Periscope: Infertility & Race
In September, African-American actress Gabrielle Union released her latest book, “You Got Something Stronger?” The autobiographical account focuses a chapter on her infertility and her surrogacy journey. Her story is not only important in terms of talking very openly about why couples (and some single people) turn to surrogacy, but also focusing on the importance of breaking the stereotype that infertility is only a white woman’s problem. Interestingly—and sadly—women of color experience medical infertility[1] at a higher rate than white women, with Black women twice as likely to experience infertility. Recent research published in the British medical journal The Lancet in April 2021, found that miscarriage rates are 43% higher in Black women.
According to the Centers for Disease Control’s 2002 National Survey of Family Growth, infertility is higher among married couples when the woman is non-white, with the incidence of infertility highest among Black women at 20%, followed by Hispanic women at 18% and then white women at 7%. Researchers found this was likely in part because of environmental factors, including living in more concentrated urban settings that can lead to more exposure to things like air pollution and toxic waste. But lifestyle aspects were also likely to play a part. Black women, for example, are more commonly affected by fibroids, which are non-cancerous tumors in or around the uterus that can be part of the reason a woman cannot have a baby. Obstruction of the fallopian tubes, also known as “tubal factor infertility”, is also more prevalent in Black and Hispanic women.
According to Judith Daar in her book “The New Eugenics: Selective Breeding in an Era of Reproductive Technologies”, over the years women from minority communities have often internalized their infertility, in part because their stories have been muzzled by social misconceptions about race, class, reproduction and fertility. For example, social and cultural factors may play a role in accessing fertility care in the Asian population and Asian-American women in general have lower pregnancy rates after IVF versus white women. Couples and women of East Asian descent often wait substantially longer before they consult a physician about fertility. Dr. Victor Fujimoto, the director of the IVF program at the University of California, San Francisco, told NBC News that they are much less likely to seek early intervention when they are having problems getting pregnant. “When we looked at our population of Asian patients,” he said, citing a report he co-authored in 2007, “40% or more were delayed in speaking for at least two years after their problem began.”
It is typically white professional-class women whose stories get told, with still almost no research on working class and poor women’s experiences with infertility. However, as Anna V. Bell writes in “Misconception” , slowly the myth of the “hyper-fertile [B]lack or [B]rown woman” has been transitioning from “a hushed reference” to being more openly acknowledged. That’s not only thanks to public figures from Michelle Obama to Angela Bassett, Naomi Campbell and Tyra Banks talking about their struggles with their infertility but also blogs like theBrokenBrownEgg.org and support organizations like Fertility for Colored Girls (FFCG).
Reverend Stacey Edwards-Dunn, the Chicago-based founder of FFCG who herself suffered from infertility, told me* that there are a lot of “myths and misconceptions of what it means to be a strong Black woman” and how that plays into fertility struggles. “We all grieve,” she said about infertility in general but, “there are some things attached to our grieving that other communities do not have to experience.” She went on to tell me that for many Black women that she counsels, it’s hard enough to have to explain to family and friends that they have to use a surrogate to have a baby. “What is more challenging is if you had to use a donor to get to that point as well,” she said. “I just spoke to a woman who is going to use a gestational carrier that I set up and that is her challenge. She was like, ‘it is one thing that I’m not going to be able to carry the baby, but how am I am going to explain that I had to use a donor?’”
Part of that might stem from the argument that perceptions around the inability to conceive are not just internalized, but also come from external forces too. There has been research that suggests that there is a lot of distrust in the U.S. healthcare system by men and women of color because, as Ms. Bell writes, of a “long history of racism and discrimination in the delivery of reproductive health care in general.” Some of that dates all the way back to the 19th century experiments by J. Marion Sims, who is considered to be both the “father of modern gynecology” and a controversial figure who operated on enslaved Black women both without anesthesia or their consent. “At the root of the gynecological practice, testing and research is the racist experimentation on Black women,” said Rev. Edwards-Dunn. “Dr. Sims embodied white supremacy and racism, which I think in turn is woven through medical education and people are very unconscious of that.”
There has been an inclination by doctors to diagnose white middle class women who are having trouble conceiving with having endometriosis, which can be treated by IVF. Black women, meanwhile, who are in the same situation are often diagnosed with having pelvic inflammatory disease, something often treated by a hysterectomy. As Ms. Bell has found, there are also lower referral rates of minority patients to infertility specialists though “[on] the other hand, physicians report that minority women, particularly African-American women” are much less likely to seek out treatment. That can then exacerbate any biological reasons. “Waiting to seek a diagnosis and treatment for infertility,” writes Ms. Daar, “means that the woman experiences reproductive aging in the interim.”
In the majority of films, books and television programs on infertility in general and surrogacy specifically, it’s often portrayed as being something that primarily affects white middle and upper-class women. So the image of “infertility as a white woman’s issue” has become normalized, writes Ms. Bell. Women of color who suffer from it are not seeing themselves onscreen, in books or the media so their feelings of alienation are reinforced because their stories are simply ignored or not depicted. Rev. Edwards- Dunn told me that when high profile Black women like Gabrielle Union speak about their infertility, it gets lots of media attention for a few weeks but then it drops off again. “There’s some surface conversation that is going on,” she said. “And we have to unwrap this onion and really get to the core of some of the issues, particularly that Black women and couples are dealing with as it pertains to issues of race and disparity around reproductive health and infertility.”
--Ginanne Brownell, MFA’s Media Liaison
*Some of this essay is excerpted from the upcoming book “How I Became Your Mother: My Global Surrogacy Journey.”
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[1] Social infertility relates to lifestyle versus a medical situation. Social infertility affects gay and lesbian couples (who because of biology cannot reproduce together) or that of single men or women who are unable to find a partner to have children with. One definition states that it is, “an individual or couple, who during a 12-month period, possess the intent to conceive, but cannot due to social or physiological limitations.”