Infertility affects at least 12 percent of all women up to the age of 44, and studies suggest Black women may be almost twice as likely to experience infertility as white women.
Yet only about 8 percent of Black women between the ages of 25 and 44 seek medical help to get pregnant, compared to 15 percent of white women.
To better understand what’s driving the disparity between the number of Black women suffering from infertility and those pursuing treatment, WomensHealthMag.com and OprahMag.com teamed up with the Black Women’s Health Imperative and Celmatix, a startup bringing personalized medicine to women’s reproductive health and fertility, to survey more than 1,000 women of multiple races about their fertility.
One thing was apparent: Socioeconomic factors are clearly at play. In our survey, women of a variety of ethnic identities cited cost as the biggest obstacle that would prevent them from seeking treatment.
But also enlightening—and alarming: Black women were more than twice as likely as white women to say that they wouldn’t feel comfortable talking about their fertility issues with friends, family, a partner, their doctor, or even a support group.
We spoke with fertility doctors, mental-health experts, and Black women who have undergone infertility treatments to further explore both the systemic and the deeply ingrained cultural factors that may be stopping them from seeking treatment—and impacting their experiences when they do seek treatment. These are some of our findings.
Black women have understandable hesitations about discussing infertility issues with their doctors.
In our survey, Black women were more than 50 percent more likely than white women to say they felt uncomfortable talking to their doctors about fertility.
“Within the Black community specifically, there is still a mistrust of the medical system,” says Desireé McCarthy-Keith, M.D., M.P.H., a reproductive endocrinologist at Shady Grove Fertility in Atlanta, Georgia. She cites incidents like the infamous Tuskegee Study, in which researchers deprived Black men with syphilis of the appropriate medical care for years without their knowledge.
“People were just victimized by the medical system and monitored without treatment,” she says. “So there are people who are still very skeptical about it.”
This lack of trust can extend to the fertility space, particularly when Black women have had negative experiences with the medical community.
Rosario Ceballo, Ph.D., a professor of psychology and women’s studies at the University of Michigan, interviewed 50 women who identified as African American about their experiences with infertility for a study she published in Psychology of Women Quarterly—and said about a quarter of her sample reported being mistreated in a medical setting.
“Some of the experiences of racial discrimination were just horrific,” she says. “One of the women was recounting experiences when she was younger, and she hadn’t been sexually active yet, but a doctor assumed she’d had many, many partners and the issues she was seeking treatment for could be a result of that.”
When Black women do seek medical care for fertility issues, failing to see people who look like them in pamphlets, on bulletin boards, or in waiting rooms can further discourage them from pursuing treatment.
“When these kind of programs and services were initially rolled out, even the marketing, the advertising for fertility treatment did not contain women of color,” says McCarthy-Keith. “So if you were a woman of color who was having trouble getting pregnant, you didn’t even see yourself reflected in the services that may be able to help you.”
Regina Townsend started her blog, The Broken Brown Egg, in 2009 because she saw this trend online, too. When the 37-year-old librarian from Chicago went searching online for women who’d gone through experiences like hers, she couldn’t find anything from Black women. And what she did stumble on only highlighted some of her own misgivings about seeking treatment.
“In some of those online communities or blogs that I would go to, there was a difference in how sometimes white women felt more comfortable saying, ‘And so, I went to the specialist, and this is what I told him, and this is what we’re doing,’” she says. “They had the courage to do that, whereas many of the women that I knew wouldn’t even know where to start.”
Ceballo’s interview subjects repeatedly said they would encourage other Black women struggling with infertility to be proactive about their medical care. “If you don’t like the doctor who you’re talking to, find another one,” she says. “Don’t waste time, do what you need to do. Especially when it comes to medical professionals. If you don’t feel right, if they don’t treat you right, if there’s no respect there, if they don’t feel like a medical professional you can trust, then just find someone else.”
Easier said than done? Perhaps. But resources like the American College of Obstetricians and Gynecologists’ physician database, Resolve’s state-by-state database of fertility doctors, and our tips on how to talk to your doctor about fertility are good starting points.
The stereotype that Black women don’t have fertility issues is persistent—and harmful.
For her research, Ceballo interviewed women in a wide swath of professions: Ph.D.s, medical doctors, school custodians, teacher’s assistants. Almost all of them voiced the same belief that Black women are highly fertile. The sentiment was so universal, regardless of socioeconomic status or education level, that Ceballo dubbed it the “Black-fertility mandate,” based on the idea that, for these women, the ability to become a mother was closely tied to their identity as Black women.
“Our stereotypical cultural images of Black women go back in history, and we still have images like the welfare mother, the poor Black woman who’s surrounded by six, seven kids, and she can’t support any of them,” says Ceballo. “Those images, as much as we think they are vile and mischaracterizations of facts and reality, they are still pretty powerful. We all breathe racism in our society, and we have to work against that, but it doesn’t mean it doesn’t seep in.”
Because of these deeply ingrained beliefs, Rev. Stacey Edwards-Dunn says she grappled with feelings of inadequacy during her own fertility journey (she did seven IVF cycles before eventually getting pregnant with her daughter in 2014). “I didn’t think that Black people struggled with infertility, because, based upon what I was led to believe, Black women and men are hyper-fertile, baby-making machines,” she says.
Edwards-Dunn, now a fertility coach and counselor, says many of the Black women who’ve opened up to her about their infertility report having experienced similar emotions.
