07 Feb 2023 Disparities Remain for Black Women Living with Infertility
Although Black History Month is a time to highlight and celebrate achievements in the Black community, it is also a time to acknowledge where we have come from, as Americans and as human beings, and how we can work together to create a more just and equitable world. In the fertility world, much work remains to be done.
The reality is Black women are more likely than women of other ethnicities to face fertility challenges. According to the National Library of Medicine, Black women “had a two-fold increased odds” of infertility compared to their white counterparts even after an adjustment for socioeconomic position. Disparities in outcomes and access to services for Black women in the infertility world have taken a back seat for too long. Word about this inequity is finally spreading among reproductive health professionals, and studies are being conducted to see why these disparities exist. Why are Black women suffering from infertility more than white women, and why are we only just now talking about it?
Black Women Seek Fertility Care at an Older Age
Age is the number one contributor to fertility issues. In general, infertility is clinically described as the inability to become pregnant after 12 months of unprotected intercourse for women under 35 and six months for women over 35. On average, Black women spend longer periods of time dealing with infertility before they reach out to a doctor for help. Parents.com discussed the issue in 2022, stating that white women between the ages of 25 and 44 were twice as likely to seek out fertility treatments earlier compared to only 8 percent of Black women who seek out treatments during child-bearing years.
Black women are also more likely to suffer in silence for longer periods of time before they seek help. Parents.com goes on to explain a strange but ongoing persistent myth in which Black women are super-fertile, perpetuating a lack of understanding of infertility issues and creating a level of shame within the community. Some Black women do not feel as though they can talk to their families or doctors, which results in more Black women seeking help later in life, or not seeking help at all.
Ijeoma Kola, Ph.D., a Nigerian American entrepreneur with a doctoral degree in the history of public health, struggled with infertility and suffered in silence for many months, even avoiding talking to her own mother about it. She tells Glamour, “Black women are presented as hypersexual. We get pregnant like this; we’re welfare queens. There’s this perception of an African woman having 10 kids and being hyper-fertile. That can be difficult to push back against if you’re struggling to get pregnant.”
Struggling to overcome such stereotypes can also affect Black women’s care. “When a Black woman comes in for her annual visit, infertility may be the last thing that is discussed,” Lynae Brayboy, M.D., an African American ob-gyn who specializes in reproductive endocrinology and infertility, also tells Glamour. She goes on to say that the loss of infertility can indicate other underlying issues. Women are scared to talk about it and, as a result, don’t seek help until age becomes an added factor.
Black Women Are More Likely to Suffer from Uterine Issues
In addition to seeking care at an older age, uterine issues including fibroid tumors are more common and more severe among Black women, according to Science Direct. Fibroids tend to be more numerous and painful leading to more drastic treatment, often including hysterectomies.
Diane, a friend who is now in her late forties and using a pseudo-name for privacy, has lived this nightmare. She says that every woman in her family has developed some type of uterine issue over time. Diane knew that she had painful periods as a teenager, but never really thought anything about it until she was in her 30s and doing crunches on the floor one day when a large lump protruded from her abdomen. At that point, she knew she needed to see a doctor, who eventually confirmed she had a grapefruit-sized fibroid growing inside her. The fibroid, which was in the lining of her uterus, ended up being risky to take out, so her surgery to remove it at that time failed, prompting her doctor to recommend a hysterectomy. Diane, however, wasn’t ready to give up her dream of motherhood and continued to endure painful periods and a swollen abdomen in hopes that she still may be able to have a baby in the future.
Finally, in her forties, Diane agreed to a hysterectomy as she couldn’t take the pain anymore and knew her age was also becoming a factor in infertility. Looking back, Diane says, “I wish I had acted on having a baby sooner, maybe in my 20s. I was just waiting for the right time. But, once I realized the hysterectomy meant that I would never have a baby, I cried and cried and cried like I have never cried before. Red face, eyes full of tears, and gobs of tissues for a long time. I went to a therapist, and she told me that I needed to grieve it, and I did. I went through a depression not only knowing a baby would never happen for me now but also, I don’t know why I just didn’t try and have a baby sooner before it got too bad. I still wrestle with it sometimes. I didn’t know it would get so bad and mean I couldn’t have a baby.” Diane goes on to say that her story was a catalyst in her niece’s decision to have her children at a very young age in case she began to have issues too.
Diane is not alone, as uterine issues affect a lot of Black women, and yet the lack of public knowledge and understanding heightens the stigma of infertility as a taboo topic in the Black community. This combination means some Black women don’t seek treatment until later in life, and by then it is sometimes too late.
Black Women Have Lower IVF Implantation Rates and Higher Cycle Cancellation Rates
Black women have higher cycle cancellation rates, decreased implantation rates, and are less likely to have a live birth after an IVF cycle compared to white women, according to a study published in the National Library of Medicine. Although age and uterine issues contribute to some of these statistics, scientists are still working on answers for lesser implantation and live birth rates.
According to WebMD, a study at the University of Chicago analyzing more than 4,000 IVF cycles over two years found that miscarriage after IVF occurred twice as often among Black women than white women. Black women also experience a significantly lower embryo implantation rate when compared to white women.
Dr. Edward Illions, a reproductive endocrinologist at Montefiore Medical Center in Hartsdale, N.Y., tells WebMD that he has observed the same disparities in his own practice. He says that in some studies higher BMIs could be a factor as women with higher BMIs tend to have worse outcomes. However, Illions goes on to add that although BMIs could be a potential factor, successful implantation rates have “to do with uterine receptivity.” This leads to the possibility that uterine issues and seeking care at an older age continue to be big predictors of infertility.
With so many questions still out there as to why racial disparities exist in IVF, with no concrete answers, it is evident that large-scale research is still needed.
Advocacy Groups Help Empower Black Women with Infertility
As questions persist, and access to information and social media platforms continue to grow, a number of advocacy groups have emerged to help educate and empower women of color struggling with infertility.
The Broken Brown Egg is a nonprofit organization that exists to inform, empower, and advocate for intended parents experiencing fertility issues with its focus on the Black community. It encourages women to begin the important dialogue about their reproductive health and to be open about their infertility struggles.
Sister Girl Foundation provides awareness education and advocacy for women suffering from chronic and debilitating diseases, with an emphasis on endometriosis and breast and ovarian cancers. The foundation helps bring awareness to Black communities through educational resources, workshops, and events that bring the community together.
Fertility for Colored Girls, a national organization, provides education, awareness, support, and encouragement to Black women and other women of color seeking to build their families. Their emphasis is on empowering women to take charge of their own reproductive health by providing emotional support and financial assistance for infertility treatments.
Tinina Q. Cade Foundation is a nonprofit organization that provides education and grants of up to $10,000 to intended parents from diverse communities seeking fertility treatments. The foundation has helped over 170 families with financial support for adoption and fertility treatments.
As modern technology and IVF continue to evolve, so must our demand for better research and legislative and policy support for better reproductive healthcare for women of color. Not only does there need to be more education for healthcare professionals on this topic, but also more outreach programs designed to educate and empower Black communities to discuss infertility and to advocate for equitable solutions to disparities in access and outcomes.
Black History Month provides all of us with a special vehicle from which to recognize and acknowledge continuing disparities in reproductive health needs, access to care and outcomes. But it’s important that we don’t confine the conversation to just one month out of the year. Here at IFLG, we make it our 365-day-a-year commitment to work toward the time when everyone benefits equally from the life-giving miracle of assisted reproductive technology and advanced fertility medicine.