Supporting Men Through Unintended Pregnancy: Lessons from Norwegian Counselors
When an unintended pregnancy occurs, the focus naturally centers on the woman, who faces both the physical reality and the legal right to make decisions about continuing the pregnancy. Yet men also navigate this challenging situation, experiencing their own emotional turmoil while trying to support their partners. A study of Norwegian pregnancy counselors reveals how healthcare professionals attempt to balance supporting both partners while respecting women's autonomy in decision making.
A Shared Crisis
Researchers interviewed 13 counselors working at a nationwide, government supported service in Norway that provides free counseling to individuals and couples facing pregnancy related decisions. All the counselors were women, ranging in age from 29 to 64, with varying levels of experience in the field.
The counselors described unintended pregnancies as creating what they called an "existential crisis" not just for women but for men as well. From one day to the next, both partners find themselves thrown into a situation that upends their sense of control and direction. The decision making process forces them to contemplate questions about their entire lives and futures, whether they'll stay together, whether they'll have children, and what kind of life they envision.
This crisis involves a "chaos" of emotions and thoughts that can feel overwhelming. The counselors observed that while the decision making process can be painful, it also serves a necessary purpose, helping clients determine what truly matters to them.
Different Ways of Expressing Distress
One recurring theme in the counselors' experiences involved the different ways women and men typically communicate about their feelings and concerns during this crisis. Counselors noticed that in couple sessions, men often approached the situation more rationally while women tended to be more in touch with their emotions.
This difference in communication styles could create challenges, with partners essentially speaking different languages and talking past one another. The counselors often found themselves needing to "translate" for men, helping them articulate their feelings and enhancing their partners' understanding of what they were experiencing.
The counselors debated whether men genuinely have a poorer emotional vocabulary, whether they suppress emotions to appear rational, or whether they simply avoid exploring their feelings. They noted that some men find sharing emotions difficult and threatening, fearing it might make them appear weak. Men often required more time to open up and discuss what truly mattered to them, and painful feelings frequently emerged once they started talking, having kept so much bottled up.
Interestingly, counselors observed generational differences, with younger men more readily sharing their feelings than older men.
The Challenge of Involvement
The degree of men's involvement in the decision making process varied widely and significantly impacted how both partners experienced the situation. Some men were genuinely supportive, others exerted pressure on their partners, and still others avoided participation entirely.
The counselors noticed that some younger men felt pressure to handle these situations appropriately, with more men now taking the initiative to book appointments for both themselves and their partners. Even men not in committed relationships were increasingly taking responsibility and wishing to be involved.
However, involvement could be complicated. Some men avoided being honest about their desires to protect their partners from feeling upset or influenced. Other men participated in conversations specifically to have the opportunity to shape the outcome. Counselors described how some men appeared passive and claimed to be there only for support, yet subtly exerted pressure through their presence and actions to influence their partner's decision.
The lack of legal decision making authority for men created additional challenges. Men who disagreed with their partner's decision or felt excluded from the process often experienced higher levels of stress and despair. At the same time, counselors recognized that men could influence women's decisions, sometimes resulting in women making choices that went against their personal wishes.
Despite these complications, the counselors generally expected men to be involved, viewing this involvement as beneficial for the woman, the man, and any potential child. They saw men as potential fathers and believed that reluctance in the present doesn't preclude good fatherhood in the future.
The Counselor's Balancing Act
The counselors described their role as requiring careful navigation of multiple competing demands. They felt an ethical responsibility to care for both partners while respecting Norwegian law, which gives women the right to decide about terminating a pregnancy up until the end of the twelfth week.
Maintaining what they called "neutrality" emerged as a central professional value. This meant treating both partners with impartiality, remaining unbiased regarding cultural and religious viewpoints, and avoiding having a personal agenda. When beginning couple sessions, counselors often explicitly stated their neutrality, partly to reassure men that despite all the counselors being women, they would not automatically side with the female partner.
However, the counselors acknowledged that complete neutrality is impossible. Their own life experiences, values, and unconscious biases inevitably influence how they interact with clients. They recognized that their body language, personal triggers, and background all play a role despite their best efforts to remain neutral.
The key, they felt, was maintaining awareness of these influences and continuously reflecting on them. Being conscious of and striving for neutrality helped them remain open to what was truly at stake for both women and men in each unique situation.
Navigating Difficult Emotions
One particularly challenging aspect of counseling men involved handling intense emotional expressions, especially anger. Counselors discussed how angry men, particularly physically large ones, could have a strong presence in the room that made both the counselor and the female partner feel uncomfortable or unsafe.
The counselors tried to maintain fearlessness and readiness to face a broad spectrum of emotions. They recognized that anger might stem from feelings of powerlessness about not being able to decide, or that other emotions like fear and sadness might underlie the anger. They used various strategies to maintain calm, balanced conversations, including naming emotions, taking breaks, ending conversations when necessary, or inviting men to individual sessions where their anger felt less threatening.
The counselors felt particularly responsible for women's safety when men expressed anger, concerned it might indicate pressure or potential violence in the relationship. Yet they also tried to create space for men to explore and express their genuine feelings.
