As the recent movement for racial equality has reignited discussions about long-standing inequities and institutionalized racism in the United States, it is important we all take the time to reflect on all the sectors that contribute to inequality. Fertility and maternal health is one such sector.
Black women are twice as likely to suffer from infertility but are half as likely to access care than white women—even considering socioeconomic status. But it’s not only fertility. Maternal mortality is higher for women of color. Black, American Indian and Alaska Native women are two to three times more likely to die from pregnancy related causes than white women.
We invited some experts in the fertility and reproductive health field to discuss why Black women aren’t getting the care they need and what they can do to advocate for themselves and improve access to treatment.
Fertility and Maternal Health in the Black Community
- Selena Campbell, Manager, Member Services, Progyny
- Genevieve Neal-Perry, MD, PhD, Reproductive Endocrinologist and Chair, UNC School of Medicine Department of Obstetrics and Gynecology
- Tia Jackson-Bey, MD, MPH, Reproductive Endocrinologist, RMA of New York and Icahn School of Medicine at Mt Sinai
- Renita White, MD, OBGYN at Georgia Obstetrics & Gynecology
Lower Rates of Fertility Care in the Black Community
Black women may have trouble accessing fertility care for a myriad of reasons, including:
- Lack of comprehensive fertility coverage.
- The false and damaging stereotype that people of color “can’t have infertility.”
- The specialized nature of infertility that requires most patients to obtain a referral from their OBGYN or primary care physician. If they’re not being taken seriously by the referring physician, they won’t know they need to see a specialist.
- The ongoing stigma of infertility which leads many Black women to cope with it alone rather than asking for support.
Higher Maternal Mortality Rates
Black women are two to three times more likely to die in childbirth related causes than white women. Complications like significant blood loss or high blood pressure issues like preeclampsia are particularly dangerous. This disparity could be due to the already higher risk of hypertension, fibroids, obesity, and diabetes in the Black community, all of which can be problematic in childbirth.
Social factors may also come into play. Lack of access to healthcare, lower socio-economic status, or even insufficient transportation options can affect outcomes. However, this increased risk is also present in Black women who are highly educated and are of higher socio-economic status.
The implicit bias of doctors is thought to affect health outcomes. Implicit biases are the opinions and stereotypes that affect behavior without us realizing. Someone can believe they are not racist, but unconsciously treat particular groups of people differently. When implicit bias bleeds into the healthcare system, it means a diminished level of care for that specific group—often without providers even realizing.
Decreased Rates of Fertility in the Black Community
Black women are at a higher risk for fibroids, which are noncancerous tumors made of muscle that can grow in the uterus. Although they can be completely harmless, they can have an effect on getting pregnant and cause complications when giving birth. This increased risk could partially explain higher rates of infertility in Black women, as well as social issues like the tendency to seek care at a later age. However, even adjusted for socioeconomic status, age, fibroids and obesity, there are still different pregnancy rates between Black and white women.
One theory for increased rates of infertility is racism itself. Institutionalized racism means many people of color experience more stress than their white counterparts, which could affect the ability to get and stay pregnant.
In the United States:
Research suggests that health outcomes for Black patients improve when treated by Black doctors. One study found treatment by a Black doctor reduce the black-white male gap in cardiovascular mortality by 19%. Although there aren’t studies comparing this in maternal health yet, having a provider that you can relate to and understand is a comfort to many patients—and can improve health outcomes.
All three panelists are some of the first in their families to go to college, let alone medical school, and all three felt pressure to specialize in a different area of medicine where they could have a bigger effect on improving outcomes for people of color. However, all three felt the importance of representation within fertility and maternal health.
As Dr. Tia Jackson-Bey said, “infertility doesn’t discriminate”.
Advocating for Yourself
- Advocate for yourself by asking questions and seeking clarification if you don’t understand something.
- Create a list of questions to ask your provider before your appointment and don’t be afraid to ask uncomfortable questions or highlight fears you have.
- Bringing a partner or trusted friend with you who can back you up or help clarify your feelings.
- Make sure you know how to follow up with your doctor so if you have any new questions you can reach out.
- Use keywords like “concerned” or “alarmed” or “scared.” Medical professionals are trained to listen out for them so keywords can help to communicate what you’re feeling.
- You are not stuck with your provider. If you are unhappy with their level of care don’t be afraid to get a second opinion or find a new provider.
Progyny is committed to improving family-building equity by providing comprehensive fertility coverage that allows for safer pregnancies and healthier babies. If you’re a Progyny member, please reach out to your dedicated Patient Care Advocate with any questions related to this webinar or to your benefit. For those without coverage, visit progyny.com/advocate to learn more about how you can get comprehensive fertility coverage at your organization.