“There’s so much shame,” she says. “You allow that to define you.” In her role as a minister, she helps women see how pursuing treatments like ovulation induction or IVF can align with—not undermine—their faith.
To add insult to injury, this stereotype that Black women are immune to fertility issues is patently false.
“There are specific factors that affect African-American or Black women disproportionately,” says McCarthy-Keith. Uterine fibroids and obesity, for example, are conditions that can negatively impact fertility—and Black women suffer from higher rates of both.
“If you’ve had unprotected intercourse for at least 12 straight months, and you’re under 35 years old, it’s time to see a fertility doctor,” says McCarthy-Keith. “If you’re 35 or older, six months unprotected, see a fertility doctor.”
Black women aren’t talking to friends and family about their fertility, either.
In addition to being less likely than white women to have spoken to their friends about their experiences trying to get pregnant, Black women in our survey were also the least likely of any of the ethnic groups surveyed to say they know someone who had undergone fertility treatments.
Prior to confiding in any friends about her issues, Lydia Sermons, a 55-year-old communications strategist in Washington, D.C., says she used to feel like the only Black woman in the world struggling to have a baby.
“Everyone in my immediate circle who had wanted to start a family, for the most part, had done so,” she says. “There was no one in my primary or even secondary circle that I could go to and say, ‘Well, have you done this? What do you think?’”
Lydia, who formerly worked as the chief of staff at the Black Women’s Health Imperative, had to do most of her research on the treatments she eventually pursued on her own. She now has two sons and one daughter from her IVF cycles. “It was such a lonely journey,” she says.
Even Lydia’s mom, a retired nurse and minister, suggested she leave it in God’s hands, only further discouraging Lydia from talking to her family. “My mother was all about, ‘We’re going pray for you. God’s going to work this out for you.’”
Ceballo says that religion often came up in the interviews she did for her research. “For some women, it was their private sense of religion and spirituality that got them through,” she says. For others, she adds, the emphasis that the church puts on reproducing—coupled with a lack of conversation around infertility—made religious settings “painful and complicated.”
For Lydia, the turning point came when she broke down to a friend after a failed IVF cycle—and she realized she wasn’t the only one suffering in silence. “When I told her, she said, ‘Girl, I’m going to the same doctor!’” she recalls. “Finally, I had someone to talk to.”
Andrena King, a 41-year-old career coach, witnessed the same thing when she first went to an infertility clinic in Columbia, South Carolina. She was discouraged by the fact that her fertility clinic’s wall of success stories (where pictures of children conceived via fertility treatments are displayed) didn’t contain any children or families who looked like her.
She couldn’t figure it out; she saw other Black women in the waiting area when she went in for her appointments—were none of them having success? When she asked the office manager what was going on, she was told that Black families often declined to have their baby’s picture posted. It wasn’t a conscious omission by the clinic—the families simply didn’t want people to know they had dealt with infertility.
Ceballo says this goes back to the Black-fertility mandate, which can make women hesitant to open up about their fertility struggles because they feel like they’re “weird” or “abnormal.” But this tendency can create a cruel catch-22 where Black women feel they’re the only one struggling with fertility issues because no one talks about it…and no one talks about it because they feel like they’re the only one struggling.
“Virtually every single one of the women I interviewed talked about their experience as being characterized by isolation and loneliness because there were very few people in their lives they felt they could talk to about this,” Ceballo says. “A lot of the women said they decided to talk to me because they didn’t want other Black women to have to go through this alone. The silence and the isolation was so painful and so difficult that they boldly decided that they were going to talk about their experiences so other women would not feel that.”
Luckily, some people are breaking the silence.
After feeling like she had no one to talk to during the seven years she struggled to get pregnant, Edwards-Dunn launched the first chapter of Fertility for Colored Girls in Chicago in 2013.
“There wasn’t a safe space for women of color and men of color to have conversations about infertility,” she says. “There wasn’t a space where I could go and find people who looked like me, who really understood what we were going through culturally, as well as personally.”
More than 100 people showed up to the first meeting.
“I was shocked,” she says. “It was amazing how people were coming out of the woodwork.”
In the past five years, the organization has grown to include chapters in seven states. Edwards-Dunn also published Hold On To Hope: Stories of Black Women’s Fertility, Faith, and Fight to Become Mommies in 2017 to help Black women struggling to get pregnant see they’re not alone.
Townsend, who now has a 2-year-old son, noticed a similar support system evolved virtually when she launched her blog and its Facebook page. She regularly receives private notes from women—family members, coworkers, people who have stumbled onto her site—thanking her for giving them a voice.
“I would get messages saying, ‘Thank you for saying that out loud because this is what I’ve been dealing with,’” she says.
Nichelle Polston, a 38-year-old journalist who lives in New Castle County, Delaware, tried to get pregnant for three years but has since come to terms with the fact that she may never have kids. “[My husband and I are] at a point in our lives where if it happens, it happens,” she says. “I’m able to cope knowing that you can still live a fulfilling life without children.”
She now co-leads a support group in Delaware facilitated by Resolve and talks publicly about her experiences in hopes that it will help empower other people to open up—regardless of what their families look like.
“If I have to be the poster child, I will become that poster child to get women to talk about their struggle,” says Nichelle. “At one time, my fear was talking because I didn’t want people to gossip about me. Now, my fear is women not talking.”
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