The racial disparities in prenatal care have been well documented. In the United States, the rates of maternal morbidity, fatality, and pre-term birth are drastically higher than in other developed nations, and women of color are at an increased risk of adverse pregnancy outcomes.
The Kaiser Family Foundation (KFF) reports that Black women are three times higher to suffer from pregnancy-related mortality compared to white women, while American Indian/Alaska Native (AIAN) women are twice as likely. Black and Hispanic women are also more likely to suffer from maternal morbidity, including pre-eclampsia and diabetes.
Unfortunately, racial disparities are not only present in prenatal care and outcomes. Research shows that this also extends to reproductive treatments, as women of color are less likely to have access to fertility assistance and have lower rates of success.
Women of Color Less Likely To Use Fertility Treatments
When speaking of racial disparities in reproductive treatments, it means that women of color are treated differently than their Caucasian counterparts, resulting in different outcomes.
Last month, the Center for Disease Control and Prevention (CDC) released new information on the rates of women accessing fertility treatments. They relied on information from the Pregnancy Risk Assessment Monitoring System (PRAMS), which collected data from 44,5000 women who gave birth between 2009 to 2019.
The research found that more than half (65%) of the women who accessed fertility treatment self-reported as Caucasian. Conversely, only 10% of those who used reproductive technology were Black while 9.7% were Hispanic. 15.2% of the respondents self-identified as “other.”
Additionally, women of color were less likely to have private insurance in order to offset the cost of fertility treatments. But even in states where insurance coverage for reproductive assistance is mandated, women of color were still less likely to utilize them compared to white women.
Fertility Issues May Be More Common In Women Of Color
Despite less women of color accessing reproductive treatments in the United States compared to white women, some research has found they may be at greater risk of fertility issues.
For instance, research from the National Survey for Family Growth found that Black women are less likely to report fertility issues than white women. Nevertheless, they add that non-Hispanic White women are the most likely group in the U.S. to use reproductive treatments.
Similarly, a study published in Women’s Health Reports in 2021 found that “minority women appear to have a lower fertility awareness than their NHW counterparts.” The authors emphasized that addressing racial disparities and improving fertility education could help remedy the problem.
More research is needed to understand if and why women of color are more likely to struggle to get pregnant. But what is clear is that racialized women are less likely to access reproductive treatments or even know that they’re struggling with fertility.
Pregnancy After Treatment Less Likely In Women Of Color
It’s not only that women of color are less likely to utilize reproductive technology. They’re also less likely to conceive following fertility treatments.
For example, a 2010 study published in Fertil Steril found that Asian, Black, and Hispanic women were less likely to become pregnant after using reproductive technology compared to White women. The women of color who did become pregnant were at greater risk of premature delivery and experiencing fetal growth restrictions.
A more recent study published in Productive Biology and Endocrinology in 2020 found that Black women had a significantly lower chance of conceiving following their first cycle of IVF compared to white women.
Factors Explaining Racial Disparity in Fertility Treatments
Racial disparity is a term used to refer to imbalances and incongruities between the treatment of different racial groups. Racial disparities are sustained by historical and contemporary discrimination, which reinforces and exacerbates unequal treatment.
This term is often used to discuss the criminal justice system in the context that people of color are more likely to face incarceration and longer sentences. However, racial disparity can be used in a wide range of contexts, including to discuss economic status, income, societal treatment, safety, reproductive health, and prenatal care.
In the U.S., the marginalization of people of color has directly contributed to racial disparities in reproductive treatment as well as in other contexts.
“Economic factors are the chief contributors to disparities in access to effective treatment,” the Ethics Committee of the American Society for Reproductive Medicine wrote in a 2015 report. “However, social and cultural factors play a role as well, including individual or systemic discrimination that disadvantages certain people because of their race, ethnicity, sexual orientation, or gender identity.”
One study published earlier this year in F&S Reviews reached a similar conclusion. Upon a systematic review of literature on reproductive health disparities, the authors found that racial and ethnic differences continue to be pervasive in access to fertility treatments as well as its success.
“Intrinsic and extrinsic factors, such as the institutionalization of racism and discrimination within medicine, remain influential in the diagnosis, care, and treatment outcomes of individuals with infertility,” the researchers wrote in their conclusion.
They add that funding research that specifically explores racial disparities in reproductive health as well as improving fertility education are important stepping stones in addressing this problem.
The Need For More Data To Improve Outcomes
Unfortunately, racial disparities are likely to persist in fertility treatments unless the underlying factors supporting systemic discrimination are addressed and dismantled. This is a complex situation with no easy way to approach it. But being aware of and challenging the treatment of women of color in healthcare (prenatal or otherwise) is an important step.
The Ethics Committee of the American Society for Reproductive Medicine emphasizes that further research needs to explore the presence of racial disparities in reproductive assistance and formulate ways to improve treatment and reduce the disparities.
The committee says this responsibility falls on all professionals involved in reproductive health – including “physicians, policymakers and insurance providers.” It’s up to them to break down the barriers and to ensure that fertility treatment is as accessible and effective for women of color as it is to their white counterparts.
In July, we reported that healthcare experts are demanding more data on the health of racialized women in order to improve pregnancy and birth outcomes. This must also include reproductive assistance to ensure that women of color have as much an opportunity to start a family as white women in the United States.
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