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Caring for Black Women Seeking Fertility Treatment: Challenges, Stigma, and Hope
As we celebrate Black History Month, we wanted to address unique challenges for our Black women experiencing infertility. Infertility is a deeply personal and often painful journey, affecting millions of people worldwide. However, we recognize Black women have unique challenges in their fertility journey—medical, societal, and cultural.
Caring for Black Women Seeking Fertility Treatment: Challenges, Stigma, and Hope
Date: February 20, 2025
Author:
Gloria Richard-Davis, MD, MBA, MSCP, FACOG1.2, Lasha Clarke, PhD, MPH1, Benjamin Harris, MD,MPH, FACOG3, Teru Jellerette-Nolan, PhD4, Michael Thomas, MD, FACOG5
1Morehouse School of Medicine, 2Virginia Mason-Franciscan Health/ Common Spirit Health, 3Shady Groove Fertility-Jones Institute, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Department of Obstetrics and Gynecology, 4Ferring Pharmaceuticals, and 5University of Cincinnati College of Medicine
As we celebrate Black History Month, we wanted to address unique challenges for our Black women experiencing infertility. Infertility is a deeply personal and often painful journey, affecting millions of people worldwide. However, we recognize Black women have unique challenges in their fertility journey—medical, societal, and cultural. Black women experience infertility at higher rates (~2X) that of White women, yet they are significantly less likely to seek or receive timely referral or treatment.(1) The reasons behind this disparity are multifaceted, and are rooted in systemic inequity, historical medical bias, financial barriers, cultural stigma, inadequate reproductive health education, and lack of representation in reproductive health providers. To meaningfully address these gaps, we must move toward structural solutions that center reproductive justice, equitable access to care, and patient-centered support.
Understanding the Disparity
Research has shown that Black women are almost twice as likely to experience infertility compared to White women. (1,3) Conditions such as uterine fibroids, endometriosis, and polycystic ovary syndrome (PCOS)—all of which can contribute to infertility—are more prevalent among Black women. Yet, they are often diagnosed later in the disease progression, leading to reduced treatment options and lower success rates. Even when Black women do initiate fertility treatment, they are more likely to discontinue care early—often due to financial strain, lack of culturally responsive care, feeling unwelcome or out of place in fertility clinics, and the emotional toll of navigating a system where they are underrepresented and unheard. (1-4)
Several factors contribute to these disparities:
- Medical Bias and Misinformation: Studies have documented racial biases in healthcare, including dismissing Black women’s pain or concerns. This often leads to delayed diagnoses and inadequate treatment for conditions affecting fertility.
- Financial Barriers: Fertility treatments like in vitro fertilization (IVF) are expensive, and many employers’ insurance plans do not cover them. Since Black women face economic disparities in income and access to employer-covered healthcare, they are less likely to afford fertility treatments. Though in a qualitative survey of 220 women in Atlanta actively pursuing fertility treatment, the average income was $110K, solidly middle to upper income.(3)
- Cultural and Religious Stigma: In many Black communities, there is a strong cultural emphasis on motherhood, and infertility is sometimes viewed as a personal or spiritual failing. The stigma surrounding infertility can lead to feelings of shame, isolation, and reluctance to seek medical help.
- Lack of Representation in Research and Treatment: Most fertility research and treatments options have been developed with data from White patients, leading to a lack of tailored approaches for Black women. Additionally, Black women are underrepresented in fertility clinics and awareness campaigns, making it difficult to find culturally affirming care and support.(1,3)
The Emotional and Psychological Toll
The experience of infertility can take a significant emotional toll. Feelings of inadequacy, guilt, anxiety, and depression are common, yet Black women are less likely to seek or be offered mental health support due to cultural stigma and the “strong Black woman” trope. Many feel pressured to endure their struggles in silence, which can further exacerbate emotional distress.
Breaking the Silence: Seeking Solutions and Support
While the challenges are real, there are growing efforts to break the silence around Black women and infertility. Advocacy groups, reproductive justice organizations, equity-focused researchers and providers, and social media movements are working to destigmatize infertility and provide resources for Black women navigating this journey.
Steps Toward Change:
- Increasing Awareness and Education: More discussions in Black communities about reproductive health and infertility can help dismantle misconceptions and encourage early intervention.
- Advocating for Medical Equity: Pushing for more research on Black women’s reproductive health and training medical professionals to address racial biases in fertility treatment.
- Financial Assistance and Policy Changes: Expanding insurance coverage for fertility treatments and supporting organizations that provide grants and financial aid for Black women seeking fertility care.
- Mental Health Support: Encouraging open conversations about the emotional impact of infertility and increasing access to culturally competent therapy and support groups.
Hope for the Future
Despite the challenges, many Black women have successfully built families through fertility treatments, adoption, surrogacy, and other paths to parenthood. Representation is slowly increasing, with more Black fertility specialists, doulas, and advocates working to ensure better outcomes for future generations.
Infertility does not define a woman’s worth, nor does it have to be a journey taken in isolation. By addressing disparities, fostering support, and advocating for equitable care, Black women can navigate infertility with greater resources, understanding, and hope.
Training a workforce that is culturally sensitive with skills to provide culturally aligned care will help to reduce Black women’s sense of isolation and feeling “unheard”. A Ferring supported research study on the lived experience of Black women, conducted by Morehouse School of Medicine Center for Maternal Health Research Director Dr. Lasha Clarke, informed the development of education modules on “Fertility Equity”. The modules, which champion equity in fertility care for Black women through interactive education, provide tools and actions for all clinic staff to reduce barriers, center the patients’ experience, and create an inclusive culture in fertility practices/centers.(3)
Resources for Support:
- Fertility Equity™ Modules – interactive modules for fertility teams to champion more equitable care. (https://resources.engagedmd.com/fertility-equity)
- The Broken Brown Egg – A nonprofit organization focused on reproductive education for Black women
- Fertility for Colored Girls – A support network offering guidance and financial assistance
- The National Infertility Association (RESOLVE) – Provides resources and advocacy for all women facing infertility
- Cade Foundation – A nonprofit that serves the needs of families battling infertility through education and financial support
References:
- Richard-Davis, G, Morris J. No longer separate but not close to equal: navigating inclusivity in a burgeoning field build on injustice. Fert Ster. 2022 Dec 13; S0015-0282(22)02040-4.
- Richard-Davis, G, Plowden, T, Asafu-Adjei, D., Diversity ASRM Commitment to Advancing Diversity, Equity and Inclusion in Reproductive Medicine, AUANews 9Apr 2024.
- Clarke, L, Morgan, I, Jellerette-Nolan, T, Charles, D Suarez, A, Patton, D, Jackson-Bey, T, Harris, B, Hernandez-Green, H, Richard-Davis, G. Advancing Fertility Equity: Uplifting Black Women’s Voices To Design Culturally Responsive Support Solutions. P-24.
- Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion The Ethics Committee of the American Society for Reproductive Medicine. Volume 116, Issue 1p54-63July 2021
Contact author: Gloria Richard-Davis, MD, MBA, FACOG, Morehouse School of Medicine, gricharddavis@msm.edu
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