For decades, studies have found that maternal and neonatal outcomes are poor for Black women. According to the Centers for Disease Control and Prevention, women of color are two to three times more likely to die from pregnancy-related causes than white women.
“I do think about it quite a bit as a woman of color, as a Black woman and also as a mother and somebody who's been on both sides of the coin here,” Amanda Adeleye, assistant professor of obstetrics and gynecology at the University of Chicago, told Yahoo News.
The maternal disparities are prevalent for women of color facing infertility too, an issue that affects more than 12% of women of childbearing age. Women of color who received infertility treatments have a substantially higher risk of losing their baby soon before or after birth, compared to white women, according to a study published last Wednesday in the American Academy of Pediatrics journal.
Adeleye explained: “This was a study looking at data retrospectively, so information that already had been provided. They looked at the years 2016 to 2017, and all live births, and also neonatal demises for singleton babies," that is, the birth of a single child.
The researchers wanted to know "what sort of association there was between exposure to fertility treatments and whether or not there was an interplay between that and racial and ethnic differences,” she said.
The study included over 7.5 million singleton births and analyzed the racial differences with assisted reproductive technology like in vitro fertilization (IVF) and nonassisted reproductive technologies, like fertility drugs and artificial insemination.
In births that used nonassisted reproductive technology, Black women were three times more likely to experience fetal death than white women. For births that used assisted reproductive technology, Black women were four times more likely to experience neonatal death compared to white women.
“And even in this study, they were able to show that even amongst people that had a spontaneous conception (the birth of a child after a birth conceived through fertility treatments), the risk of neonatal demise and other maternal and neonatal complications was higher in minorities,” Adeleye said.
After years of researching reproductive medicine and infertility treatments, the findings of the study didn’t catch Adeleye off guard. “I'm disappointed, of course, but I'm not sure that I'm surprised,” she said.
The study's lead author, Dr. Sarka Lisonkova, an associate professor of obstetrics and gynecology at the University of British Columbia, told NBC News that the results of the study did surprise the research team. Originally, Lisonkova and the team hypothesized that women who could afford fertility treatments would also have access to high-quality health care, regardless of their race.
According to the American Society for Reproductive Medicine, the cost of fertility treatments range from a few thousand dollars to $30,000 for IVF. But for many who achieved successful outcomes, the costs were estimated at approximately $60,000.
Isabel Morgan, the director of the birth equity research scholars program for the National Birth Equity Collaborative, told Yahoo News that infertility treatments do not reduce structural racism or the discrimination that Black women may experience in the health care system.
“We know that racism exists, and that structural racism has been linked to maternal health outcomes more broadly, but specifically, prematernal health and pregnancy outcomes,” Morgan said.
“Technology does not necessarily eliminate the negative experiences that Black women experience across the life course, and as they're specifically going to receive maternity care and reproductive health care,” she added.
While the new data may seem alarming, experts say it must be framed carefully, because people's lives are at stake. “When we stratify the data by race [and] ethnicity, it's important, because it allows us to see we have these disparities and inequities. At the same time, we have to be mindful of how Black women and their families and clinics are going to interpret the data,” Morgan said.
Experts say this is a crisis, but the problem is not in the technology that women of color receive for infertility. “There's not great physiologic plausibility behind why IVF would somehow negatively impact embryos of Black women and Black people, more so than non-Hispanic white people. But I think that even within the data presented, there's pretty clear socioeconomic differences,” Adeleye said.
Studies indicate that Black women experience infertility at double the rate of white women, but a National Health Statistics study found that from 2006-2010, only 8% of women of age 25-44 sought medical help to conceive, compared to 15% of White women."It's so clear that we're not giving women of color the same treatment that we do to white women, and that's the disparity. I think it's in the application of care. It's not in the technology," Adeleye added.
