Fertility in the Shadow of Cancer: Experiences of Reproductive Loss Among Women with Gynecological Cancers in Ghana

Abstract

BACKGROUND: Gynecological cancers remain a threat to women's health in Ghana, where the burden is shaped by late diagnosis, limited specialized care, and treatment-related infertility. Surgery, chemotherapy, and radiotherapy can damage the ovaries and uterus, causing premature ovarian failure, early menopause, and loss of reproductive potential. In a pronatalist context where motherhood supports identity, marriage stability, and social standing, infertility carries a psychosocial burden. Yet, the lived experiences of women with gynecological cancer-related infertility remain poorly understood. OBJECTIVE: This study explored the experiences of reproductive loss among women with gynecological cancers receiving care at a tertiary referral hospital in Ghana. METHODS: A qualitative descriptive design guided the study. Fourteen women aged 22-48 years with cervical, ovarian, uterine, or endometrial cancers, who had completed or were undergoing treatment, were purposively recruited. Semi-structured interviews (30-45 minutes) were conducted face-to-face or by telephone in private settings in English, Twi, or Ewe by trained nurses, audio-recorded, transcribed verbatim, and analyzed inductively using thematic analysis. RESULTS: Three interconnected themes and thirteen subthemes emerged from the data: (1) psychological and emotional experiences, (2) social challenges, and (3) coping and resilience strategies. Fertility loss was experienced as a threat to womanhood, motherhood, and relational security, especially among younger, single, and childless participants. Women undergoing active treatment emphasized symptom burden, whereas those post-treatment focused on childbearing loss. Participants described incompleteness, fear of rejection, anxiety, denial, and shattered aspirations, while social stigma and strained intimate relationships intensified distress. These experiences were compounded by treatment-related symptoms, financial strain, and interrupted education. Coping drew on adherence to treatment, dietary changes, prayer, and family support, which helped sustain hope and resilience. CONCLUSION: Reproductive loss among women with gynecological cancers in Ghana is a psychosocial, sociocultural, and economic burden that affects quality of life. Holistic, culturally sensitive care should integrate fertility counseling, psychosocial support, symptom management, financial protection, and guidance on alternative family-building options such as adoption.