize the area of preconception health, investigate what pregnancy planning means to men and explore the relationship between pregnancy planning and fertility awareness.In Study I, 136 couples who attended their first antenatal visit answered questions about pregnancy planning. Most pregnancies were planned and couples had similar perceptions of the level of their planning. Study II describes pregnancy planning behavior and fertility knowledge among 796 recent fathers. Also in this study, most pregnancies were planned and 17% of the men had made at least one preconception lifestyle adjustment to improve health and fertility. Fertility knowledge varied greatly, although men with higher education demonstrated higher knowledge. Study III explores if Reproductive Life Plan-based counselling during a sexual health visit could increase men’s fertility awareness. The counselling had a moderate effect on participants’ fertility knowledge but managed to raise new thoughts about their own fertility, and was well received. Study IV follows up on the results from the first three studies, through in-depth interviews and focus group discussions with 25 men aged 23-49. Most participants took their fertility for granted. To cis-men in heterosexual relationships, the meaning of pregnancy planning usually meant taking the decision to try to become pregnant, and not much more. Trans-men and gay men where more invested in practical planning issues. In conclusion, this thesis shows how pregnancy planning is gendered, and that it is a more complex phenomenon than previously acknowledged.