{"id":19066,"date":"2020-12-29T11:24:37","date_gmt":"2020-12-29T16:24:37","guid":{"rendered":"https:\/\/progyny.com\/?p=19066"},"modified":"2023-04-27T21:04:34","modified_gmt":"2023-04-27T21:04:34","slug":"inequality-in-infertility-black-indigenous-and-people-of-color","status":"publish","type":"post","link":"https:\/\/progyny.com\/blog\/fertility-family-building\/inequality-in-infertility-black-indigenous-and-people-of-color\/","title":{"rendered":"Inequality in Infertility: Black, Indigenous and People of Color"},"content":{"rendered":"

Inequality comes in many forms, but race-related disparities in fertility and maternal health, especially among Black women, are\u00a0<\/span>particularly<\/span>\u00a0resistant to change.\u00a0<\/span>Black, Indigenous, and <\/span>People of\u00a0<\/span>Color\u00a0<\/span>(BIPOC)\u00a0<\/span>continue<\/span>\u00a0to have\u00a0<\/span>higher rates of infertility and lower rates of\u00a0<\/span>accessing<\/span>\u00a0fertility<\/span>\u00a0care\u00a0<\/span>than\u00a0<\/span>their\u00a0<\/span>white\u00a0<\/span>contemporaries<\/span>\u2014<\/span>as well as a\u00a0<\/span>higher risk of maternal mortality.<\/span>\u00a0<\/span>A<\/span>s a fertility and family building benefits\u00a0<\/span>provider<\/span>,<\/span>\u00a0we envision a world where anyone can have a child when they want to<\/span>, while acknowledging\u00a0<\/span>we need to do more to<\/span>\u00a0raise awareness of these issues and<\/span>\u00a0<\/span>truly\u00a0<\/span>eliminate these\u00a0<\/span>health\u00a0<\/span>disparities<\/span>.\u00a0<\/span>\u00a0<\/span>\u00a0<\/span><\/p>\n

Infertility<\/span>\u00a0in the BIPOC Community<\/span>\u00a0<\/span><\/h3>\n

Infertility impacts 1 in 8, but\u00a0<\/span>BIPOC women<\/span>\u00a0experience infertility\u00a0<\/span>at\u00a0<\/span>even\u00a0<\/span>higher rates than\u00a0<\/span>their white counterparts<\/span>, even\u00a0<\/span>when taking into account socioeconomics<\/span>\u00a0or risk factors\u00a0<\/span>such<\/span>\u00a0as fibroids.\u00a0<\/span>Despite these <\/span>higher rates of infertility<\/span><\/a>,\u00a0<\/span>Black\u00a0<\/span>women are<\/span>\u00a0<\/span>less likely to access treatment and if they do, may wait twice as long before seeking help<\/span><\/a>.<\/span>\u00a0<\/span>\u00a0<\/span><\/p>\n

T<\/span>here are many factors<\/span>\u00a0that contribute to these disparities<\/span>, including health conditions that disproportionately impact Black women.\u00a0<\/span>One common cause of infertility is <\/span>fibroids<\/span><\/a>,\u00a0<\/span>which are noncancerous tumors made of muscle<\/span>\u00a0that\u00a0<\/span>can grow in the uterus. Although they can be completely harmless, they can have an effect on\u00a0<\/span>fertility<\/span>\u00a0and cause complications when giving birth.<\/span>\u00a0<\/span><\/p>\n

Black women are<\/span>\u00a0three times as likely to have fibroids than white women\u00a0<\/span>when adjusted for other confounding factors<\/span><\/a>. About\u00a0<\/span>42 per 1,000\u00a0<\/span>U<\/span>.<\/span>S<\/span>.<\/span>\u00a0<\/span>women<\/span>\u00a0are hospitalized as a result of fibroids every year<\/span>,<\/span>\u00a0but Black women have increased rates of\u00a0<\/span>hospitalization, myomectomies, and hysterectomies compared with white women<\/span>.<\/span>\u00a0<\/span><\/p>\n

A\u00a0<\/span>2008<\/span>\u00a0comparison<\/span>\u00a0<\/span><\/a>of\u00a0<\/span>139,027\u00a0<\/span>assisted reproductive technology<\/span>\u00a0(ART)<\/span>\u00a0procedures<\/span>\u00a0sought to\u00a0<\/span>analyze how demographics might influence IVF success rates<\/span>\u00a0<\/span>and\u00a0<\/span>found\u00a0<\/span>Asian women had lower odds of pregnancy<\/span>\u00a0than white women<\/span>,<\/span>\u00a0and live birth rates were reduced in Asian, Black<\/span>,<\/span>\u00a0and Hispanic women<\/span>\u2014<\/span>but not white women.<\/span>\u00a0<\/span><\/p>\n

