What fertility awareness campaigns can learn from lived experiences

Earlier this year, France introduced a national fertility strategy that includes – among other public health measures – sending a reproductive health information letter to all citizens turning 29 and offering publicly funded access to elective gamete cryopreservation, available from ages 29-37 for women and 29-45 for men (see BioNews 1327).

This recent initiative by the French government has sparked renewed debate about how we communicate with the public about fertility. Such campaigns are usually well-intentioned. They aim to help people make informed reproductive choices, and prevent them from 'sleepwalking into infertility'. Research consistently shows in fact that many people underestimate the impact of age on fertility while overestimating the effectiveness of medically assisted reproduction in overcoming age-related decline.

Good intentions, however, do not always translate into good communication. Many fertility awareness campaigns have been criticised for disproportionately placing the responsibility on women while paying little or no attention to the social, economic and relational factors that influence reproductive decisions. Some campaigns risk reinforcing ageist, ableist, and heteronormative assumptions by promoting a narrow image of who should become a parent, and how families should be formed. Others seem to trivialise infertility by suggesting that conception is simply a matter of relaxing, taking a holiday, or having more sex.

Such messages, however, can leave people feeling blamed, anxious, misunderstood or isolated. Therefore, the most important questions are not only what fertility awareness campaigns communicate, but also how they communicate it and whose experiences they reflect. Fertility awareness is not simply about transmitting knowledge; it is also about understanding how people receive, interpret and live with that knowledge.

Now imagine how two different women might experience the same fertility awareness letter from the French government.

Viola is a childhood cancer survivor who underwent fertility preservation prior to her treatment. Single and hoping to become a parent soon, she has long known her fertility might be compromised, yet she has never received clear medical guidance on what this actually means for her reproductive future. She remains uncertain about the viability of the eggs she preserved, her realistic chances of biological parenthood, and what alternative options would entail for someone with her medical history.

Emma was born without a uterus due to Mayer-Rokitansky-Küster-Hauser syndrome. She is in a stable relationship and hopes to become a parent in the near future. As with Viola, her questions are not primarily about declining fertility with age, but rather whether pregnancy is medically possible and which pathways to parenthood are available. Is uterus transplantation possible? What are the legal possibilities for surrogacy? Who can help her navigate these choices?

Although the letter focuses on fertility, it may touch on much broader questions that have accompanied both women for many years. For Viola, fertility is only one part of a much larger survivorship story. Her hopes for parenthood are intertwined with concerns about her long-term health, the possibility of recurrence and whether she will have enough time to start a family. She is also worried that her cancer history could affect any future children she might have. Other pathways to parenthood, such as adoption, may also be complicated, particularly given the practical, financial and social barriers that can affect a cancer survivor's access to adoption.

For Emma, fertility has also been part of her life from an early age. Having been born without a uterus, she has been familiar with the healthcare system since childhood, starting with investigations into her missing periods. The diagnosis process involved repeated examinations and conversations that focused heavily on fertility and reproductive possibilities. A fertility awareness message may therefore evoke earlier experiences of being defined by what her body was perceived to 'lack', rather than by her broader identity and life goals. Her hopes for parenthood are shaped not only by available reproductive options, but also by a history of medicalisation, stigma, and learning to live with bodily 'difference'.

For both women, infertility is thus not a problem that suddenly emerged when they started trying to conceive. It has been part of their lives long before they entered intimate relationships or actively considered parenthood. Their experiences therefore challenge a narrow framing of fertility awareness, which often centers on age, timing, and future family planning. They show that fertility and infertility are often lived across the life course. Yet, in research, clinical care and public communication, fertility is often approached as a series of discrete moments: the diagnosis of a condition that may affect fertility, the decision to preserve reproductive material, or the point at which someone begins trying to conceive.

Much less attention has been paid to what happens between and beyond these moments: how people understand their reproductive possibilities over time, how fertility shapes their lives and relationships, and how they navigate uncertainty.

This focus on discrete moments can also make fertility awareness feel more straightforward than it is in practice. Like most fertility awareness messages, the French campaign reflects this moment-based approach by encouraging people at age 29 to consider oocyte cryopreservation. While preservation may expand future options, it also illustrates a broader tendency to frame fertility as something that can be managed (and controlled) through timely intervention, rather than as a lifelong process shaped by changing health, relationships, social circumstances, and reproductive aspirations.

The stories of Viola and Emma also remind us that reproductive futures depend not only on biology or individual planning, but also on the legal, financial, and healthcare systems in which people live. This is particularly relevant for fertility awareness campaigns, which often emphasise knowledge and individual choice. Still, awareness does not automatically create options. Across Europe, access to assisted reproductive technologies, donor gametes, uterus transplantation, surrogacy, national and international adoption, and financial support varies considerably, while eligibility may depend on relationship status or sexual orientation.

Viola and Emma should therefore not be understood as exceptional cases. Rather, their stories can help us rethink what fertility awareness should mean. Fertility is not only about understanding biological timelines or modifying individual health behaviours, but also about recognising the diverse ways in which people encounter reproductive uncertainty throughout their lives. Good communication should therefore move beyond simply transmitting information about fertility risks. It should help people understand what this information means for them, recognise the complex questions it raises, and identify where they can find appropriate support, legal clarity and inclusive care.

I am currently working on an interdisciplinary Swiss research project exploring the experiences and needs of people with variations of sex characteristics and their families to develop more inclusive, person-centred and participatory healthcare. To find out more, visit the project overview and the SHARED-VSC project page.