Understanding the Experiences of Black Women & Fertility Treatments

For Fertility Providers

Throughout the pandemic, the number of people seeking fertility treatments across Canada increased.¹ Everyone undergoing fertility treatment experiences the harsh ups and downs, but for Black Canadians, there are often additional challenges. 

Systemic racism in Canada’s healthcare system has been well documented. Especially in reproductive healthcare, there has been a history of coercive practices, including forced sterilization and experimentation.² This history has understandably resulted in low levels of trust between Black communities and healthcare providers.  

Furthermore, stereotypes about Black women’s fertility has contributed to myths that Black women are ‘more fertile’ than others.³ These myths can create stigma within the community, increase feelings of isolation, impair Black women’s sense of gender and identity, and prevent people from seeking medical reproductive support.⁴ 

The result is that, according to a U.S. Department of Health and Human Services study, Black women are less likely to seek medical help to get pregnant.⁵ When they do seek support, Black patients tend to start IVF later than other ethnic groups.⁶  On the other hand, fertility treatments for Black women tend to be less successful, with IVF resulting in fewer live births, even when we control for other factors, such as physical health and socioeconomic status.⁷  

This is despite the fact that Black women have higher rates of infertility than their peers.⁸ For example, a UK study noted that Black women have a higher prevalence of tubal diseases than other groups.⁹ 

It is important to note that most of the above data reflects American and UK populations. Unfortunately, there is a real lack of research regarding the experiences of Black Canadians in fertility treatment. At the same time, there is anecdotal evidence to support similar gaps in care.¹⁰

So in the face of these challenges and objective differences in care for Black women, what can we, as providers, do to bridge the gap in fertility services?

First, it goes without saying that all service providers at an individual level need to continue to engage in dedicated learning around equity, diversity and inclusion to better understand their own biases and how that may shape the way clinicians treat patients.  

Second, at a more systemic level, organizations need to look at their service offerings to determine if those services are really meeting the needs of the entire patient population. Consider collecting race-based identity data to determine whether your clinic is over or under serving some populations and how patients from different populations feel about your services. This evidence, even if only collected at an organizational level, is a necessary starting point to ensure consistent quality of service.

Third, when we identify gaps in service for Black communities, we have to think creatively about ways to improve services to meet community needs. It may require offering free information sessions with Black organizations to help build trust, increasing the number of Black service providers at our clinics or partnering with Black-led organizations to deliver more culturally responsive services. With more diverse service offerings, Black patients will have the option to select services that meet their distinct needs. 

These are just some ways we, as both individual providers and a sector, can work towards measuring and eliminating negative experiences and outcomes for Black women in fertility treatment. 

If you have other ideas to improve services, we would love to connect. Email nakema@betterbria.com. 

Nakema Rea McManamna is a Registered Social Worker (RSW) with the Ontario College of Social Workers and Social Service Workers and Alberta College of Social Workers. She graduated with her Master of Social Work (MSW) at the University of Toronto’s Factor-Inwentash Faculty of Social Work. Nakema specialized in perinatal health while completing her training at Women’s College Hospital in the Reproductive Life Stages program. Nakema also has a background supporting children, youth and families in child welfare, youth justice and experience in community development as the former Director of Policy for the Canadian Black Policy Network and provincial policy analyst responsible for the Ontario Black Youth Action Plan. 

Sources: 

1. Press, T. C., & Bains, C. (2022, March 16). More Canadians opting for fertility treatment during pandemic, advocacy group says. CTVNews. Retrieved January 19, 2023, from https://www.ctvnews.ca/health/more-canadians-opting-for-fertility-treatment-during-pandemic-advocacy-group-says-1.5821156 
2.  Coen-Sanchez, K., Idriss-Wheeler, D., Bancroft, X., El-Mowafi, I. M., Yalahow, A., Etowa, J., & Yaya, S. (2022, February 16). Reproductive justice in patient care: Tackling systemic racism and health inequities in sexual and reproductive health and rights in Canada. Reproductive health. Retrieved January 19, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8849010/ 
3.  Alexia Fernández Campbell, N. J. (2015, September 3). Five myths about women of color, infertility, and IVF debunked. The Atlantic. Retrieved January 19, 2023, from https://www.theatlantic.com/politics/archive/2015/09/five-myths-about-women-of-color-infertility-and-ivf-debunked/432711/ 
4.  Ceballo, R., Graham, E. T., & Hart, J. (2015, April 27). Silent and Infertile: An Intersectional Analysis of the Experiences of Socioeconomically Diverse African American Women With Infertility. Sage Journals. Retrieved January 19, 2023, from https://journals.sagepub.com/doi/abs/10.1177/0361684315581169 
5.  Chandra, A., Copen, C. E., & Stephen, E. H. (2014). Infertility service use in the United States: Data from the national … National Health Statistics Report. Retrieved January 20, 2023, from https://www.cdc.gov/nchs/data/nhsr/nhsr073.pdf 
6.  Ethnic diversity in fertility treatment 2018. HFEA. (2021). Retrieved January 20, 2023, from https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2018/ 
7.  Jain, T. (2020, November 19). Racial disparities and in vitro fertilization (IVF) treatment outcomes: Time to close the gap – reproductive biology and endocrinology. BioMed Central. Retrieved January 20, 2023, from https://rbej.biomedcentral.com/articles/10.1186/s12958-020-00672-2 
8.  Wellons, M. F., Lewis, C. E., Schwartz, S. M., Gunderson, E. P., Schreiner, P. J., Sternfeld, B., Richman, J., Sites, C. K., & Siscovick, D. S. (2008, November). Racial differences in self-reported infertility and risk factors for infertility in a cohort of black and white women: The Cardia Women’s Study. Fertility and sterility. Retrieved January 20, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2592196/ 
9.  Ethnic diversity in fertility treatment 2018. HFEA. (2021). Retrieved January 20, 2023, from https://www.hfea.gov.uk/about-us/publications/research-and-data/ethnic-diversity-in-fertility-treatment-2018/ 
10.  Adhopia, V. (2021, June 23). Canada has a blind spot for black maternal health. better data could help, doctors say | CBC news. CBCnews. Retrieved January 25, 2023, from https://www.cbc.ca/news/health/canada-black-maternal-health-1.6075277