Infertility and BIPOC (Black, Indigenous & People of Color) Women

Fact sheet from the Committee on Women in Psychology

As women’s options for work outside of the home have increased, so too has the age of first-time mothers. Women delay starting a family for a variety of reasons, including educational and career opportunities, delayed marriage, and increased access to contraception. The rates of women experiencing infertility and/or utilizing reproductive technology to become pregnant will continue to rise as women and couples wait to have children and start a family. Below are some case vignettes to illustrate experiences that some women face when dealing with infertility. It is important to note that although we focus on people who identify as women or who were assigned female at birth, some people who have a womb and seek fertility services identify as male or as non-binary.

Related

  • Lucy is Asian American and at 32 years of age, has just completed her first round of IVF and got a BFN (big fat negative) on the pregnancy test. She is devastated but feels she has to hold it together for her wife and herself. She never expected to be in this position and always thought that if she worked hard, she would be successful at what she started, but after five years of trying and lots of money, she is still not a mom.
  • Lena is a 27-year-old African American woman who has been with her partner for about five years. They want to start a family and have not been using protection for about 3 years, but nothing has happened yet. She didn’t think it would be so hard to get pregnant. She has decided to be patient because she believes that babies come from God and it will happen at the right time.
  • Rosa and her husband have been wanting a baby for the past five years. She is 35 years old and all of her cousins from both sides of her large Latinx family appear to have become pregnant quickly. She is ashamed to talk about her struggles with family and friends because she feels she is failing as a woman and a wife. After a shocking miscarriage, she recently used a donor for IVF, but it didn’t result in a pregnancy. Although they are struggling financially and she is finding it difficult to cope, she was getting ready to start another round of donor IVF when the COVID-19 pandemic started and all new treatments were canceled, which has resulted in increased depression and anxiety.
  • Debra is a divorced Native American mother of one child. She has been with her partner for 10 years and over the past year and a half they stopped using birth control in hopes that they would get pregnant. She experienced domestic violence in her past marriage and things are good for her right now. At 39 years of age, she is wondering if she should be happy with just one child, who she adores, and the opportunity to share the rest of her life with the love of her life.

All of the women in the examples above meet the criteria for the medical diagnosis of infertility. Many women who experience infertility may relate to their feelings of shame at not being able to conceive, isolation and lack of support, emotional distress, confusion, and financial pressures.

What is infertility and how common is it for those born female?

  • Infertility is “a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.” 1
  • According to the CDC, approximately 12% of women aged 15 to 44 years (regardless of marital status) have difficulty getting pregnant or carrying a pregnancy to term. Among married women in the U.S., between the ages of 15 and 44, 6% are unable to get pregnant after one year of unprotected sexual intercourse 2.
  • Women who experience infertility are at high risk for chronic medical conditions, adverse pregnancy outcomes and morbid perinatal events 3. Black women who are fertile have been found to have significantly higher risk of morbidity and mortality than White women 3.

Infertility and Disparity for Black, Indigenous, People of Color (BIPOC) Communities

  • Some have found that married Black and Latina women are more likely to be infertile than White women 4,5.
  • Black and Latina women are less likely to seek fertility treatment than their White counterparts 6. Also, Black women take more years to seek fertility treatment than White women 6. However, when financial barriers are removed or reduced, there is an increase in use of assisted reproductive services by Black women 7.
  • Black, Asian and Latina women undergoing fertility treatment experience decreased pregnancy and live birth rates in comparison to White women 8,9. Also, some research has identified decreased fertility among Native American women 10. Further, Native American women undergoing fertility treatment had lower pregnancy rates when compared to White women 10.
  • Black and Latina women using egg donors experience lower pregnancy and live birth rates in comparisons to White women 11. Black women had worse outcomes whether using Black or other race donors 11.
  • While BIPOC women are less likely to be referred for fertility treatment, once receiving care many find that clinics and providers lack cultural understanding. Close to half of Black women reported that their physician does not understand their cultural background when seeking fertility treatment 12. Low-income Latina women receiving care in a fertility clinic reported linguistic and cultural communication challenges with providers, as well as perceptions of providers being uncaring 13.

The Stigma of Infertility

  • Many BIPOC women growing up in the United States have heard stereotypes about their own group related to high rates of teenage pregnancy, hyper sexualization, and hyper fertility. Many people do not talk about their experiences which often leaves BIPOC women with the impression that they are alone in this process or that infertility is a reflection of their character and ability to parent 12.
  • One study found that the social stigma of infertility was “very concerning” to 49% of fertility patients, and Black and Chinese women were more concerned about social stigma related to infertility than White women 14.
  • One study found that Latina women had difficulty accepting the term “infertile” and did not want that term applied to their condition as it was perceived to indicate a hopeless situation 15.
  • The stigma of mental illness is also a concern when addressing infertility as many women coping with infertility may experience depression, anxiety and grief 12.
  • One study found that 26% of women and 9% of men undergoing infertility treatment met the criteria for major depressive disorder 12.

What Can Women Do?

