By Tonya Wood, PhD
Dr. Wood is a licensed psychologist who provides consultation, evaluation and psychotherapy. She is also on the faculty at Pepperdine University. Her academic scholarship focuses on reducing healthcare disparities and improving quality of care for communities of color. For more information about Dr. Wood visit her website at www.tonyawood.com.
Having spent so much time and energy in my 20s avoiding getting pregnant, it was quite the shock and surprise in my 30s when I realized that having a baby was going to be hard. Really hard. I was told that my irregular periods were probably “just stress.” So, I did not seek medical attention. After my first miscarriage, I was told not to worry because it was very common. So, I kept it to myself and didn’t reach out to anyone. When I expressed worries about my medical history and reproductive health to my OBGYN, I was told to “slow down.”
My own experience mirrors those of many Black women dealing with infertility and highlights the racial disparities that persist. Current statistics suggest that African American women are 1.5 to 2 times more likely than white women to experience infertility (Bey et.al, 2021). However, we also are much less likely to talk about our infertility struggles or seek out help. Not only do we have lower rates of utilization of assisted reproductive technology treatments to conceive we often wait longer than women of other ethnic groups to seek care (Seifer et al. 2020, Bey et al. 2021).
That was true for me. Being exposed to all the same myths and racial tropes about the hyper-fertility of women of color, I was sure that my fertility problems were a direct result of some action or inaction on my part. I did not know any other Black woman who had a miscarriage or trouble getting pregnant, so I waited. By the time I sought medical attention, I was already at an advanced maternal age with compounding medical risk factors impacting my likelihood of successful treatment outcome. The first of which were undiagnosed and untreated uterine fibroids.
Examination of racial disparities of infertility in Black women reveal that healthcare disparities exist not only seen in the rates of infertility but also in the causes. Black women are more likely to suffer with tubal or uterine abnormalities that interfere with achieving pregnancy (Seifer et. al 2020). Not only do Black women not have higher incidences of uterine fibroids, our uterine fibroids tend to be more numerous, painful and thus, we are much more likely to be recommended for more drastic interventions such as hysterectomies (Eltoukhi et al , 2014). All of this has dramatic impacts on the reproductive health of Black women. For years, I endured heavy and painful menstrual cycles, to learn later during a saline sonohysterogram conducted by a Reproductive Endocrinologist that those were symptoms of undiagnosed uterine fibroids (13 to be exact) that would need to be surgically removed before I had any chance of a successful pregnancy. Now I know that my fibroids should not have been a surprise to anyone, in fact they nearly should have been assumed as nearly 80% of Black women experience uterine fibroids (Eltoukhi et. al., 2014). In addition, a 2020 study conducted by Siefer et. al using cohort data from SARS found that Black women had less implantation rates, higher cycle cancellation rates and were less likely to have a live birth after an initial cycle than white women. Thus, there are also disparities found in treatment outcomes for Black women that need further review and attention.
Racial and ethnic disparities in infertility persist at all levels in Black women showing higher rates of infertility, less engagement in treatment and less outcomes in response to treatment.
Understanding the source and nature of these continued health care disparities is complex and multifaceted. Limited state mandates on insurance coverage of infertility treatments; early and accurate dissemination of information and resources to communities of color; increased number of providers from diverse ethnic and racial backgrounds; and bias in treatment of women of color are all considered to be contributing factors that impact access to care for Black women.
All women, particularly Black women, are encouraged to start early and often talking with each other about our reproductive health. Knowledge is power and equipping ourselves with information so that we can make informed decisions about when and how to begin the family building process is critical in increasing access to services. There are several groups and support systems designed specifically for Black women (e.g., Fertility for Colored Girls, The Broken Brown Egg, Black Mamas Matter and The Cade Foundation). Identify, connect or maybe even create your own support network through friends, church or advocacy groups.
Bridging the gap in disparities requires efforts at the systemic level as well. There is a great need for advocacy and legislation to broaden and mandate insurance coverage for infertility and reproductive health. Agencies and clinics can help decrease disparities by recruiting and hiring staff and healthcare workers from diverse racial and ethnic backgrounds and providing training on systemic racism and bias. Agencies can increase the number of available and qualified Black donors and surrogates through outreach and engagement in the Black community. Finally, funding is needed to research and mitigate the varied causes of infertility disparities for Black women.
Eltoukhi, H. M.; Modi, M.N.; Weston, M.; Armstrong, A.Y; Stewart E.A. (2014). The health disparities of uterine fibroid tumors for African American women: a public health issue. American journal of obstetrics and gynecology, 210(3), 194–199.
Jackson-Bey, T., Morris, J., Jasper, E., Edwards, D., Thornton, K., Richard-Davis, G., & Comeaux Plowden, T. (2021). Systematic review of racial and ethnic disparities in reproductive endocrinology and infertility: where do we stand today?, Fertility & Ster. Fertility & Sterility Reviews.
Seifer, D. B,; Simsek, B., Wantman, E., & Kotylar, A.M. (2020). Status of racial disparities between black and white women undergoing assisted reproductive technology in the US. Reproductive Biology and Endocrinology, 19(1) 117