Oncofertility: Beyond Biological Motherhood, Towards Reproductive Justice

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Is Childlessness Really Another Side Effect of Cancer?

The emphasis on biological motherhood in the field of oncofertility masks at least two societal forces contributing to the cancer/infertility equation.

silent-invaders-coverFirst, the conditions in which people live and work are are already linked to cancers and adverse effects on women’s and men’s reproductive health. In 2003, Miriam Jacobs and Barbara Dinham edited a powerful book titled Silent Invaders that outlined how exposure to pesticides in air, water, soil, food, cleaning products, pets, cattle and wildlife reduces semen quality and increases birth defects and miscarriages as well as breast, cervical, and penile cancer. Four years later, a briefing on occupational exposures reiterated that the 100,000 synthetic chemicals in our workplaces expose more people than ever to a regular dose of carcinogenic contamination.

Second, socio-economic disadvantage compounded with racism and sexism can also lead to women’s infertility. Dorothy Roberts argues, for example, that structural disadvantages cause some women to “postpone childbearing until an age when they have a greater risk of getting cancer.” In other words, it is not that these women develop breast cancer because they are nulliparous (do not have biological children) per se, but that cancer risk increases with age for all women, those who have biological children and those who do not. Roberts cites evidence suggesting that age-related cancer risk is exacerbated by structural conditions such as poor working conditions that include job insecurity and exposure to toxic chemicals, all of which impact poor and low income women and men, especially ethnic minorities, more than others. (See links here and here).

Thus, the field of oncofertility frames reproductive health in a way that speaks only in terms of biological motherhood, which applies only to women who want to bear children.

Revisioning Women’s Reproductive Health Post-Cancer

I deeply appreciate what the field of oncofertility has done to put reproductive health on the international cancer agenda and expand options for cancer survivors. However, to realize the full potential of women’s reproductive health post-cancer, I propose moving beyond the field’s emphasis on biological reproduction towards a more inclusive redefinition of oncofertility that links motherhood to wider struggles for reproductive justice.

First, we need to recognize different definitions of motherhood which may include fostering children, adoption, gender queer parenting, and other visions of “family care.”

Second, we need to actively promote the diverse range of reproductive and parenting options, which includes information about non-parenthood. It should be clear that childlessness (or, being child free”) is a legitimate and healthy option for women as well as men.

Third, we need to provide clear and complete information about the impact of cancer treatments on women’s ability to conceive children so they are informed and better equipped to make decisions and understand possible side-effects.

Fourth, women should be informed of the potential psychological and physiological risks and benefits of oncofertility treatments, as well as gaps in existing data about long-term and adverse effects, to expand their capacity to exercise choices over their health.

Fifth, oncofertility advocacy strategies need to promote reproductive rights by challenging the discrimination of fostering and adoption agencies against cancer survivors.

Sixth, oncofertility advocates should connect their efforts to environmental justice campaigns such as Breast Cancer Action, Alliance for Cancer Prevention, Pesticides Action Network, La Plataforma NoGracias, and others, that are calling on governments and corporations to take action on the social (human-made) determinants of cancer.

Seventh, we need to reflect carefully on the bioethical considerations of oncofertility treatments before enthusiastically embracing them as the panacea for women’s reproductive health post-cancer.

Infertility as a consequence of cancer treatments can be traumatic for women. But not all women experience trauma in the same ways. As advocates, policymakers, educators, and health professionals, we have a responsibility to use the best evidence available about possible cancer and fertility treatments (including what is known and unknown about the potential benefits, risks, and adverse and long-term effects). We must find safer treatments and, until we do, use precautionary measures to safeguard the public health. We must broaden definitions of womanhood and respect women’s choices even if they go against the expected norms of biological motherhood, and our own values.

Acknowledgments

I owe a special thanks to the NIHR CLAHRC NWC, especially Professor Jennie Popay, for granting study leave to visit the Oncofertility Consortium in Chicago and Pen Law School in Philadelphia. I gratefully acknowledge the Division of Health Research at Lancaster University for funding my visit. I thank Professors Dorothy Roberts and Teresa Woodruff for welcoming me and generously sharing their time, reflections and resources.

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