Abstract
Purpose
Understanding how women navigate fertility-related decisions after a breast cancer diagnosis is critical for patient-centered survivorship care in low-resource settings. This study explored young women's fertility-related perspectives and, importantly, how their experiences point to system-level gaps in oncofertility counseling and access to fertility preservation at a periurban cancer center in Uganda.
Methods
A qualitative phenomenologic study design was used. Twenty young adult women diagnosed with breast cancer were purposively selected from St Francis Hospital Nsambya, in Kampala, Uganda. Data were collected through face-to-face, semistructured, in-depth interviews guided by an interview schedule. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis to systematically identify themes, subthemes, and illustrative quotes from participants' narratives.
Results
Four major themes emerged from the analysis: (1) Cultural and Societal Significance of Motherhood—childbearing held significant personal and cultural importance, affecting participants' identity and relationship decisions; (2) Need for Comprehensive Fertility Counseling—participants expressed the necessity for timely, empathetic, and detailed fertility information from health care providers and self-esteem; (3) Uncertainty about ika Fertility—considerable anxiety was expressed regarding potential infertility and adverse treatment effects on future offspring, resulting in difficult prioritization between survival and reproduction; and (4) Beyond reach—significant barriers, including high costs, lack of health insurance, and limited service availability, restricted participants' ability to pursue fertility preservation.
Conclusion
Young women with breast cancer in Uganda experience profound fertility-related distress shaped by sociocultural expectations and by health system constraints. Limited integration of oncofertility counseling into routine oncology care, gaps in provider communication, and restricted access to affordable fertility preservation (infrastructure constraints, high out-of-pocket costs, insurance exclusions, and geographic centralization) complicate decision making and highlight priorities for equitable service delivery.