Researchers from the National Institutes of Health recommend integrating men into the family-planning process in the age of Zika.
Men must play a significant role in protecting pregnant women, and their newborns, for feeling the effects of Zika virus infection and its complications, including birth defects such as microcephaly.
This is the key message of a commentary written by two members of the National Institutes of Health’s (NIH) Department of Bioethics and published online by the journal PLOS Neglected Tropical Diseases. The authors Pauline E. Osamor, PhD, and Christine Grady, RN, PhD, offer 6 key recommendations for integrating men into the education, consultation, and decision-making process as they pertain to family planning in the age of Zika.
“Recent heightened media and public health attention to Zika virus infection has focused on mosquito control, risks to pregnant women, and controversy over the summer Olympics,” Drs. Osamor and Grady write. “Missing from these messages is an emphasis on the essential role of men in decisions and behaviors related to [Zika] transmission and outcomes… Men play essential roles in decision-making affecting the couple and the family, [and their role] is even more important in non-Western countries or patriarchal structures where husbands or other family members often control health-related decisions that are often considered the exclusive province of women in Western societies.”
As the authors note, the Centers for Disease Control and Prevention (CDC) currently recommends that both men and women with possible exposure to Zika via recent travel or unprotected sex with an infected male wait several months before trying to get pregnant. Based on the CDC recommendations, and current World Health Organization guidelines, they write, “the total sum of the expected role of men in the control of [Zika] is limited to prevention of sexually transmitted infections.” However, Drs. Osamor and Grady argue that clinicians advising and/or working with couples should engage and educate men on the importance of safe-sex practices, respecting women’s rights in “negotiating sex,” their roles as husbands or partners of women at high risk for Zika, and their role as fathers of Zika-infected children. Indeed, they add that engaging men in these roles may be vital in countries in which patriarchal cultures and norms persist, particularly as part of efforts to enroll patients in research studies designed to increase understanding of Zika and, hopefully, identify potential treatments.
According to Drs. Osamor and Grady, ways in which clinicians can engage men in women’s reproductive health with regard to Zika include: tailoring interventions based on societal norms, recognizing that in some cultures “men are the primary decision makers in… fertility and family planning, the best ways to communicate with them and involve them may not be through their spouses.” They also advise clinicians to educate couples outside of conventional clinic settings, which may include the home, as men in many cultures do not accompany women on medical appointments related to reproductive health. In addition, the authors emphasize that men should be involved in decisions related to contraception use and family planning, and that clinicians designing educational programs for specific populations should engage men in the local area in “program design” as they are “the best sources of information about effective outreach and service delivery strategies.” They may also serve as excellent staff members, educators, and mentors in these programs, as they have the trust and respect of men in the population.
“Public health education efforts should help men be aware of and follow public health guidelines during a [Zika virus] outbreak, highlighting the fact that minimizing risk of… transmission benefits not only themselves but also their families,” Drs. Osamor and Grady write. “These efforts would help men be fuller partners with their spouses, especially in the countries where [Zika virus] outbreaks are occurring.”
Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.