A patient once told me how reassured she was to have found me because of how hard it was to find a black fertility doctor.
To see a physician who looked like her.
She told me that she had not discussed her infertility with anyone (besides her husband) because she did not know anyone who looked like her who had been through this.
It just was not discussed.
Not at work, not with family and not with friends.
Even when she went online to try to look at blogs about other women going through infertility, she did not find herself represented in many of the spaces she found.
This patient of mine is not alone in her feelings.
The American Society for Reproductive Medicine (ASRM) states that “It is the responsibility of all assisted reproductive technology (ART) stakeholders, including physicians, policymakers, and insurance providers, to address and lessen existing barriers to infertility care. Efforts should include increasing insurance coverage, reducing the economic and noneconomic burdens of treatment, improving public and physician awareness of the existence and causes of treatment disparities, and reaching underserved populations and geographic areas.”
From the pervasive misinformation that infertility does not impact black men and women to the cultural stigma around seeking help for infertility to the reduced access to care, we have more work to do.
Black Women are 2x as Likely to Experience Infertility
Studies have noted that black women are more 2x as likely to experience infertility compared to white women. Possible reasons for this may include higher rates of uterine fibroids and tubal factor infertility. Studies have consistently found that black women have a 2-3x higher risk of uterine fibroids, which depending on location can have an impact on pregnancy outcomes. Reasons for these higher rates of fibroids in black women are still not well known but may be related to differences in genetic factors, environmental exposures, psychosocial stress or lifestyle. Additionally, black women have higher rates of tubal factor infertility. The fallopian tubes are a vital part of natural reproduction as they are responsible for picking up the egg that was ovulated from the ovaries and is where fertilization and early embryo development take place. One possible reason for the increased rates of tubal factor infertility is that black women have a 7-8x higher rate of sexually transmitted infections with gonorrhea and chlamydia, both of which can lead to pelvic inflammatory disease and possible subsequent tubal damage. We need to continue to educate all women, and especially black women, about the risks of STDs, the importance of immediate treatment, and the risk on future reproductive health.
Black Women are 50% Less Likely to Seek out Fertility Care
Despite having higher rates of infertility noted in some studies, black women have been shown to seek out fertility care 50% less than white women with infertility. One study that interviewed 50 black women going through infertility found that 98% of the women experienced silence, isolation, or loneliness associated with their infertility. Additionally, 26% of the women experienced some sort of stereotype or discrimination whether based on race, class, or socioeconomic status from the medical field. Another survey of women who presented to a Midwestern fertility clinic found that black women were 3-4x more likely than white women to feel a social stigma of infertility, feel concerned by friends or family finding out about treatment, and to feel a personal sense of “failure” for not being able to conceive.
Empowering Black Women to Speak about Infertility
The purpose of black women speaking out about infertility not only normalizes the diagnosis for the black community, but it allows us to realize we are not alone on our path to parenthood.
As a fertility specialist, I feel that we (as a medical field) must be actively inclusive of all people going through infertility regardless of race, socioeconomic status and sexual orientation. This means that not only should the staff and physicians working in a fertility clinic be diverse, but that our clinic websites and the pamphlets that we give to our patients also depict diversity.
We need to be competent medically, but we also need to be competent culturally.
We may not have walked in the exact shoes of our patients, but we need to be able to empathize with them and the journey they have been on to get to where there are today, sitting in our office seeking support in building their family.
As black women continue to discuss their infertility and their path to parenthood that may look different from what they envisioned, I hope we can give them the space and the support they need. I hope we can recognize that this journey may not have been easy for them and also remind them of the importance of sharing their story which may be helpful to so many others like them who are suffering in silence.