Time Pressure and Structure
Time emerged as a crucial factor affecting both clients and counselors. With women having only until the end of the twelfth week to decide about termination, counselors often met clients with just a few weeks remaining. This created pressure to build trust and rapport quickly to address what clients truly needed to discuss.
The limited timeframe meant counselors had to effectively structure conversations while still providing space for reflection. They aimed to create a safe environment where clients could think freely, share thoughts, and openly express feelings. Building safety, trust, and recognition in the counselor relationship was critical.
The counselors used strategies like open ended questions, providing information, normalizing emotions, and raising awareness to help clients gain confidence in their decision making. They adapted their communication during crises to ensure comprehension and repeated information when needed.
Cultural and Religious Challenges
Counselors reported particular challenges when working with men whose cultural or religious beliefs led them to oppose abortion or hold conservative views about women. In these situations, they felt responsible to speak clearly about Norwegian laws, support women's autonomy, and address what they viewed as unethical behaviors like controlling women or deceiving them about relationship intentions.
These situations tested their commitment to neutrality and required heightened awareness of their own biases. The counselors emphasized the importance of reflecting on their personal values and how these might affect their interactions with clients from diverse backgrounds.
A Relational Understanding
The counselors' approach reflected what researchers describe as a relational understanding of decision making. Rather than viewing the pregnancy decision as solely the woman's concern, they recognized that partners often navigate the situation together and that their decisions influence each other.
This perspective acknowledges that respecting individual autonomy involves understanding the relationships people hold important and recognizing how individuals incorporate values from these relationships into their decisions. Including men in counseling enables them to support their partners and fosters shared responsibility for the situation and its consequences.
The approach also represents a shift from viewing unintended pregnancies as exclusively women's issues toward recognizing the involvement and impact on both partners.
The Need for Specialized Skills
The counselors stressed that their work required what they called "double competence" in both reproductive healthcare and counseling skills. They needed extensive knowledge of crisis management, abortion, pregnancy, laws, and rights, as well as understanding of the ethical considerations inherent in these sensitive conversations.
They also highlighted the importance of understanding different constructions of masculinity and how these shape both men's experiences and counselors' own expectations and perceptions. This awareness helped them recognize when their assumptions about how men "should" behave might be limiting their ability to meet men where they actually were.
Regular professional supervision provided crucial support, giving counselors space to reflect on their practice, examine their values and biases, and ensure they were providing ethical, competent care.
Implications for Healthcare
This study reveals the complexity of supporting both partners through unintended pregnancy while respecting women's legal rights and autonomy. The Norwegian counselors' experiences suggest that inclusive pregnancy counseling requires careful attention to power dynamics, communication differences, emotional intensity, and personal values.
Their approach recognizes that men, like women, may experience unintended pregnancy as an emotional and psychological challenge deserving of support. At the same time, it maintains awareness that including men must not compromise women's rights or autonomy in decision making.
The findings highlight gaps in understanding how healthcare providers can best support men in these situations. Further research could explore men's own experiences of unintended pregnancy and their interactions with healthcare services, as well as examining how different cultural contexts shape both men's involvement and providers' approaches to counseling.
As societies continue evolving their understanding of gender equality and shared parenting responsibilities, healthcare services face the ongoing challenge of developing practices that truly support all individuals affected by unintended pregnancy.
Follestad, H., & Berg, A. (2025). Counselling men involved in unintended pregnancy. Culture, Health & Sexuality, 1-16.
Infertility has become a significant public health concern, affecting more couples than ever before. The journey through fertility treatment is notoriously complex and lengthy, involving multiple specialists from gynecologists to psychologists to reproductive medicine experts. Yet many couples drop out of treatment before achieving their goal of pregnancy, and research reveals that patients often have surprisingly little understanding of fertility and the female menstrual cycle.
A study from France examined an alternative approach to fertility care that involves training general practitioners and specialized fertility instructors to support couples throughout their treatment journey. The results suggest this model could improve both patient engagement and treatment outcomes.
The Problem with Current Care Models
Traditional infertility treatment typically requires couples to navigate a maze of specialists and clinics. The process can be overwhelming, contributing to high dropout rates. Additionally, at a time when shared decision making between doctors and patients is becoming the standard, many patients lack basic knowledge about how fertility works and what their treatment options actually mean.
This knowledge gap makes it difficult for couples to participate meaningfully in decisions about their care. It can also lead to confusion about treatment protocols and poor adherence to medical recommendations.
Enter the Fertility Instructors
The French study focused on a network of trained fertility instructors who provide what's known as therapeutic patient education. These instructors, many of whom have backgrounds as midwives, pharmacists, or nurses, help couples prepare for medical consultations and support them throughout their entire fertility treatment process.
A central tool in this approach is the woman's menstrual cycle chart. Women learn to record specific observations about their cycles, including days of bleeding and characteristics of cervical discharge. With guidance from an instructor, women can create high quality charts that provide valuable clinical information.
