Disparities in fertility knowledge among women from low and high resource settings presenting for fertility care in two United States metropolitan centers

Abstract

Background: Few studies have examined health literacy and fertility knowledge among women from low income, socio-culturally diverse communities presenting for fertility care in the United States. Our study sought to examine demographic predictors of fertility-related knowledge among infertile women from low and high-resource communities in two major metropolitan centers in the United States. Methods: Fertility Knowledge Assessments were administered to women presenting for fertility care at county medical centers serving low-resource, largely immigrant patients and to women from largely affluent populations presenting to comprehensive fertility centers in two cities. The influence of demographic predictors on fertility knowledge was examined through regression analysis. Results: A total of 143 women were included in our analysis. In the county hospital/low resource clinic (LR, n = 70), the mean age was 32.8 ± 6.1 years vs 35.0 ± 5.0 years in the fee-for-service/high resource clinic (HR, n = 73). Among the LR patients, 74% were immigrants, 71% had an annual income <$25,000 and 52% had completed high school. Among HR patients, 36% were immigrants, 60% had an annual income >$100,000, and 95% had some college or above. On average, women from HR settings scored 3.0 points higher on the Fertility Knowledge Assessment than their LR counterparts (p < 0.001). Upon multivariate analysis, education level remained the sole independent factor associated with fertility knowledge assessment score (p < 0.001). Stratifying by resource level revealed that income was highly associated with fertility knowledge (p < 0.01) among high resource individuals even when adjusting for education level. Conclusions: Women from low resource, largely immigrant communities, seeking fertility care have greater disparities in fertility knowledge and lower health literacy compared to women from high resource clinical settings. Further studies are needed to understand these barriers and to develop targeted inventions to lower disparities and improve care for these vulnerable populations.

U.S. Women's Knowledge of Reproductive Biology

“…Our finding of a positive relationship between education and reproductive biology knowledge is consistent with previous fertility knowledge studies, including 19 of 24 studies in a systematic review by Pedro et al (2018), a multi-country study (n ¼ 10,045) by Bunting et al (2013), and a study (n ¼ 143) by Hoffman et al (2020).…”

“…Pedro et al (2018) excluded income from their systematic review, whereas in their large multicountry study, Bunting et al (2013) found that respondents who had paid work or a partner with paid work had higher fertility knowledge than those who did not. In contrast, Hoffman et al (2020) found no income-related differences in fertility knowledge among infertility care clients (n ¼ 143), who are likely better informed, regardless of income, than the general population.…”

See one, do one, teach one: Reimagining reproductive endocrinology and infertility training programs to expand access to care

“…Although in-person interpreters are generally preferred by patients and providers, using telephonic or video interpreters during clinical encounters is effective and helps reduce patient wait times ( 64 ). Furthermore, access to straightforward information pamphlets written at grade 6–7 level and translated into common languages can help provide basic infertility information to patients in low-resource settings who often have a lower level of education and understanding of infertility ( 36 , 65 , 66 ). These educational materials can be printed materials or, through the production of short videos, posted online.…”

Fertility Awareness and Perceptions among Procreant Age Group in Western India

“…[ 3 ] A recent tendency among them was observed wherein first-time parenthood was considered in late thirties. [ 4 5 6 7 ] As child conception is deferred for considerable time giving priority to professional goals, it deteriorates the probability of natural conception and subsequently requires specialized treatment to help the couples. [ 3 ] Statistics are available, emphasized the fact that there was downward trend in the total fertility rate, i.e.…”

“…[ 9 ] There are further evidence of lower levels of health awareness among low resource settings and individuals with lower academic qualification. [ 7 ] Looking into all the aspects, it is apparent that infertility is progressively becoming alarming and a public health issue.…”