February is Black History Month, and in its honor, Progyny hosted a webinar about understanding the health conditions that increase infertility in the Black community and finding the right doctor. We expanded the dialogue we started with our Fertility and Maternal Health in the Black Community webinar by pulling together experts to discuss the health conditions specific to the Black community and insights for finding a physician you connect with.
While infertility impacts 1 in 8, Black Indigenous and People of Color (BIPOC) women experience infertility at even higher rates than their White counterparts, even when taking into account socioeconomics or risk factors such as uterine fibroids. Despite these higher rates of infertility, Black women are less likely to access treatment and if they do, may wait twice as long before seeking help. In case you missed it, here are the highlights of the webinar:
Infertility in the Black Community: Understanding Your Health Conditions and Finding the Right Doctor
- Lissa Kline, LCSW, SVP Member & Provider Services, Progyny
- Kanika Harris, PhD, MPH, Director of Maternal Health, Black Women’s Health Imperative
- Isiah Harris, MD, MSc, Reproductive Endocrinologist, Spring Fertility
There are a lot of myths out there about Black women and fertility, so we wanted to take the time to address some of the most commons we’ve heard.
Myth: Black Women do not have fertility issues because they are baby-making machines.
- This myth can directly impact utilization rates as black women feel shame or low self-worth when processing an infertility diagnosis. This stereotype also has consequences at a provider level—engaging in this belief likely limits the number of referrals Black women get from their general practitioner when seeking fertility specialists. Additionally, Black men historically feel shame around sperm testing, and this can also slow the diagnosis and treatment plan.
Myth: Fertility treatments are expensive fads that the “average” woman of color cannot afford and is only for white women.
- This is partially true since fertility treatments can be very expensive and if you don’t have insurance, the out-of-pocket costs skyrocket. However, 13% of women who utilize fertility treatments fall below the poverty line so there are still ways to get care even if you are struggling financially. This debunks the theory that only the extremely wealthy can afford treatment.
- A key fact is that price can vary based on your needs, initial tests, and treatment plans.
- Some states are beginning to mandate private insurance carriers provide fertility coverage, but there is a long way to go and even then, private insurance carriers are often more expensive than public carriers like Medicaid.
- To best equip yourself for the infertility journey, try to find and research as many clinic options as possible. Looking into outside support groups can also be helpful. Additionally, while your physician should be one to educate you throughout the journey, make sure to do your part to get conversation going. Look up questions to ask and write them down for your next appointment. This will help you better advocate for yourself to your physician.
Myth: Racism does not exist in the healthcare community.
- This is false. Racism in the healthcare community is very pervasive. Only recently the American Medical Association has publicly addressed the topic, claiming racism is a threat to healthcare and public health.
- Historically Black women have been left out of fertility research and are less likely to seek care than White women. With both in mind, Black women still have higher rates of maternal death and infant mortality compared to White counterparts.
Understanding the Health Conditions that Increase Infertility in the Black Community
Uterine fibroids are noncancerous tumors made of muscle that grow in the uterus. Although they can be harmless, uterine fibroids can also increase the chances of infertility and cause complications when giving birth.
Half of Black women will be affected by uterine fibroids in their lives, which is about 2–3 times the rate of White women. Additionally, Black women often develop symptoms much younger than White women (26 compared to 35) and are more likely to experience fibroid growth at ages later ages. Black women are also twice as likely to have fibroid removal surgery recommended than White women.
Some treatments for fibroids include surgery (e.g., hysterectomy), birth control, and other hormone replacement medications.
Access to Care and Education
Black women may face additional difficulties when seeking fertility care. Some of these might look like:
- Lack of access to comprehensive fertility coverage.
- The myth (busted above) that Black women “can’t experience infertility.”
- Dismissive physicians and difficulty getting referrals to specialized reproductive endocrinologists.
- Increased risk of stress and feelings of loneliness from the stigma of infertility.
The direct impact of obesity on infertility (decreases rates of natural conception) is well known. According to Black Women’s Health Imperative on ‘What Healthy Black Women Can Teach Us about Health,’ close to 60% of Black women are overweight or obese. Being overweight can look average, but the implications for miscarriage or a high-risk pregnancy remain. Learning to monitor your weight and finding motivation to get active can be helpful in promoting a healthier lifestyle—even if it’s a short walk daily or incorporating squats into your daily routine. However, it’s important to remember that ideal for weight and height are based on European women and often don’t take into account differences among races, such as bone density differences. Often Black women are categorized as overweight but when compared to BMIs of other Black women, they may be a healthy weight.
Here are a few tips on maintaining a healthy BMI:
- Get out and walk (make personal goals, walk with a group, GirlTrek).
- Exercise 3–5 times per week for 30–60 minutes at a time.
- Eating fewer carbohydrates but more protein and fat.
- For those who are obese, a 5–10% decrease in weight can help individuals regain menses and thus have a better chance of conceiving naturally.
Men should avoid high heat, keep laptops away from the pelvis, and should switch to loose-fitting underwear.
Mental Health Support
Experiencing infertility can carry a stronger stigma in the Black community. Because of this many individuals struggling will not speak out about their experience and the accompanying stress.
Some simple ways you can advocate for yourself and expand your support circle include educating yourself about your conditions and the questions you have about it, bringing a significant other or friend to (virtual) appointments with you who will back you up, and using buzzwords like “concerned” or “alarmed” with your physician.
If you are not experiencing infertility personally, do your best to educate yourself and your peers about the treatment plans and language. This can help create more accepting communities and lead you to become a more supportive friend or sibling to someone who is personally experiencing infertility.
Here are a few tips/next steps for if you’re feeling stressed during treatment:
- Reach out to a trusted friend or family member to talk or just “be there.”
- Look for and join support groups (ex. Sisters In Loss, Broken Brown Egg, etc.).
- Give yourself credit for living in a pandemic.
- Get some rest.
- Learn some breathing exercises.
Finding the Right Doctor
Studies have shown that health and satisfaction outcomes for Black patients improve dramatically when treated by a Black physician. However, there is a lack of Black physicians, especially in the fertility space. This means finding a physician you connect with more challenging.
Some things to look for when assessing your fit with a clinic and physician include:
- The areas they specialize in, where they are located.
- Online testimonials.
- How the physician responds to your questions and any reservations you bring up.
- Your gut feelings about their bedside manner.
- Their availability for follow-up and ways of communication.
- If your goals align with the physician’s treatment options. This can be a great way to open communication and see if you and your physician are aligned!
Not everyone has many choices of specialists and clinics. If you have limited access and decide to stay with a practice because of its location convenience, that is okay. However, if you don’t love your physician, make sure you are aware of any other resources.
During this process, if any feelings of distress or disconnect between you and the physician, trust your gut! These are red flags. You are not stuck with your provider. If you are unhappy with your level of care or want a second opinion, ask for a referral or help finding a new provider.
And, if your physician exhibits patience, knowledge, personalization, and sensitivity to you during your question and appointments, these are green flags! You should leave appointments feeling knowledgeable and empowered.
Thank you for joining as we continue to educate people on infertility in the Black community and understanding the health conditions that affect infertility. Be sure to check out the webinars we have next month:
March 3rd at 3:00pm EST: COVID-19 Update: What to Know About the Vaccine While Trying to Conceive
March 24th at 2:00pm EST: Journey to Fatherhood: Finding Emotional Support