Exploring Reproductive Decision-Making Among Women With Multiple Sclerosis in Assiut Governorate: Mixed-Methods Study

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.