Invisible Influencers: Men’s Perspectives on Preconception Health and Pregnancy Preparation in Scotland: A Mixed- Methods Study

For decades, the story of preparing for a new life has been told almost entirely from one perspective: the mother's. Public health campaigns, medical advice, and family planning resources have focused on the woman's body, her diet, and her habits before conception. This approach rests on a biological truth: a healthy pregnancy begins with a healthy womb. However, a growing body of science now recognizes that the father's health matters just as much, though in different ways. Before a pregnancy even begins, a man's lifestyle—what he eats, whether he smokes, how much he drinks, and his overall physical fitness—can influence his fertility and the health of the child he helps create. These factors act through biological pathways, affecting the quality of sperm, but also through social and emotional ones, as partners support each other through the transition to parenthood. Despite this knowledge, the systems designed to guide families into pregnancy have largely left men out of the conversation, assuming that reproductive health is a woman's domain alone.

A new study from Scotland seeks to change that narrative by listening directly to men. Researchers from Abertay University conducted a mixed-methods investigation, combining in-depth conversations with a national online survey, to understand how Scottish men think about getting ready for a baby. The team wanted to know if men were aware of their role, what they were actually doing to prepare, and why they might be missing out on support. They found that men are not indifferent to the process; they are willing to engage, but they are often flying blind. The study reveals a population that is ready to step up but lacks the map, the language, and the invitation to do so.

The research began by gathering a group of twenty-six men for focus group discussions. These participants ranged from teenagers to men in their forties and came from all walks of life across Scotland, representing both wealthy and deprived areas. The researchers then used insights from these conversations to build a national online survey, which was completed by sixty-seven men who had supported a partner through a pregnancy in the last five years. By listening to the stories first and then asking the questions, the team ensured they were exploring the issues that actually mattered to the men themselves.

What emerged was a picture of preparation that was often reactive rather than proactive. Many men described pregnancy as something that "just happened," a phrase they noted was common in Scotland to describe a conception that was unplanned but not necessarily unwanted. While nearly thirty percent of the men in the survey reported having experienced at least one unplanned pregnancy, the broader pattern showed that most did not have a structured plan. When they did prepare, it was often informal. Some men described stopping contraception and simply letting things take their course, while others waited until a pregnancy was confirmed before making any changes to their lifestyle.

The timing of these changes was telling. Almost half of the men reported that they only reduced their alcohol consumption after the pregnancy was confirmed. Similarly, while many men knew that smoking was bad, the decision to quit often came only when the reality of a baby was imminent. The study highlighted a significant gap in knowledge: men were far more familiar with how to prevent a pregnancy than how to optimize their health to create one. One participant captured this imbalance perfectly, noting that it seemed easier to find information on ending a pregnancy than on helping a life begin. This lack of knowledge extended to specific nutrients; many men had never heard of folic acid, and fewer than ten percent knew that supplements existed specifically for men to support fertility.

Despite these gaps, the men were not passive observers. They described their role in pregnancy preparation as one of support, often focusing on the practical and emotional rather than the clinical. They talked about creating a comfortable environment for their partners, managing finances, and offering reassurance. In the survey, nearly half of the men who were planning a pregnancy said they actively prepared alongside their partners. However, this support was often framed as helping the woman do her job, rather than recognizing that the man's own health was a critical piece of the puzzle. When fertility issues arose, the immediate assumption among the participants was that the problem lay with the woman, reflecting a deep-seated belief that reproduction is a female responsibility, even though medical evidence suggests male factors contribute to infertility in about half of all cases.

The study also uncovered a silence around these topics. Men reported that discussions about fertility and reproductive health were rare among their peers. It was not a subject they felt comfortable bringing up with friends, and they often felt excluded from the healthcare conversations that did take place. When they did interact with doctors, they found that preconception advice was almost always directed at the woman. The researchers noted that while men expressed a willingness to discuss pregnancy intentions with a general practitioner, the system rarely invited them to do so. This created a mismatch: men were ready to engage, but the door to the conversation was often closed.

The findings suggest that the current approach to preconception health in Scotland is missing a vital opportunity. The men in the study were not unwilling to change; they were simply unsupported. They wanted to know what to do, when to do it, and why it mattered. The researchers argue that treating men's preconception health as a public health priority, rather than an afterthought, could significantly improve outcomes for families. This would require a shift in policy to include men explicitly in health plans, a change in how doctors talk to patients to include both partners, and a new wave of public health messaging that speaks directly to men.

Ultimately, the study paints a portrait of men who are eager to be part of the journey but are currently navigating it without a guide. They are willing to adopt healthier habits, from eating better to reducing alcohol, but they need the right information and the right invitation to do so. By recognizing men as active participants rather than bystanders, and by building services that welcome them, Scotland has the chance to create a more inclusive and effective system for preparing for the next generation. The potential is there, waiting to be unlocked by a simple change in perspective: that the health of a future child begins with the health of both parents.