Imagine the following scenario: The alarm clock is beeping, and John’s eyes creak open, landing on a book he was reading the night before: A Man’s Guide to Producing Healthy Sperm. He and his wife, Jen, have been trying for months to have a baby, and they are both doing all they can to improve their chances. Rolling out of bed, he hops in the shower, keeping the water lukewarm so he doesn’t cook his sperm. He brushes his teeth with a natural toothpaste to avoid excess exposure to chemicals. Throwing on a shirt and pair of pants he washed with a new detergent stripped of all dyes and scents, he and Jen say their goodbyes and head off for the day.
As John commutes, he passes a billboard that warns passersby about the effects of aging sperm. Illustrated with an hourglass, the sign’s boldface type cautions men about their ticking biological clock. Feeling a twinge of anxiety because he waited until his late thirties to have children, he rushes on to work. While eating a superfood sandwich of avocado, sprouts, and organic cheese for lunch, John flips through a men’s health magazine. He reads that sperm take about three months to mature in the male body. Not only that, nearly everything a man does during that time can damage these cells: eating unhealthy food, smoking cigarettes, taking drugs, coming into contact with chemicals at work or home, and so on. And from his own reading, John already knows that damaged sperm can lead to miscarriage, birth defects, and even childhood illnesses.
Back at his desk, the afternoon passes quickly, and one of his friends stops in to see about a drink after work. John joins the happy hour crew but opts for juice, thinking about all the times he has seen the standard-issue government label on beer bottles, warning that excessive alcohol consumption can damage sperm. He does not want to take any chances.
Not only is John not real, the world I have just described does not exist. Men going about their daily lives are not subject to endless advice about their sperm. They do not encounter books and billboards and warning labels about how their health might affect their children’s health. And even when they do contemplate becoming a father, men do not experience anxiety about every last morsel they consume or product they use.
But they could. In recent years, researchers have been amassing evidence that the health of men’s bodies—including factors such as their age, behaviors, and exposure to toxins—can damage sperm and, in turn, affect their children’s health. The headline of one front-page story in the New York Times announced “Father’s Age Is Linked to Risk of Autism and Schizophrenia.” Fathers who smoke heavily before conception cause changes in their sperm that raises their children’s risk of cancer. And men who breathe polluted air, drink polluted water, or work with any sort of chemicals—from pesticides to paint thinners—might be damaging their sperm. Collectively referred to as paternal effects, the “news” here is that it is not just women’s bodies that affect reproductive outcomes.
Alas, of course, it is women, not men, who are accustomed to hearing endless advice about their reproductive health. It comes to a crescendo during pregnancy. There are long lists of do’s and don’ts from clinicians and well-meaning friends, family, co-workers, and sometimes strangers on the street. There are even guidelines about what to do before pregnancy to make sure one’s body is fully prepared to gestate the next generation. The message is clear: It is women’s responsibility to make sure reproduction goes well. And when it doesn’t, when there’s a miscarriage or a baby arrives in anything but full health, it is often women who bear the blame.
Now that scientists are learning just how important men’s health is for reproduction, the question is: What took so long? After all, researchers have spent more than a century scrutinizing every tiny aspect of women’s lives for potential effects on fetus health. Gynecology and obstetrics were two of the first specialties to emerge as medicine professionalized during the last part of the nineteenth century. Today, women are encouraged to schedule regular visits to have their reproductive organs examined, and public health campaigns remind women regularly that their fertility comes with a deadline. In contrast, there is still no cohesive medical specialty devoted solely to men’s reproductive health, no recommendations that men have their reproductive organs examined regularly, no public health campaigns about the male biological clock, and no government labels warning men about the toxic effects of alcohol and drugs on sperm.
So what to do about the lack of GUYnecology? I’m a sociologist at Yale who spent the last six years writing a book about the missing science of how men’s health matters for reproduction. The major recommendation that flows from my research is that we should all be paying much more attention to men’s reproductive health.
But just how to do that is not at all obvious. Most importantly, there is the question of how to talk about men and reproduction without replicating the typical and problematic approach to women’s reproductive health. In the past, such messages have usually been directed at individual women, encouraging them to be as healthy as possible, but this tends to turn reproductive health into a moral issue and stigmatize those who cannot achieve it. It can even result in punishment. Just ask the hundreds of women who have been imprisoned for their behavior during pregnancy.
Rather than just adding men to the list of those who can be blamed for reproduction gone wrong, perhaps we could use the new attention sperm health is getting as an opportunity to reconsider all messaging about reproductive health. Public health officials could emphasize that both women’s and men’s health can affect the health of their children, and that any one body’s health is not solely a matter of individual control. As the devastation wrought by the coronavirus on our unequal society has made deadly clear, people’s health is just as much a matter of racism and financial resources as it is what we eat and drink.
Reframing reproductive health as not just about women would entail nothing less than a paradigm shift. Rather than placing the onus on individual women to eat right and avoid toxins, maybe officials would redouble their efforts to ensure that everyone has access to a healthy lifestyle and that nobody is exposed to harmful chemicals.
Adding men to the reproductive equation has the potential to improve men’s health and the health of their children. It could also reshape reproductive politics and gendered inequalities. And in the best possible scenario, it could provide a much-needed nudge to longstanding efforts to address structural and environmental contributors to disease, like increasing access to quality health care, reducing racial and economic inequalities, and adopting more stringent regulations to protect the air and water. Such efforts would benefit all bodies, whether they are reproducing or not.
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