Exploring Reproductive Decision-Making Among Women With Multiple Sclerosis

Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system that predominantly affects individuals during their reproductive years. The increasing availability of effective disease-modifying therapies and improvements in the management of MS have allowed many women living with MS to consider marriage, pregnancy, and parenthood. However, reproductive decision-making may remain complex because women may have concerns about disease progression, disability, pregnancy and postpartum disease activity, effects of medications on pregnancy and breastfeeding, possible health risks to the child, and their ability to fulfil maternal and family responsibilities. Reproductive decisions among women with MS may also be influenced by factors beyond the clinical characteristics of the disease. These may include age, marital status, educational and socioeconomic circumstances, family and social expectations, partner support, reproductive autonomy, previous reproductive experiences, access to appropriate counseling, and perceptions of the impact of MS on family life. Women may therefore make reproductive decisions within a complex interaction of medical, psychological, interpersonal, social, and demographic factors. Despite the importance of reproductive health in women with chronic diseases, there is limited information about how women with MS in Egypt experience and make reproductive decisions, particularly within the social and cultural context of Upper Egypt. Understanding women's perspectives is important for identifying unmet reproductive health needs and improving counseling and support provided by healthcare professionals. This study will use a sequential explanatory mixed-methods approach to explore reproductive decision-making among women of reproductive age living with MS in Assiut Governorate. The study will initially collect quantitative information from eligible married women with MS. The quantitative component will assess reproductive decision-making and related factors, including reproductive intentions and preferences, reproductive autonomy, partner support, and relevant sociodemographic and disease-related characteristics. The quantitative findings will subsequently inform the qualitative component. In-depth interviews will be conducted with selected women with MS to provide a deeper understanding of the experiences, concerns, perceptions, and contextual factors underlying reproductive decisions. Married women participating in the quantitative component may be invited to participate in the qualitative interviews. Single women will be explored separately through the qualitative component to capture their perspectives regarding marriage, fertility intentions, future childbearing, and concerns related to reproductive life that cannot be adequately assessed through the quantitative component. The qualitative sampling will use purposive maximum-variation sampling to include women with diverse sociodemographic, marital, and disease-related characteristics. These may include age, residence, educational level, employment, disease duration, disability severity, disease-modifying treatment, fertility intentions, motherhood status, and pregnancy experience after MS diagnosis. Interviews will continue until sufficient depth and diversity of information are achieved and thematic saturation is reached. The qualitative interviews will explore women's experiences of living with MS and its perceived influence on marriage and intimate relationships, fertility intentions and timing of childbearing, desired family size, pregnancy and childbirth, breastfeeding, motherhood and childcare, and family planning and contraceptive decision-making. Participants will also be asked about their experiences of receiving reproductive health counseling and information related to pregnancy, contraception, breastfeeding, MS treatment, and potential risks to themselves or their children. The interviews will further explore the roles of partners, families, healthcare professionals, and the broader social context in shaping reproductive decisions. Quantitative and qualitative findings will be interpreted together to develop a comprehensive understanding of reproductive decision-making among women living with MS. The qualitative findings will help explain and contextualize important quantitative patterns and may identify experiences or factors that are not captured by structured questionnaires. The study is intended to generate evidence about the reproductive concerns, needs, and decision-making experiences of women living with MS in Assiut Governorate. The findings may help identify gaps in reproductive health information and counseling and may support the development of more responsive, patient-centered reproductive health services for women with MS. The study may also provide a basis for future research and interventions addressing reproductive health and family planning needs among women living with chronic neurological diseases.