Unfortunately, there isn\u2019t<\/span>\u00a0<\/span>even enough data\u00a0<\/span>to\u00a0<\/span>show if Native American women experience decreased fertility rates, although\u00a0<\/span>one study<\/span><\/a>\u00a0found lower pregnancy rates.\u00a0<\/span>The\u00a0<\/span>authors<\/span>\u00a0acknowledged the<\/span>re are many factors that impact the study of racial and ethnic disparities<\/span>\u00a0(social, cultural, nutritional, environmental,\u00a0<\/span>physical<\/span>, etc.), but this data\u00a0<\/span>demonstrates significant differences in ART treatment outcomes for<\/span>\u00a0<\/span>BIPOC\u00a0<\/span>women.<\/span>\u00a0<\/span>\u00a0<\/span><\/p>\n

Rooted in Racism<\/span>\u00a0<\/span><\/h3>\n

Although researchers cannot pinpoint exactly why the fertility rates are lower for\u00a0<\/span>BIPOC<\/span>\u00a0women<\/span>,\u00a0<\/span>there are several theories.\u00a0<\/span>\u00a0<\/span><\/p>\n

One prominent hypothesis about why there are l<\/span>ower health outcomes in the Black community could be due to<\/span>\u00a0reduced ac<\/span>cess to medical care and comprehensive health insurance, which stops patients from getting even basic health care. However, poorer outcomes could also be due to \u201c<\/span>long-term physiologic programming<\/span><\/a>\u201d\u2014<\/span>or\u00a0<\/span>in other words, stress.\u00a0<\/span>\u00a0<\/span><\/p>\n

The\u00a0<\/span>systematic<\/span>\u00a0racism<\/span>\u00a0in\u00a0<\/span>our society causes massive amounts of stress, flooding the body with cortisol\u00a0<\/span>which may\u00a0<\/span>increa<\/span>se<\/span>\u00a0health risks.<\/span>\u00a0This theory, which is known as the \u201c<\/span>weather<\/span>ing<\/span>\u00a0hypothesis<\/span><\/a>\u201d was first\u00a0<\/span>proposed<\/span>\u00a0in 1992 and suggest<\/span>s<\/span>\u00a0that\u00a0<\/span>increased\u00a0<\/span>cortisol<\/span>\u00a0levels\u00a0<\/span>associated with\u00a0<\/span>stress<\/span>\u00a0<\/span>cause\u00a0<\/span>Black<\/span>\u00a0<\/span>women to age faster.\u00a0<\/span>This\u00a0<\/span>can\u00a0<\/span>help\u00a0<\/span>in\u00a0<\/span>understanding\u00a0<\/span>why Black women experience higher rates of infertility than their white counter<\/span>part<\/span>s<\/span>.<\/span>\u00a0<\/span><\/p>\n

Cultural\u00a0<\/span>practices<\/span>\u00a0<\/span>and differences\u00a0<\/span>could also affect why Black women and\u00a0<\/span>other\u00a0<\/span>women of color experience higher rates of infertility.\u00a0<\/span>A\u00a0<\/span>2015 study<\/span><\/a>\u00a0found that Black women\u00a0<\/span>a<\/span>void sharing\u00a0<\/span>ab<\/span>out their infertility\u00a0<\/span>with their closest family members and friends<\/span>\u00a0and even\u00a0<\/span>experience discomfort talking with their doctors<\/span>, which could lead to delays in treatment that\u00a0<\/span>mean increased difficulty conceiving<\/span>.\u00a0<\/span><\/p>\n

T<\/span>h<\/span>e study proposed thi<\/span>s<\/span>\u00a0silence\u00a0<\/span>could be<\/span>\u00a0due to the private nature of conception<\/span>, a desire to be\u00a0<\/span>self-reliant<\/span>,<\/span>\u00a0<\/span>or<\/span>\u00a0to cultural expectation<\/span>s<\/span>\u00a0of privacy<\/span>. One\u00a0<\/span>respondent<\/span>\u00a0<\/span>mentioned,\u00a0<\/span>\u201c<\/span>I never said anything to anyone else because in our <\/span>culture<\/span>\u00a0i<\/span>t<\/span>\u00a0was not something that you shared.<\/span>\u201d<\/span>\u00a0<\/span><\/p>\n

Overcoming Historical Trends<\/span>\u00a0<\/span><\/h3>\n

It is\u00a0<\/span>also\u00a0<\/span>worth noting<\/span>\u00a0<\/span>that many people in the BIPOC community distrust\u00a0<\/span>the\u00a0<\/span>U.S.\u00a0<\/span>healthcare system<\/span>\u00a0<\/span>because of<\/span>\u00a0<\/span>the<\/span>\u00a0<\/span>long history of\u00a0<\/span>racist and\u00a0<\/span>un<\/span>ethical\u00a0<\/span>practices<\/span>\u00a0<\/span>by medical professionals\u00a0<\/span>on BIPOC<\/span>\u00a0populations<\/span>.\u00a0<\/span>T<\/span>his<\/span>\u00a0history is vast and\u00a0<\/span>has affected<\/span>\u00a0countless\u00a0<\/span>unknown\u00a0<\/span>people<\/span>.<\/span>\u00a0Examples include<\/span>:<\/span>\u00a0<\/span>\u00a0<\/span><\/p>\n