Disparities in Infertility and Assisted Reproductive Technology (ART) Utilization- Race, Socioeconomic Status, Education

Academic Blog by: Daria Stelmak

Daria StelmakDaria Stelmak is a junior at the University of Michigan studying Neuroscience, with a minor in Gender and Health.

Women's reproductive justice is a topic we need to be especially vigilant about, especially now as women's bodies are constantly under scrutiny by policy makers and institutions. Furthermore, vulnerable populations and minority women face even more obstacles and disparities in receiving the equitable care they need when it comes to their reproductive health. A salient example of this includes the examples of disparities in infertility and in assisted reproductive technology (ART) treatments.

Infertility is a common problem, affecting approximately 10% of women (ages 15-44) in the United States ("Infertility," 2018). However, there is a social stereotype and perception that high income women with  high levels of education and typically portrayed in media to be white are the main demographic of who struggles with infertility. However, this highly regarded national multivariate study showed that this was not the case. Non-Hispanic Black women and Hispanic Women had higher rates of infertility compared to Caucasian women. Additionally, women of a lower household income and women with fewer years of education had increased rates of infertility in their respective demographic groups. Thus, the stereotype that is often portrayed in the media and in American society leaves out many demographic groups out of the narrative surrounding women who deal with infertility.

Not only is there a disparity in who is struggling with infertility, but this divide continues with who is most likely to have access to and obtain infertility treatment. Currently, though women of color, women with lower levels of education, and women of low SES (socioeconomic status) are more likely to struggle with infertility, ART procedures are more utilized by white women, highly educated women, and women of high SES. Research has considered financial and sociocultural factors as barriers to ART services for women.

There have been studies that look at whether or not mandated insurance coverage for infertility treatment affects the ability of women of various identities to better access ART. Mandated insurance coverage is meant to remove the barrier of cost and paying out of pocket for these expensive ART services. However, findings show that the same disparities continue in who is represented in being able to obtain ART services; there was an underrepresentation of African American and Hispanic women, low income women and women with lower levels of education. Other studies looking at mandated insurance states had similar findings. This suggests that though financial struggles can play a role, there might be other considerations for why women of certain identities are not as represented in ART treatment distributions. Possible explanations include potential sociocultural factors such as stereotypes and prejudice.

My call to action and recommendations are closely intertwined. There needs to be more explicit and intentional research into the root causes of the disparities in infertility and ability to access and receive treatment. There has been some research that draws on different prevalences of certain infertility related sexually transmitted infections as well as delayed infertility treatment for various demographic groups. However, there needs to be more studies looking at potential sociocultural factors that can impact treatment and overall care. It is possible there is potential prejudice, social stereotypes and false narratives that are perpetuated within our society and even in the medical community that should be further explore in order to find solutions to fix health disparities relating to infertility. Additionally, I am curious about what is going on within the medical community– how do medical practitioners make sure they are not prejudiced in their recommendations and resource dispersal based on identities? Furthermore, how does Michigan Medicine compare to other findings in terms of what identities they are serving with treatment for infertility? Starting to dive into root causes of infertility and exploring targeted solutions based on these causes may help ameliorate the disparities seen in this area.