Racial/Ethnic Differences in the Utilization of Infertility Services: A Focus on American Indian/Alaska Natives

Abstract

Objectives Previous studies have identified racial/ethnic disparities in infertility care, but patterns among American Indian/Alaska Natives (AI/AN) have not been reported. Our objective was to evaluate infertility services use in the US by race/ethnicity using data from the National Survey of Family Growth (NSFG). Methods We analyzed female respondent data from the pooled NSFG cycles 2002, 2006-2010 and 2011-2013. Respondents reported use of infertility services and types of services. We calculated weighted crude and adjusted prevalence proportion ratios (PPR) and 95% confidence intervals (95% CI) using modified Poisson regression with robust error variances accounting for the complex survey design to compare infertility services use across race/ethnicities. Results Overall, 8.7% of women reported using medical services to get pregnant. The prevalence of using any medical service to help get pregnant was lower for American Indian/Alaska Native (AI/AN) (PPR: 0.60, 95% CI 0.43-0.83) and black (PPR: 0.53, 95% CI 0.44-0.63) compared to white women and in Hispanic compared to non-Hispanic women (PPR: 0.57, 95% CI 0.48-0.67). The prevalence of accessing treatment, testing, and advice also differed by race and ethnicity. Conclusions for Practice We observed disparities in accessing services to get pregnant among AI/AN and black women and reduced use of advice among Asian/Pacific Islanders compared to whites. We also observed reduced service utilization for Hispanic compared to non-Hispanic women. Differential utilization of specific services suggests barriers to infertility care may contribute to reproductive health disparities among underserved populations.

Association between maternal race and the use of assisted reproductive technology in the USA

“…Humphries et al [ 13 ] cited that race and ethnicity, especially Blacks, were strong predictors of poorer outcomes on ART treatment. A racial and ethnic difference in pregnancy rates following intrauterine insemination (ART) was also observed to be lower among American AIAN (prevalence PPR 0.60, 95% CI 0.43–0.83) and Black (PPR 0.53, 95% CI 0.44–0.63) compared to White women in a study by Craig et al [ 22 ] and Janitz et al [ 17 ]. Also, a reduced ART service utilization was also observed for Hispanic women compared to non-Hispanic women as observed by Janitz et al [ 17 ] in a binary racial/ethnic perspective.…”

“…A racial and ethnic difference in pregnancy rates following intrauterine insemination (ART) was also observed to be lower among American AIAN (prevalence PPR 0.60, 95% CI 0.43–0.83) and Black (PPR 0.53, 95% CI 0.44–0.63) compared to White women in a study by Craig et al [ 22 ] and Janitz et al [ 17 ]. Also, a reduced ART service utilization was also observed for Hispanic women compared to non-Hispanic women as observed by Janitz et al [ 17 ] in a binary racial/ethnic perspective. Dimitriadis et al [ 23 ] concluded that race affects timely access to infertility care, diagnosis, and treatment cycle, having some racial groups waiting significantly longer prior to seeking evaluation.…”

“…Prevention of reproductive health disparities affecting utilization of ART requires “monitoring race-specific infertility prevalence, treatment patterns, and related risk factors to identify, guide, implement and monitor effective public health action strategies to safeguard reproductive health” [ 9 , 10 ] (World Health Organization [ 16 ]). Given the differential utilization or outcome of a specific service in healthcare delivery or practice like ART, the service suggests a barrier to infertility care which in turn populates reproductive health disparities among underserved populations [ 17 ]. Then, there is the need to establish/elucidate this association and inform literature, thus improving practice and utilization in the USA as well as globally.…”

Systematic review of racial and ethnic disparities in reproductive endocrinology and infertility: where do we stand today?

“…The investigators found that each non-White group-Black, Hispanic, and other race-was more likely to have infertility than White women. However, all non-White groups were much less likely to receive fertility treatment-Black women were most significantly impacted and were 29% less likely to report ever having received fertility treatment (19) The most recent studies evaluated the NSFG data including responses from the 2002, 2006-2010, and 2011-2013 surveys and broadened the typical racial categories by additionally including American Indian/Alaskan Natives (AI/ANs) women (22,23). Black women had a 1.45 times greater prevalence of infertility than White women.…”

Barriers to Achieving Reproductive Justice for an Indigenous Gulf Coast Tribe

“…According to their analysis, Indigenous women experienced 1.37 times greater prevalence of infertility compared to White women. Though Indigenous women face increased rates of infertility, very little research attends to the particular barriers they face in accessing fertility care (Janitz et al, 2019). To our knowledge there is also no research exploring this topic for non-federally recognized tribes.…”