The study surveyed 66 of these trained instructors across France in 2024. All were women, ranging in age from 26 to 55 when they completed their training. More than half had initial medical training, particularly as midwives. About one third of French regions had at least one trained instructor available.
Training General Practitioners
In addition to the fertility instructors, the study involved 15 general practitioners who received specialized training to participate in fertility care. This training equipped them to initiate treatment and guide couples through the process, rather than immediately referring all fertility concerns to specialists.
The idea is to bring fertility care closer to primary care settings, where patients already have established relationships with their doctors. This could reduce some of the intimidation and complexity associated with specialty fertility clinics.
What the Doctors Found Useful
The trained general practitioners were interviewed about their experience with this approach. They reported that the menstrual cycle charts provided by women offered several clinical benefits.
First, the charts helped with diagnosis. By tracking patterns over time, doctors could identify specific causes of infertility more accurately. Second, the charts helped doctors determine optimal timing for blood tests and other diagnostic procedures, as hormone levels vary significantly throughout the menstrual cycle. Third, the charts guided medication timing, ensuring treatments were administered at the most effective points in the cycle. Finally, the charts allowed doctors to monitor how the cycle improved gradually in response to treatment.
The doctors also noted that women gained a much clearer understanding of their own menstrual cycles through this process. This knowledge helped women communicate more effectively with their healthcare providers and understand the rationale behind various treatment decisions.
Patient Outcomes
The study analyzed records for all couples who received fertility counseling and treatment through this model between January 2022 and December 2023. The data covered 551 women.
Remarkably, only four women were lost to follow up, a dropout rate of less than 1%. This stands in stark contrast to the high dropout rates typically seen in fertility treatment. Of the remaining 547 women, 204 became pregnant, representing a 37% pregnancy rate. Among those who became pregnant, 75% either had a live birth or had an ongoing pregnancy when the study ended.
These retention and pregnancy rates suggest the approach may indeed improve outcomes, though the study design doesn't allow for direct comparison with traditional care models.
Why This Model Might Work
Several factors could explain the apparent success of this approach. The involvement of fertility instructors provides couples with ongoing support and education outside of medical appointments. This continuous engagement may help couples feel less isolated and more empowered throughout what can be an emotionally draining process.
The menstrual cycle chart serves multiple purposes. Clinically, it provides doctors with detailed, individualized data that can guide diagnosis and treatment. Psychologically, it gives women an active role in their care and a concrete way to contribute to their treatment. The act of charting may also help women feel more connected to their bodies and cycles.
Having general practitioners involved brings fertility care into a familiar setting where patients already have trusting relationships. Rather than feeling shuttled between specialists, couples have a consistent primary care provider who knows their full medical history and can coordinate their care.
The emphasis on patient education addresses the knowledge gap that often prevents couples from fully participating in treatment decisions. When patients understand what's happening in their bodies and why certain treatments are recommended, they're better positioned to make informed choices and stick with treatment protocols.
Limitations and Considerations
The study has some limitations worth noting. It examined a specific model of fertility care that may not be easily replicated everywhere. The fertility instructors and doctors received specialized training from a particular organization, and it's unclear whether similar results would occur with different training programs.
The study also didn't include a comparison group receiving traditional fertility care, making it difficult to definitively attribute the positive outcomes to this specific approach rather than other factors. The women who sought care through this model may differ in important ways from those who pursue traditional fertility treatment.
Additionally, the study focused on France, where the healthcare system and cultural attitudes toward fertility may differ from other countries. The transferability of this model to other healthcare contexts remains an open question.
A Patient Centered Approach
Despite these limitations, the study highlights the potential value of bringing more support and education into the fertility care process. The near zero dropout rate alone suggests this approach resonates with patients and keeps them engaged in treatment.
The model recognizes that infertility is often a chronic, multifactorial condition requiring sustained engagement over time. By providing ongoing education and support, training primary care doctors to participate in fertility care, and giving women tools to track and understand their cycles, this approach attempts to make the fertility journey less overwhelming and more collaborative.
As infertility continues to affect growing numbers of couples, finding ways to improve the care pathway becomes increasingly important. This French study suggests that investing in patient education and bringing fertility care closer to primary care settings may offer benefits worth exploring further. Whether through this specific model or adapted versions, the core principles of patient education, provider training, and continuous support could help more couples navigate the challenging path to parenthood.
Bernot, G., Lallemand, L., Le Menager, C., & Ecochard, R. (2025). Participation of general practitioners and therapeutic patient education in the care of infertile couples. European Journal of Obstetrics & Gynecology and Reproductive Biology, 310, 113956.
When couples enter therapy, they often arrive with different ideas about what they want to change. Sometimes these differences are subtle, other times they're stark enough to make the relationship feel impossible. A therapist working with these couples faces a unique challenge: how do you help two people move forward when they may not even agree on which direction to go?
Solution focused brief therapy offers some intriguing approaches to this dilemma. This therapeutic method, developed in the 1980s in Milwaukee, emphasizes building solutions rather than dissecting problems. When applied to couples, it focuses on what partners want their future to look like rather than endlessly analyzing what went wrong in the past.
