Where Are All the Black Women at the Fertility Clinic?

I am a 20-something Black woman and I have dreams of one day having a baby. I look forward to feeling my baby’s kicks concealed as flutters and caressing my swollen belly in any photo opportunity I get. But with this dream comes the reality that I am also a medical student with years of training ahead of me—I have made peace with the fact that those dreams may be deferred.

I recently did a medical school elective in reproductive endocrinology and infertility, which exposed me to women with various fertility-related issues. Our days in the office were bustling. Appointments scheduled at 20- to 40-minute intervals brought in a steady stream of patients seeking services ranging from treatment for polycystic ovarian syndrome to preparation for a cycle of in vitro fertilization.

Most of our patients were white professionals who had private insurance.

I attend school in a fairly diverse city where over 76 languages are spoken. One would think that our patient population would naturally mirror the ethnic diversity of the area. This was not the case. I saw only a handful of women who shared my complexion, leaving me to wonder where all of the Black women were.

The Racial Disparity in Fertility Treatment

My experience in the clinic wasn’t unusual—Black women access fertility treatment at lower numbers. A National Health Statistics study found that only 8% of Black women access medical care for fertility-related concerns compared with 15% of white women. But research also shows that Black women may have a higher need for these services—12% of Black women will have infertility compared with 7% of White women, according to the Association of Obstetricians and Gynecologists (ACOG)—leading to a vast fertility gap. Which means that Black women like me may face more challenges in achieving their dreams of motherhood.

Black women of course face a number of disparities when it comes to reproduction and maternal health. Every few weeks our community is met with another heart-wrenching story of a Black woman perishing from pregnancy-related causes. When it comes to actually getting pregnant, Black women are not safe from disparities in outcomes or care there either.

The driving force behind these disparities is multifold, rooted in social, economic, and political factors. “A lot of people talk about IVF and going to specialists, but that was not on the table for us because we had no insurance,” says Shaylene Costa, a doula and a Black mother of two who experienced a more than five-year journey with infertility before giving birth to her first daughter eight years ago. The average cost of one IVF cycle is $12,000 without insurance. “We were paying out of pocket for all of the treatments and blood tests,” Costa says, “which meant that we ate ramen noodles instead of good food.”

Even for those who have some form of insurance, accessing fertility services can still pose a disproportionate challenge for Black women. “There is a higher proportion of women of color who use federal insurance coverage, or Medicaid. Medicaid has absolutely no coverage for infertility,” says Lynae Brayboy, M.D., FACOG, an African American ob-gyn specializing in reproductive endocrinology and infertility.

Cost is not the only thing keeping Black women from fertility clinic waiting rooms. It’s impossible to ignore the role of social factors and cultural perceptions surrounding infertility. Ijeoma Kola, Ph.D., a Nigerian American entrepreneur who holds a doctoral degree in the history of public health, was just 28 when she experienced fertility struggles. After a disheartening trip to the doctor, she was told she would need IVF in order to conceive. But she suffered in silence for many months, feeling that she couldn’t talk to others about what she was going through—she even struggled to talk to her own mother about it. “Black women are presented as hypersexual—we get pregnant like this; we’re welfare queens. There’s this perception of an African woman having 10 kids and being hyperfertile,” says Kola. “That can be difficult to push back against if you are struggling to get pregnant.”

These harmful stereotypes not only make it difficult for Black women to talk about their infertility but may also have implications for their care. “When a Black woman comes in for her annual visit, infertility may be the last thing that is discussed,” Brayboy says. This can have implications that extend past the inability to conceive—fertility is a vital sign, Brayboy says, and loss of fertility can be an indication of underlying health issues.

Closing the Fertility Gap

Public service campaigns, pushing back against harmful stereotypes, and continued lobbying for increased access to fertility services for patients of all backgrounds are just some of the ways to eliminate these disparities. And many stakeholders are advocating for making fertility services such as IVF more accessible. Some states have made great strides in this effort, enacting legislation that mandates private insurance must cover a bulk of the cost of these services. However, patients who are uninsured or on Medicaid are still out of luck.

There are fertility centers and organizations that provide a handful of IVF grants to patients each year. For example, Fertility for Colored Girls is an organization that provides three types of grants to support those seeking IVF, intrauterine insemination (IUI), embryo adoption, egg freezing, and other fertility procedures. But the number of people who need financial assistance often exceeds the number of grants available.

Thankfully, the social stigma surrounding infertility is starting to erode—photography, film, and social media can help speed that along and raise awareness of the racial gap. Over the years I have indulged in many medically related television shows and documentaries—a handful of them even showcasing people’s experiences with infertility. However, these bodies of work often leave out the voices of those impacted by the fertility gap the most: Black women. In response to this glaring lack of representation, I filmed and produced a documentary series, Black Motherhood Through the Lens, which highlights four Black women navigating the reproductive health care system. One segment focuses on fertility, featuring Shaylene Costa’s and Ijeoma Kola’s experiences in accessing IVF and grappling with the social stigma associated with infertility in various communities.

Creating this series as a full-time medical student was nothing short of challenging, balancing production days with busy clinical rotations for two years. However, watching Shaylene and Ijeoma share some of their most vulnerable moments, opening their hearts to my camera lens, reminds me that this is all for a greater purpose.

I have many goals for Black Motherhood Through the Lens—film festival screenings, facilitating nuanced conversations, and maybe even fostering change in the medical system. And I also have many goals for Black motherhood. By creating space for diverse perspectives and experiences in mainstream media, I hope that we can reduce the number of Black women who suffer with infertility in silence.

Adeiyewunmi (Ade) Osinubi is a medical student, documentary filmmaker, photographer, and freelance writer based in Rhode Island. She is passionate about women’s health, digital storytelling, and traveling. Follow her on Twitter at @Ade_Osinubi.

Originally Appeared on Glamour