By Jane Van Dis, MD, FACOG
Maven strives to create better, more equitable health outcomes for all women during the family planning process. Although there are significant disparities in care throughout our healthcare system, an often overlooked aspect of women’s health and equity is the fertility journey. In honor of the upcoming National Infertility Awareness Week, let’s reflect on the fertility experiences of Black women and women of color.
Black women and women of color have nearly twice the rates of infertility compared to white women and lower rates of accessing fertility care than their white contemporaries. Many of these inequalities stem from a history of systemic racism and its resulting consequences.
A history of limited access to care and systemic racism
Black women and women of color, importantly, are less likely to have access to medical care, face discrimination and systemic and individual racism in medical care and are therefore less likely to access medical care.
Their distrust of the medical community can be traced to many events including the performance of gynecologic surgery on Black women without their consent and without anesthesia, the Tuskegee experiment, the use of Henrietta Lacks’s cells without her consent, and the manner by which, in the 1950s, the first large-scale clinical trials of birth control pills secretly tested high dose birth control on women in the poorest cities in Puerto Rico without their consent. The Lancet recently published an article exploring the history of medical racism and violence, including the use of “enslaved Black bodies as anatomical material,” a widespread practice in the 19th and early 20th centuries.
The generational experience of racism by Black women and women of color has had harmful effects on their health, their ability to access, request, and receive adequate care, especially for issues like infertility.
BIPOC women experience higher rates of fibroids and reproductive comorbidities
Infertility affects one in eight couples, but BIPOC women experience infertility at higher rates than their white counterparts and, importantly, BIPOC women are less likely to have adequate access to treatment, and wait longer before seeking help. Black women are more likely to experience fibroids and their associated risk factor for infertility.
By age 50, about two-thirds of all women have experienced uterine fibroids, but Black women are diagnosed with fibroids roughly three times as frequently as white women, develop them earlier in life and experience larger and more numerous fibroids causing more severe symptoms. According to the article, “nearly 25% of Black women between ages 18-30 have fibroids, compared with about 6% of white women.” Whereas white women are more likely to be offered fertility-sparing surgeries or therapies for fibroids, Black women are twice as likely to undergo a hysterectomy (removal of the uterus) thereby preventing the possibility of using their uterus for a pregnancy.
Black women are also more likely to suffer from comorbidities like hypertension, obesity, and diabetes, all of which can be contributing and independent risk factors for infertility and which, when combined, can have cumulative effects on fertility. Likely long term weathering, or stress, also referred to as allostatic load, also plays a role in decreased fertility rates. This hypothesis was first proposed in 1992 and suggests that elevated cortisol levels in response to environmental racism, microaggressions beginning in early childhood and extending throughout schooling and workplace, housing insecurity, fear of police and policing, fear of harm and death when seeking treatment for medical care, causes Black women to age faster and for cortisol to have harmful effects on blood vessels affecting every organ of the body.
Additionally, some have suggested that cultural norms play a role in keeping women from speaking about infertility due to feelings about being self-reliant, and to cultural expectations around privacy. There is also a persistent and harmful racist stereotype that suggests that Black women are hyper-fertile or can’t experience infertility.
Deep disparities in care between Black women and white counterparts
BIPOC women also experience disparities in access to care, and likewise in quality of care. Thus, their fertility journeys are often significantly more difficult. Below are a selection of statistics and studies that further elucidate the problem:
- Black women aged 33-44 had 2x odds of infertility after adjustment for socioeconomic status, correlates of pregnancy intent, and risk factors for infertility.
- In 2000, Black women underwent 4.6% of IVF cycles compared to 85.4% in White women
- Black women have higher miscarriage rates, especially in the 10-20 week gestation
- In a first time IVF cycle, there was marked difference in spontaneous miscarriage rates across races: 14.6% in white women versus 28.9% in black women, 20.6% in Asian women, and 15.3% in Hispanic women.
- Black women experienced a significantly longer duration of infertility before seeking care compared with white women (4.3 vs. 3.3 years).
- A recent study from the CDC examining the National ART (assisted reproductive technology use) Surveillance System (NASS) data demonstrated that Black women along with other women of color have lower than average US ART utilization rates defined as the number of ART procedures per million women of reproductive age.
How can we help Black women in their fertility journeys?
At Maven we have spoken frequently regarding the effects of systemic racism and inequality on maternity care. We train care advocates and providers in how to address unconscious race bias and better serve Black women and people of color on our platform.
We encourage our members to switch providers, on Maven or in person, if they don’t feel heard or listened to regarding their health care concerns or needs. Similarly, we encourage women to ask for a second opinion, in person or on Maven, if they don’t understand or feel comfortable with advice they’ve been given. Additionally, we encourage members to take notes when speaking with in-person providers and to ask for copies of medical records, to print notes from Maven visits so that they have and can understand and track their own medical history.
Beyond empowering our members, there are “fertility doulas” who are experienced in supporting those going through a fertility journey. We also encourage our members (during non-COVID times) to bring along a trusted family member or friend to in-person visits with providers for support.
Beyond visits with providers, Black women and women of color can join any number of fertility communities, on Maven’s forums, in private chats, or in communities on social media. They can also explore communities like:
Below are some additional resources to learn more about racism and infertility.
- American Journal of Public Health, Black Lives Matter: Claiming a Space for Evidence-Based Outrage in Obstetrics and Gynecology
- Fertility IQ, Fertility for Black Families
- The pervasive issue of racism and its impact on infertility patients: what can we do as reproductive endocrinologists?
- Here’s why many black women are silent about their struggle with infertility
Read more from Maven on health equity on the health section of our blog.
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