People of color face disparities when it comes to infertility and reproductive health outcomes — studies have demonstrated this, and it’s crucial that we acknowledge the facts. Black women in particular have lower pregnancy and birth rates when using donor eggs or undergoing fertility treatments, for example. But it’s also important to acknowledge that challenges that aren’t always reflected by data — for example, the medical biases, the cultural stigmas, and the enduring stereotypes that make the world of infertility care even more difficult for Black patients to navigate.
Luckily, efforts are underway to address these issues: CCRM Fertility’s Black Fertility Matters Fund, for example, provides resources to increase awareness and advocacy for Black families as they navigate fertility journeys.
“The Black Fertility Matters Fund was started by CCRM Fertility, which is a nationwide fertility center, with the intention of spreading awareness, providing support, and truly just empowering Black women to start their fertility journey [and] continue their fertility journey,” says Stephanie Thompson, MD, a reproductive endocrinologist and infertility specialist at The Institute of Reproductive Medicine and Science.
CCRM will partner with several other organizations to move conversations about fertility within communities, challenge medical biases, encourage Black patients to advocate for themselves, and eventually improve medical outcomes for this marginalized group. Because in many cases, the barriers Black people face start before they set foot in a fertility clinic.
Addressing the issues Black patients face starts with rescripting conversations and prioritizing awareness, according to Dr. Thompson.
“As a Black fertility specialist myself, this is truly a dream come true to see the education and funding going into this conversation,” says Dr. Thompson. “This is really where it starts. I think just learning about our reproductive health from the very beginning is crucial — we can rewrite the narrative of how we think about our reproductive health, especially Black women’s reproductive health because I think there are a lot of innate biases in healthcare [as well as] stigmas and misconceptions. I think the conversation is [so] important.”
Success rates for Black fertility patients
It’s important to acknowledge the nuances of why Black patients don’t see the same rates of success as their white counterparts in fertility clinics. For one thing, according to Dr. Thompson, Black women often don’t see a fertility specialist until they’re well into their fertility journeys. And while they are not necessarily more likely to experience fertility issues, which appear to present equally across races, they do tend to have different outcomes. This is, in part, because they’re often not directed towards fertility testing or treatment thanks to the inaccurate, yet persistent, stereotype that Black people do not experience infertility.
“I think if we can increase awareness and have people start seeking care earlier on, the outcomes would be so much better,” she explains. “I think there’s generally a stigma in the Black community, one that we are not infertile, which is not true.”
Racial biases in fertility care
That misconception is one that’s endured in the medical community, even when it isn’t explicitly stated. “I think a lot of healthcare providers [such as] OB-GYNs, have that stigma. I’ve had patients tell me [about their experiences with this bias] — I’ve had three in the past two weeks say that they were never offered fertility testing, or they asked for it and were told they don’t need it. A re-education of everybody involved is really important.”
Racial biases in medicine affect the way providers care for their patients in some really serious ways, often causing them to overlook certain conditions. “We can’t have a cultural bias towards certain conditions. For example, endometriosis: As a medical student, I was taught endometriosis is for white women, fibroids are for Black women,” says Dr. Thompson.
There are several ways to combat this: For one thing, getting more providers of color into the world of reproductive medicine will help patients find providers who understand these biases and cultural differences.
“There’s no doubt that we have to get more Black providers. There’s plenty of data that the outcomes are better, and I think there’s also a general mistrust of the healthcare system [among patients of color]. People feel more comfortable with someone who looks like them and understands the cultural bias for sure,” says Dr. Thompson
Part of the issue is that reproductive endocrinology tends to be an “old white man’s” field. “If you look at the number of Board-certified Black fertility specialists, there’s probably about 60 of us in the country,” adds Dr. Thompson. “There’s a lack of fertility providers in general, and now you’re talking about probably 2-3 percent, a very small amount when it comes to Black reproductive endocrinologists.”
All practitioners need to become more culturally aware in order to address this issue. “One of my nurses said to me the other day that she wished I, as a Black physician, had an all-Black team. And I said ‘I don’t want an all-Black team, I want a team that understands the experiences of Black patients,” says Dr. Thomspon. “Training for everyone is extremely important, and there are a lot of programs out there [in] diversity training, in putting yourself in the shoes of someone else.” This includes some virtual reality programming that allows people to walk through a medical setting from the perspective of a marginalized patient.
But change can happen outside of fertility clinics too. “I think it starts with awareness, but it also starts with just being open. I think it starts with sharing on a grassroots level,” says Dr. Thompson. “You know, I think that in our homes and communities, we need to demystify fertility, we need to get rid of the stigma of talking about things like recurrent pregnancy loss, we need to learn to listen to our bodies and learn what’s normal and what’s not normal.”
Starting conversations, being open, and asking questions that are open-ended rather than intrusive are examples of ways people can initiate important conversations within families and communities.
Advocating for yourself as a Black fertility patient
Black patients also ought to advocate for themselves in healthcare settings, and Dr. Thompson believes really gaining an awareness of their own bodies and reproductive health are key. “The first thing you start with is knowing your body and yourself,” she says. “I’m a huge proponent of cycle tracking, keeping a journal, if you have pelvic pain, write it down — really get to know your body from the time you’re a teenager. I think that’s something we should incorporate into our households so that we have that information. I think also, you do know yourself, and it’s really important to find a physician who you’re comfortable saying ‘Hey, this just isn’t right’, [who will then] listen to you and take you seriously. If you feel like that hasn’t happened, there’s somebody who will listen to you. And do research — there’s a lot of bad research on the Internet, but there’s a lot of really good information too.”
The barriers Black patients face are incredibly nuanced, but the evidence that they exist is clearly found in the data — and combating this health disparity starts with awareness. Understanding the biases, including and centering Black patients in conversations on fertility and reproductive health, and making the field of reproductive endocrinology more diverse are essential.
“For many years, IVF was a white woman's treatment,” says Dr. Thompson. “But we really have an opportunity here to do a lot of good, to help build Black families, and to make infertility care and treatment accessible to everyone as it should be.”
Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, Marie Claire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.