Racial disparities in access to reproductive health and fertility care in the United States

Abstract

Purpose of reviewTo examine the status of racial and ethnic inequalities in fertility care in the United States (U.S.) at inception of 2022. This review highlights addressable underpinnings for the prevalent differentials in access to and utilization of infertility treatments and underscores gaps in preventive care as key contributors to racial and ethnic disparities in risk burden for subfertility and infertility.Recent findingsSignificant gaps in access to and utilization of fertility care are consistently reported among racial and ethnic minorities, particularly Black and Hispanic women. Access to and utilization of contraceptives, human papilloma virus vaccination rates, preexposure prophylaxis use, and differentials in treatment of common gynecologic disorders are relevant to the prevalent racial and ethnic disparities in reproductive health. The spectrum of differential in reproductive wellness and the magnitude of reproductive health burden afflicting racial minorities in the U.S. raise concerns regarding systemic and structural racism as plausible contributors to the prevalent state of affairs.SummaryDespite efforts to reform unequal reproductive health practices and policies, racial and ethnic disparities in fertility care are pervasive and persistent. In addition to measures aimed at reducing barriers to care, societal efforts must prioritize health disparity research to systematically examine underpinnings, and addressing structural racism and interpersonal biases, to correct the prevalent racial inequities and mitigate disparities.

Infertility Services for Veterans Enrolled in Veterans Health Administration Care

“…Examining access to and utilization of treatment by race and ethnicity is an important consideration for future work, especially as a recent review indicates that within the general population, Black and Hispanic women wait longer before seeking or accessing treatment for infertility, have a lower prevalence of receiving testing and/or treatment for infertility, have a lower likelihood of pursuing fertility treatment after undergoing infertility evaluation, and are less likely to utilize medical services to conceive compared to White women. 24 Furthermore, unique aspects of the VHA healthcare system (e.g., the ability to receive a referral to a mental health provider while undergoing infertility treatment) may provide opportunities for improving care related to the broader impacts of infertility diagnoses and treatment on Veterans and their families.…”

Navigating Unequal Paths

“…9 Given the historical and contemporary experiences of inequity endured by Black women, it is not surprising that, in the face of viewing the health care system as untrustworthy, they may delay or avoid seeking infertility evaluations. 10 Moreover, feelings of shame, guilt, failure, and aversion to the "infertile" label have been reported among Black women. 11 The stereotype of Black women as hyperfertile contributes to the stigma and misconception that infertility is rare among Black women.…”

Association of Primary Care Physicians’ Individual- and Community-Level Characteristics With Contraceptive Service Provision to Medicaid Beneficiaries

“…Disparities exist for vulnerable populations due to barriers such as lack of insurance coverage and scarcity of practitioners offering contraception care. 2,3 Medicaid, which insures more than 87 million individuals, mostly populations with disabilities and low income, is one of the largest payers of contraception care. 4 While it is known that the income, insurance coverage, and socioeconomic status of an individual are associated with contraceptive use, 5 little is known about the factors associated with physicians choosing to provide contraception care, especially to Medicaid beneficiaries.…”

“…However, this care is not uniformly accessible across the US. Disparities exist for vulnerable populations due to barriers such as lack of insurance coverage and scarcity of practitioners offering contraception care . Medicaid, which insures more than 87 million individuals, mostly populations with disabilities and low income, is one of the largest payers of contraception care .…”