Infertility Does Not See Race, Unfortunately Society Does

According to data from the 2006–2010 National Survey of Family Growth, infertility or impaired fecundity affects between 6 and 12% of the U.S. population aged 15 to 44, depending on the definition used when assessing prevalence (NSFG, 2015; Chandra et al. 2013). For nulliparous females who had unprotected intercourse in the past 12 months and intended to conceive, rates were as high as 46% between 2006 and 2010.

Clinical and population-based comparisons have identified disparities in both infertility prevalence and infertility care, predominantly among African American and Hispanic women.

Infertility is a public health issue with social, economic and health consequences extending well beyond quality of life. It is worth understanding why these disparities exist.

1. Access to care

Women who use fertility services are more likely to be higher income, white, married and older. In 2016, 15% of white women aged 25 to 44 in the United States had sought medical help to get pregnant, compared with 7,6% of Hispanic women and 8% of black women, according to the National Center for Health Statistics.

Access to care strongly predicts diagnosis and therefore treatment — and access is itself strongly correlated with race and socioeconomic status (Dieke et al. 2012; CDC 2013). A 2012 National Healthcare Disparities Report concluded that ethnic minorities had poorer quality of and access to care than white patients across a broad range of indices. Delays in accessing infertility care have been documented for several groups: Asian/Pacific Islander and black non-Hispanic women reported longer durations of infertility and accessed assisted reproductive technologies at a later age than white non-Hispanic women.

The main driver appears to be insurance coverage. A study of military families found no disparity in infertility rates by race — and no difference in the proportion of women using infertility treatment — suggesting that equal-access insurance coverage substantially reduces the gap (Feinberg et al. 2006).

2. Education and income

Data from the same survey suggests a pattern of primary impaired fecundity by educational attainment as well as race. Holding age constant, non-Hispanic white women without a bachelor's degree were 53% more likely to report difficulty conceiving than those with one — 20% against 13%.

The link between education and infertility is likely mediated by income, and again by access to treatment and speed of diagnosis.

What this means

There is strong evidence that racial disparities in infertility rates are driven by mechanisms correlated with access to treatment, income and education — not by biology. That matters, and it should offer some reassurance to women in communities with high recorded infertility rates.

Infertility does not see race. Unfortunately, society does — and the resulting misconceptions have caused real harm.

This article discusses published research and is general information rather than medical advice. If you have concerns about your own fertility, speak to your doctor.

References

Dieke, Ada C., et al. "Disparities in assisted reproductive technology utilization by race and ethnicity, United States, 2014: a commentary." Journal of Women's Health 26.6 (2017): 605–608.

Frieden, Thomas R. "CDC health disparities and inequalities report — United States, 2013. Foreword." MMWR supplements 62.3 (2013): 1–2.

Feinberg EC, Larsen FW, Catherino WH, Zhang J, Armstrong AY. "Comparison of assisted reproductive technology utilization and outcomes between Caucasian and African American patients in an equal-access-to-care setting." Fertil Steril. 2006;85:888–894.

Chandra A, Copen CE, Stephen EH. "Infertility and impaired fecundity in the United States, 1982–2010: data from the National Survey of Family Growth." Natl Health Stat Report. 2013 Aug 14;(67):1–18.

Warner, Lee, Denise J. Jamieson, and Wanda D. Barfield. "CDC releases a national public health action plan for the detection, prevention, and management of infertility." Journal of Women's Health 24.7 (2015): 548–549.