  • Make reproductive health a part of health care meetings with physical and mental health providers. The health care system must also do better at making sure that providers have adequate training and skill in serving women of diverse racial/ethnic and cultural backgrounds.
  • Do not wait to seek help from a fertility specialist. It is best to seek a consultation even before one year of trying without protection has passed.
  • Seek mental health treatment when needed and preventatively.
  • Develop a consistent self-care routine that includes healthy nutrition, physical activity, adequate sleep, support from trusted loved ones, and opportunities for relaxation and stress management.
  • Consider complementary treatments like acupuncture during the infertility process.
  • Consider incorporating meditation approaches like mindfulness and mindful movements like yoga and tai chi.
  • Seek support from other women who are experiencing challenges with fertility. Organizations like Resolve often lists support groups available by state.
  • Seek guidance from your spiritual community if hesitancy about medical treatments to promote pregnancy, like IVF or donor eggs, includes a strong faith component.

What Can Psychologists Do?

  • Educate yourself about reproductive health and infertility.
  • Bring up the topic of reproductive health with clients. Normalize discussing these issues with clients.
  • Encourage clients who indicate that they want to have a family in the future to discuss early options (i.e., freezing eggs) with their health care provider.
  • Educate clients who plan to delay starting a family about family planning options.
  • Train reproductive medicine health care professionals on the psychology of infertility, how to (and how not to) respond to patients when they receive a diagnosis of infertility, and when to refer patients to a mental health specialist.
  • Advocate for medical insurance coverage for fertility treatments.

References

  1. World Health Organization (2020, September 14). Infertility. https://www.who.int/news-room/fact-sheets/detail/infertility
  2. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (2019, January 16). Retrieved April 8, 2021. https://www.cdc.gov/nccdphp/
  3. Murugappan, G., Li, S., Lathi, R. B., Baker, V. L., Luke, B., Eisenberg, M. L. (2020). Increased risk of severe maternal morbidity among infertile women: analysis of US claims data. American Journal of Obstetrics and Gynecology, 223(3), doi:10.1016/j.ajog.2020.02.027
  4. Chandra, A., Copen C.E., Stephen E.H. (2013). Infertility and Impaired Fecundity in the United States, 1982-2010: Data From the National Survey of Family Growth. National Health Statistics Reports.
  5. Stephen E.H. & Chandra A. (2006). Declining estimates of infertility in the United States: 1982–2002. Fertility and Sterility, 86, 516–23.
  6. Reported in : Insogna, I. G., & Ginsburg, E. S., (2018). Infertility, Inequality, and How Lack of Insurance Coverage Compromises Reproductive Autonomy. AMA Journal Of Ethics, 20(12), E1152-1159.
  7. Feinberg, E.C., Larsen, F. W., Catherino, W.H., Zhang, J., Armstrong, A. Y. (2005). Comparison of assisted reproductive technology utilization and outcomes between Caucasian and Black patients in an equal-access-to-care setting. Fertility and Sterility, 85(4), 888-894. doi:10.1016/j.fertnstert.2005.10.028
  8. McQueen, D. B., Schufreider, A., Lee, S. M., Feinberg, E.C., Uler, M. L. (2015). Racial disparities in in vitro fertilization outcomes. Fertility and Sterility, 104, 398–402.
  9. Humphries, L., Chang, O., Humm, K., Sakkas, D., Hacker, M. R. (2016). Influence of race and ethnicity on in vitro fertilization outcomes: systematic review. American Journal of Obstetrics & Gynecology. doi: 10.1016/j.ajog.2015.09.002.
  10. Craig, L. B., Weedin, E. A., Walker, W. D., Janitz, A. E., Hansen, K. R., Peck, J.D. (2018). Racial and Ethnic Differences in Pregnancy Rates Following Intrauterine Insemination with a Focus on American Indians. Racial Ethnic Health Disparities, 5(5): 1077–1083. doi:10.1007/s40615-017-0456-8.
  11. Zhou, X., McQueen, D. B., Schufreider, A., Lee, S. M., Uhlers, M.L. & Feinberg, E. C. (2020). Black recipients of oocyte donation experience lower live birth rates compared with White recipients. Reproductive BioMedicine Online, 40(5), 668-673. 
  12. Galic, I., Swanson, A., Warren, C., Olivia, N., Bozen, A., Brown, D., Lawson, A. and Jain, T. (2021). Infertility in the Midwest: perceptions and attitudes of current treatment. American Journal of Obstetrics and Gynecology. doi: https://doi.org/10.1016/j.ajog.2021.02.015
  13. Nachtigall, R. D., Castrillo, M., Shah, N., Turner, D., Harrington, J., Jackson, R. (2009). The challenge of providing infertility services to a low-income immigrant Latino population. Fertility and Sterility, 92(1), 116-123.doi:10.1016/j.fertnstert.2008.05.037
  14. Missmer, S. A., Seifer, M.D., Jain, T. (2011). Cultural factors contributing to health care disparities among patients with infertility in Midwestern United States. Fertility and Sterility, 95(6), 1943-1948
  15. Becker, G., Castrillo, M., Jackson, R., Nachtigall, R. D. (2006). Infertility among Low-income Latinos. Fertility and Sterility, 85(4), 883-887. doi:10.1016/j.fertnstert.2005.09.052