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Preterm Birth: Causes, Consequences, and Prevention
Disparities in Infertility Treatment
As discussed in Chapter 4, socioeconomic differences in multiple gestations have not been well studied (Kramer et al., 2000). The literature on infertility, utilization of treatment, and outcomes of treatment has been focused on white and socieconomically advantaged populations. While the extent to which various racial-ethnic minority populations and subpopulations experience fertility problems is not precisely known, a series of recent reports developed from a workshop, Health Disparities in Infertility, began to shed light on infertility problems among racial-ethnic minority populations (Berkowitz and Davis, 2006). This workshop was sponsored by the National Institute of Child Health and Human Development, Office of Behavioral and Social Sciences Research, and Office of Research on Women’s Health of the National Institutes of Health, and Agency for Healthcare Research and Quality.
In an effort to assess whether racial-ethnic or socioeconomic disparities exist in infertility, impaired fecundity, or infertility treatment, Bitler and Schmidt (2006) analyzed data from the National Survey of Family Growth. The authors reported that infertility was more common for Hispanic, non-Hispanic black, and non-Hispanic women of other races than for non-Hispanic white women. In addition, results suggested disparities by educational attainment. Non-college educated women were more likely to experience problems with infertility and impaired fecundity than women with 4-year college degrees. Despite a higher likelihood of fertility problems for minority and socioeconomically disadvantaged women, these women were less likely to have ever received infertility treatment. Further, state-level infertility insurance mandates (currently in place in 15 states) did not ameliorate these disparities. Within a population of women receiving ART services in the military health care system, clinically significant differences in the live birth rate and statistically significant differences in spontaneous abortions were observed between African American and white women (Feinberg et al., 2006). The authors speculate that this may be due, in part, to higher prevalence of leiomyomas (benign uterine tumors) in the African American women. Other investigations also revealed delayed time to seeking treatment in African American women (Jain, 2006), and economic barriers to care seeking in Arab American (Inhorn and Fakih, 2006) and Latinas women (Becker et al., 2006).
The study by Becker and colleagues also suggests that Latino women raised in the United States may be more likely to seek care, compared with Latino women raised elsewhere. Continued research to understand disparities in infertility, infertility treatment, and outcomes of treatment including multiple gestations and preterm birth is needed.