Disparities in access to fertility care: who’s in and who’s out

Abstract

Objective: To study the racial and socioeconomic characteristics of women seeking fertility care in a state with mandated insurance coverage for fertility testing and treatment. Design: Cross-sectional, self-administered survey. Setting: Academic fertility center in Illinois. Patient(s): Of 5,000 consecutive fertility care patients, 1,460 completed the survey and were included in the study sample. Intervention(s): None. Main Outcome Measure(s): Details about demographic characteristics and health care access on the basis of patient race/ethnicity and socioeconomic status. Result(s): The mean age of participants was 36.1 years; 75.5% were White, 10.2% Asian, 7.3% Black, 5.7% Latinx, and 1.3% Other. Most women had a bachelor's (35.5%) or master's degree (40.5%) and an annual household income of >$100,000 (81.5%). Black and Hispanic women traveled twice as far (median 10 miles) as White and Asian women (median 5 miles for both) for treatment. Black women (14.7%) were more likely to report that their race was a barrier to getting fertility treatment compared with White (0.0%), Hispanic (5.1%), and Asian (5.4%) women. Black and Hispanic women were approximately twice as likely to report income level (26.5% and 20.3%, respectively) and weight (7.8% and 8.9%, respectively) as barriers compared with White and Asian respondents. Conclusion(s): Significant racial and socioeconomic disparities exist among fertility patients accessing care. Beyond providing all Americans with health insurance that covers fertility treatment, further research in the general population is needed to understand the complex social, cultural, racial, and economic factors that prohibit many individuals from accessing needed fertility care. (Fertil Steril Rep Ò 2021;2:109-17. Ó2020 by American Society for Reproductive Medicine.

Infertility: still a largely uncovered and undertreated disease

“…A survey from one such “mandated state,” Massachusetts, found that the majority of individuals accessing infertility services were Caucasian, highly educated, and wealthy [ 7 ]. The authors of the study identified “glaring disparities” and speculated that the reasons for these were “unclear and likely multifactorial.” Galic et al reported very similar findings in Illinois, another “mandated state” [ 8 ]. In their cross-sectional survey of 1460 fertility care patients, three quarters were White, and the vast majority (81.5%) reported an annual household income of >$100,000.…”

“…The authors of the study identified "glaring disparities" and speculated that the reasons for these were "unclear and likely multifactorial." Galic et al reported very similar findings in Illinois, another "mandated state" [8]. In their cross-sectional survey of 1460 fertility care patients, three quarters were White, and the vast majority (81.5%) reported an annual household income of >$100,000.…”

Fertility trends and comparisons in a historical cohort of US women with primary infertility

“…This limits the generalizability of our findings but provides an opportunity for future evaluation of identified trends in more racially diverse groups. A need for expanded representation of diverse racial groups is especially important as racial and ethnic disparities in accessing fertility treatment have also been recorded with non-Hispanic white women being more likely to access care than Black and Hispanic counterparts [ 28 , 32 , 33 , 45 ]. Additionally, although the cohort aimed to develop a population-based sample of primary infertility, it could not capture women with primary infertility who did not seek medical evaluation or treatment for this condition.…”

A review of disparities in access to infertility care and treatment outcomes among Hispanic women

“…More recently, a cross-sectional survey of 1460 women seeking fertility care at an academic center in Illinois, a state with mandated insurance coverage for fertility testing and treatment, assessed racial and socioeconomic characteristics and access to care [ 9 ]. Hispanic women in this population traveled twice as far as White and Black women.…”

“…Hispanic women in this population traveled twice as far as White and Black women. Additionally, Hispanic and Black women were twice as likely to report their income level and weight as barriers to treatment compared to White and Asian women [ 9 ]. Hispanic patients were significantly more likely than White patients to report being very/extremely worried about side effects of treatment, miscarriage, ectopic pregnancy and birth defects [ 10 ].…”