Race-Ethnicity and Medical Services for Infertility

Abstract

Evidence of group differences in reproductive control and access to reproductive health care suggests the continued existence of "stratified reproduction" in the United States. Women of color are overrepresented among people with infertility but are underrepresented among those who receive medical services. The authors employ path analysis to uncover mechanisms accounting for these differences among black, Hispanic, Asian, and non-Hispanic white women using a probability-based sample of 2,162 U.S. women. Black and Hispanic women are less likely to receive services than other women. The enabling conditions of income, education, and private insurance partially mediate the relationship between race-ethnicity and receipt of services but do not fully account for the association at all levels of service. For black and Hispanic women, social cues, enabling conditions, and predisposing conditions contribute to disparities in receipt of services. Most of the association between race-ethnicity and service receipt is indirect rather than direct.

Who receives a medical evaluation for infertility in the United States?

“…Not surprisingly, having financial means, insurance coverage, and connection with the medical system (recent physical exam) were all predictive of reporting a medical evaluation for infertility in our cohort. We did not find significant differences between race and marital status and fertility evaluation, which have been reported previously (5, 7, 11, 14, 26). This may be a reflection of our highly educated, relatively homogenous population among which there may be limited power to detect such differences (n black women=68) or this may support previous work in which, after adjustment, the effect of race was attenuated by other socio-economic factors (9, 15).…”

Supply of and demand for assisted reproductive technologies in the United States: clinic- and population-based data, 1995–2010

“…Previous analyses have shown that women who make use of medical help for infertility tend to be a highly select group, which may reflect the fact that women of lower socioeconomic status are less likely to have adequate health insurance coverage and other financial resources to afford the necessary diagnostic or treatment services (4, 5, 6, 7, 8, 9, 10). We anticipate that women who utilize ART are an even more select group given the expense and duration of treatment, and limited insurance coverage for ART.…”

Clinical vignettes and global health considerations of infertility care in under-resourced patients

“…A cohort of immigrant Latinos also reported that cost, education, communication, difficulty navigating hospital and insurance systems, and poor physician care prevented them from accessing infertility treatments [8]. African American and Hispanic women were less likely than white women to have money or private insurance to help cover the costs of infertility treatments [9]. They also reported having difficulties finding a physician, taking time off of work, and paying for infertility treatments [26].…”

“…Even with coverage, the associated cost of ART remains high for many [2, 4, 5]. Recent literature has revealed that of the infertile women who are unable to pay for treatments, a large proportion are non-white and must deal with racial prejudices, high cost of treatment with low income, lack of understanding of medical terminology and procedures, and additional cultural expectations and stigmas [5–9]. Out of the infertile minority patient population in the United States, refugees and asylum seekers have even more difficulty accessing infertility care due to even larger language and cultural barriers, traumatic histories, and difficulty applying for cost support grants before they can be approved for permanent United States residence [10].…”