As a Nurse Practitioner working in the medical field who also happens to be a woman of color, I have a unique perspective on the state of fertility care. The racial disparities between Black women and white women when it comes to reproductive and maternal health outcomes are shocking.

Black women are twice as likely to struggle with infertility than their white counterparts, due in part to a higher prevalence of uterine fibroids, ovulatory dysfunction, and tubal disease.

Many studies show that Black women also have higher rates of pregnancy loss, including miscarriages and stillbirths, compared to white women. This is likely due to the fact that Black women have higher rates of risk factors that are associated with pregnancy loss. These include obesity, diabetes, and low socioeconomic status. 

Beyond these biological determinants, a variety of other factors have contributed to the disproportionately high infertility rate among Black women.

Lack of Representation in Medicine

It is important for people of color to have access to healthcare providers who are BIPOC (Black, Indigenous, and People of Color) because it provides a sense of comfort and familiarity. BIPOC healthcare providers possess culturally-specific knowledge, skills, and experience that helps with the communication and health management process involving people of color.

Diversity in providers helps reduce barriers to the patient-physician relationship for racial/ethnic and linguistic minority patients.

In many situations, seeing someone that looks like you and understands your cultural background brings comfort and reassurance, increasing comfort levels and improving communication between patients and care professionals.

Many studies have shown that there are better health outcomes when patients of color are seen by BIPOC providers. A result of this is increased trust and communication developed between the patient and provider. The patient may also feel that someone who has a similar cultural experience to them is easier to share things with.

BIPOC providers also have insight into the specific and nuanced experiences of other people of color. They also bring an unspoken understanding of what the patient may be going through. Additionally, Black women who have a provider with similar cultural history may feel more comfortable speaking up and advocating for themselves.  

Many people of color have a (warranted) sense of mistrust when it comes to our healthcare system, due to historical practices based on racist ideals. As healthcare providers, we need to remain dedicated to bridging the gap to improve outcomes for patients of color.

Structural Racism & Implicit Bias

Both of these issues heavily contribute to racial disparities in fertility and maternal healthcare in different ways. Structural racism goes beyond the individual. It refers to inherently racist laws, rules, economic practices, and cultural and societal norms that are embedded in the system itself. 

Implicit (or unconscious) bias occurs automatically and unintentionally, nevertheless affecting our judgments, decisions, and behaviors. For example, a white doctor might downplay a Black patient’s complaints of pain after surgery due to subconscious, inherited stereotypes about the strength or pain tolerance of people of color, only to discover the patient is experiencing true discomfort.

Accessibility

Many people of color encounter barriers to accessing the healthcare they need due to lack of insurance (or insurance coverage that excludes fertility treatment). In addition to financial roadblocks, accessibility to quality reproductive care is often limited by their location (those in rural or underserved areas may not have fertility clinics nearby) and their employment situation (not everyone can take time off of work to go in for morning monitoring appointments, for example).

Harmful Stereotypes

Black women are thought of as being incredibly strong, and we are. But when we are elevated to Superwoman status, and then need to take off our proverbial capes to ask for help, we are often judged harshly or perceived as weak. 

There’s also a long-held myth that Black women (and men) are “hyper-fertile.” Basing medical care decisions on this assumption causes considerable harm, leading to a cascade of issues as a result. 

Religious Beliefs

Many people in the Black community believe in “praying your way” through difficult situations. And while it’s wonderful to have faith, sometimes it’s necessary to seek professional help. Trusting that a higher power will correct infertility leads some people to delay or avoid treatment altogether.

Mental Health

Shame, guilt, or anxiety about how people in our community may react prevents or delays many women of color from seeking treatment for infertility. The stigma of mental illness is also a concern when addressing infertility. Many people coping with infertility experience depression, anxiety and grief, and cultural norms can discourage people from sharing that they are struggling with their mental health. 

Isolation

Many people hesitate to talk about their personal experiences with infertility, which often leaves Black women with the impression that they are alone in their struggles or that infertility is a reflection of their character or a personal failing. That’s why sharing fertility stories is so important, especially in communities of color. 

————————————————

Thelma Osei is a Nurse Practitioner at Illume Fertility, specializing in fertility and family-building care for patients in Connecticut and New York. She graduated with her Bachelors of Science in Nursing from Western Connecticut State University and went on to receive her Family Nurse Practitioner degree from the University of Connecticut, graduating May 2019. Thelma joined the team at Illume Fertility in 2022.