Oncofertility: Beyond Biological Motherhood, Towards Reproductive Justice

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Cancer and cancer treatments can have a huge impact on women’s sexual and reproductive health. Yet, when I started my research on breast cancer and social inequality in Spain a decade ago this issue was hardly being addressed in international scholarly debates or in clinical settings. Several of the women I interviewed explained that their doctors never approached the topic of fertility. On several occasions, when women raised questions about their reproductive and sexual future with doctors their concerns were quickly dismissed. The priority, they were told, was curing cancer; any other concern was considered a ‘luxury’ or ‘secondary’ to the disease.

Around that time Teresa Woodruff, a formidable expert in ovarian biology and Director of Women’s Health Research Institute at Northwestern University, coined the term of oncofertility. Oncofertility is a word which combines the terms oncology (the study of cancer) and fertility (capacity to produce offspring).

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In 2007, Woodruff established the Oncofertility Consortium, with a commendable mission. She wanted to put this overlooked aspect of the disease on the international cancer agenda; to explore and “expand fertility options for cancer survivors;” and, promote collaboration between specialists of different disciplines as the most effective way to address women’s reproductive concerns. As explained by Woodruff’s team, the Consortium addresses these goals in several ways:

  1. Understanding women’s lived experiences of infertility;
  2. Providing insights into the ways medical drugs affect women’s reproductive organs and processes;
  3. Developing treatments to preserve fertility;
  4. Helping health professionals to improve communication with patients;
  5. Supporting a global network of partners to build their own networks, sharing the latest scientific research, and facilitating transnational collaboration.

Woodruff’s work with the Oncofertility Consortium is impressive and has indeed raised awareness about the impact of cancer on women’s fertility. Oncofertility is now a well-established and respected field in many Western clinical settings.

Bioethical Considerations

The Oncofertility Consortium invited professor of law and sociology at Penn Law School, Dorothy Roberts, to consider some of the bioethical aspects surrounding the field of oncofertility. In response, Professor Roberts wrote in 2012 “The Social Context of Oncofertility – an incisive, clear and engaging critique of the how the field’s intensive focus on biological motherhood might mask racial, gender and class inequalities in women’s reproductive health.

Several issues raised by Roberts resonate with the conversations I’ve had both with women who are living with breast cancer and with feminist health professionals. I highlight them here not to criticize the important work of the Oncofertility Consortium, but rather to encourage constructive reflection.

Social pressures and kin expectations, for instance, can make infertility stigmatizing for childless women. In most societies, including Western societies past and present, women’s gender and social identity has been based on their role as mothers. Motherhood is deemed the rite of passage for women to enter the world of adulthood and gain access to economic and social support.

Infertility can be an agonizing experience for women who wanted to become mothers but delayed having children due to social and economic concerns. Carmina, one of the women I interviewed for field research, explained that she deliberately postponed having children because she couldn’t afford to be unemployed. She worked through an outsourcing company, as a cleaner in a health center. She said, “If you get sick, you’re likely to be fired.” By the time her family felt more settled economically and decided to have a child, Carmina was diagnosed with breast cancer.

Distress associated with the physical inability to bear children may not be about having children at all, but instead be related to cancer’s assault on a woman’s decision-making power. My colleague Grazia de Michele told me that cancer-induced infertility is traumatic because it “strips women of their right to choose whether they want to have children or not.” Her statement denaturalizes the automatic linkages between infertility, bereavement for the loss of one’s fertility, and women’s desire to become mothers in the first place.

Part of the success story around oncofertility lies in its focus on biological motherhood, and the traditional notion that motherhood is a natural thing for women to want (links here and here). But the potential desirability of not becoming a mother, as de Michele pointed out, is rarely a topic of conversation. In fact, the dialogue surrounding oncofertility has gone from one extreme to the other in attending to women’s reproductive health following cancer. At one extreme, women’s reproductive concerns were ignored or disregarded as secondary to cancer treatment. At the other, the exclusive focus in oncofertility on helping women to become mothers post-cancer may have inadvertently (re)created constraining norms around reproduction.

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