Reproductive autonomy of women living with multiple myeloma participating in a pregnancy prevention program.

backgroundMultiple myeloma is an incurable hematologic cancer that primarily affects older adults. Females of childbearing potential represent a small but uniquely affected proportion of the multiple myeloma population. The immunomodulatory agents (thalidomide, lenalidomide and pomalidomide) are highly effective treatments in improving prolonged periods of deep remission and long-term survival in Multiple Myeloma, is dispensed through controlled distribution programs that require pregnancy monitoring for females of childbearing potential to reduce the risk of fetal exposure. There is limited understanding of the impact of pregnancy prevention and monitoring measures on the reproductive health, autonomy, and rights of women living with multiple myeloma.

methodsThis critical qualitative study is informed by a descriptive methodological approach, and a feminist reproductive justice theoretical framework informed the data analysis and interpretation. We employed purposive sampling to identify and conduct interviews with females of childbearing potential, living with multiple myeloma, that have experience participating in a controlled distribution program.

resultsThis study reflects the experiences of 15 females of childbearing potential living with MM, all of whom identified as women and ranged in age from 33–50 at diagnosis. Participants were situated in provinces across Canada, with most identifying as White, married, and of higher socioeconomic status. Findings illuminate a multitude of ways in which controlled distribution programs imposed threats to the reproductive health and autonomy of these women. Although many participants acknowledged the importance of preventing fetal exposure to teratogenic medications, the prescriptive and controlling nature of hyper-vigilant pregnancy monitoring programs and practices imposed significant burden and constraints on females of childbearing potential. Key analytic themes highlight the perceived paternalistic nature of controlled distribution programs, the systemic distrust of females of childbearing potential, and women’s actions and advocacy efforts to (re)claim their reproductive agency.

conclusionParticipant-informed adaptations to the design and delivery of pregnancy monitoring and prevention requirements in existing controlled distribution programs to promote the reproductive autonomy and agency of females of childbearing potential are both necessary and feasible. Key recommendations include increased provision of timely, comprehensive information and education, psychosocial support, as well as modifications to programs and regulatory bodies to recognize women as trustworthy and capable of autonomous, reproductive health decision-making.