For this study, we didn’t interview the population of women who have access to but chose not to donate to the public bank. We tried to recruit women who considered donating to the public bank and chose not to donate, but we weren’t able to recruit any women who fell in this category. Only 3 participants did not donate and this was because of access obstacles (e.g., were not giving birth at a hospital that collects cord blood). Given that this study was focused on the public bank, we also didn’t interview women who had access to bank at a private bank and decided not to bank. Studies that examine these populations would be very insightful.

That’s an interesting idea and one that would be interesting to explore. I think one significant difference between cord blood/faecal microbiota and blood/plasma is that the former human biological materials are associated with promissory sciences (e.g., hope and hype of stem cells and human microbiota) and part of the social and scientific imagery that supports the donation of these materials is not only helping others in the present but future potential for these materials to lead to breakthroughs in science. As far as I know, this is not the case for blood and plasma. Neither is associated with new emerging sciences and the social imagery of blood and plasma is very much focused on clinical use. It would be interesting to examine if contributing blood and plasma to scientific research would be a motivator to donation and whether the type of scientific research – e.g., new promissory research for a new cure versus less “exciting”, “ground breaking” type studies – might make a difference.

There are many areas for further research regarding cord blood, donors and healthcare systems. One area that’s under-researched in Canada is cord blood donation by different communities of racialized donors to better understand donation from their perspectives. Second, social determinants of cord blood donation and how social factors, such as social capital, may influence whether women donate cord blood. Third, given that cord blood collection occurs in hospital in Canada, examining the perspectives of healthcare staff who assist in the recruitment and collection processes would contribute to improving these processes. Lastly, I think the question posed in Q1 raises an important area for further research – what are the barriers or reasons why women who consider donating cord blood decide not to?

We chose to conduct a process evaluation to assess how the cord blood program was doing after a few years of implementation. A process evaluation views a process as a social activity made up of various social actors and begins from an understanding that how a process is intended to occur, in theory, is often not how it happens in practice. While the cord blood bank had been in operation for a few years, recruitment of cord blood donors continued to be a challenge so we focused our process evaluation on in-hospital donor recruitment and collection. For the full project, I interviewed managers of the cord blood bank, frontline staff, and women who donated or tried to donate cord blood. I found it to be a really useful approach and we able to identify what was working well and where there were some gaps in the process. For example, we identified some gaps in follow up with women who had registered to have their cord blood collected, but were uncertain if it had been collected and/or banked. Knowing this, the cord blood bank improved their follow up with women who had registered. Interestingly, through the interviews, we also learned that labour and delivery nurses are key social actors in the process and recommended additional research to better understand their role in the process.

 I started out with the aim to interview 40 women who had donated or tried to donate cord blood (based on general conventions in qualitative research that indicates 20-30 “information rich” participants often provides sufficient data to reach saturation). However, most women who register to have their cord blood collected don’t have a bankable unit (i.e., cord blood collections must meet minimum standards to be banked) so they will only have completed the first stage of consent; that is, completed the registration to donate. Only those women who have a bankable unit are asked to complete the second stage of consent in order for their cord blood unit to be banked (the cord blood bank in Canada has a two-stage model of consent). It is the second stage of consent that requires women to complete a maternal health questionnaire, provide a blood sample, etc. For most women this is completed before they leave the hospital, so for many within the first 24-48 hours of giving birth. Because most women don’t have a bankable unit, I found that with the first round of recruitment and interviews the vast majority of participants had only completed the first stage of consent. Given that women who have a bankable unit must participate in completing the second stage of consent (i.e., an additional part of the donation process), we felt it was important to ensure we hear from a sufficient number of these women as well. So we modified recruitment to over recruit women who had completed the second stage of consent and we went from an initial aim of 40 participants to 76.