Cost and culture keeping black women out of infertility centers

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Liana Roxanne Clark married her husband Mason in 2003, when she was just two months shy of turning 40 years old. Clark wanted to be a parent, and after being instructed by her doctor immediately began in vitro fertilization treatments.

“Because in your 40s, you don’t have a lot of time to wait and see what happens,” said Clark. But after several failed treatments and growing anxiety, they decided to look another route to have a baby.

“I’ll try donor eggs,” said Clark. “I had resisted that for a long time. Everyone wants to see a little of themselves in their child.”

As an African-American woman, Clark wanted the donor to be black, and after struggling to look for one the Pennsylvania couple finally found a solution in a South African clinic. After one South African donor backed out, and another donor conceived her own child, Clark wasn’t sure what to think. “It was just kind of like this struggle, but I was thinking, I can go through a struggle, I can beat adversity. Then it became — why can’t you do this? It was just that pain of…you are broken, God is trying to tell you, you don’t get to be a mother.”

Clark eventually found a match in the South African clinic and became pregnant. But then her rollercoaster ride of emotions continued. She miscarried at the beginning of her second trimester and she was convinced that “God didn’t want me to be happy.” As an adolescent medicine physician, “I went into this clinical mode. I asked, what do we do now? The doctor replied, ‘grieve.’ And that’s when the clinical armor was just shattered, and that was probably the lowest point in my entire life. I just stopped feeling.”

Like other infertile women, Clark was faced with options including adoption, surrogacy, or another try with a donor.

At 43, Clark looked to adoption. Her daughter Zara is now 4 years old.

“I thought God was telling me I didn’t deserve to be a mother, but he wanted me to be the mother of this baby,” said Clark.

Approximately 12 percent of women ages 15-44 in the U.S. are not able to have children according to the American Congress of Obstetricians and Gynecologists (ACOG).

But for black women, infertility is a problem that is increasing according to Dr. David Seifer, Co-Director of Genesis Fertility and Reproductive Medicine Center in Brooklyn, New York.

“In 1995, the percentage of black women who received any service for infertility was 13 percent, compared with 16.3 percent of white women with one or more previous births…in 2002 that number declined to 10 percent of black women compared with 18.8 percent of white women,” Seifer wrote for the American Society for Reproductive Medicine.

Black women aren’t seeking out infertility services to the same degree as white women; economic and cultural reasons may be part of the reason why.
Dr. John Zhang is the Director of New Hope Fertility Center in New York City. The center has about 4,000 active patients, and the large majority are middle class or above. “About 5 percent of my patients are black,” said Dr. Zhang “and zero black women use our center for fertility preservation.”

Some fertility services are expensive.

“Socio-economic status can dictate how many blacks you see in practices,” said Dr. Diana Broomfield, Medical Director at Maryland IVF Fertility Health and Wellness Center in Columbia, Maryland. “In vitro fertilization can cost between 10 and 15 thousand dollars. What percentage of the population can afford that? Not many.”

And while 85 percent to 90 percent of infertility cases can be treated with conventional therapies such as medication or surgery, in vitro fertilization (IVF) accounts for less than 5 percent of infertility services (ACOG) and among reproductive age women in the United States, .01 percent of black women are using Assisted Reproductive Technology (ART), according to the American Society of Reproductive Medicine.

“A greater percentage of black women underwent ART in 2004-2006 than in 1999 and 2000,” notes a study published in the American Society for Reproductive Medicine (ASRM)’s “Fertility and Sterility” Journal. “However, black women still remained underrepresented in proportion to the number of women of reproductive age who may have had infertility and may have benefited from ART during this study period.”

There are only five states that have mandated comprehensive coverage for their residents — Connecticut, Illinois, Massachusetts, New Jersey and Rhode Island. And “even in states with mandated insurance coverage, the individuals who access IVF services tend to be predominantly Caucasian, highly educated, and wealthy.” (Fertility and Sterility, Vol. 94, No.1, June 2010).

So finances may not be the only reason why African-Americans do not seek infertility services.

“Its still a taboo, an area of shame, resistance,” said Dr. Broomfield. “You feel embarrassed, that because you’re infertile you are less of a woman — and that becomes another cultural issue as to whether or not you should seek help because there’s a perception, and a myth that Hispanics and blacks don’t have any problem getting pregnant.”

Anika Palm, 36, went through four years of infertility treatments, and wasn’t comfortable talking about it until she was well into her third year.

“People would say things like, ‘infertility is for white people, black people aren’t infertile. Pray about it, just relax,’” said Palm. “Let’s be frank, what some people think about a black woman, it is so crushing.”

But infertility is an issue that affects all people, regardless of ethnicity or gender.

Infertility may be looked at as a woman’s issue, but “infertility affects men and women nearly equally. About one-third of infertility cases can be attributed to men; about one-third to factors attributed to women; and the remaining one-third are caused by either a combination of problems in both partners or by unknown factors (ACOG).

“It affects everybody,” explained Dr. Broomfield, “but black cultures — Africans, those from the Caribbean, are more reluctant to come seek medical help.”

Palm was married in 2002, and around 2005 her and her husband Eric began intensive infertility treatments. After spending all of their savings and undergoing extensive emotional baggage, they decided to stop trying in late 2008. In January 2009, Palm was pregnant.

“Although I was not undergoing treatment when I became pregnant, I do believe all the years of treatment led to my pregnancy in 2009,” said Palm.

Palm is blessed to have given birth to her 18-month-old daughter Olamina, but she is still very connected to the infertility community and will not forget how isolated she felt during the infertility time period in her life.

“You are not visible, you feel very invisible,” Palm said. “Even when there was another black couple in the waiting room, they wouldn’t meet my eye. I desperately wanted someone to talk to about this, and it just wasn’t there.”

Desperation for conversation is what led Palm to write about her experience with infertility on her blog Writeblack.com, Clark on Welcome to the Dollhouse and it has led Regina Townsend to start her own company.

Townsend, 29, is Founder and Executive Director of The Broken Brown Egg Inc. Initially started as a blog in 2009, last February it transitioned into an organization that “puts a brown face” on the issue of infertility for women.

After her own obstacles with trying to conceive- ups and downs with medical doctors and ovulation drugs, “I took a backseat to my own issues,” said Townsend “and became adamant about advocacy and why black people weren’t talking about it.”

The Broken Brown Egg Inc. responses have overall been positive, and Townsend urges all people to “get involved in the debate. Black people are prime candidates when it comes to talking about contraception, but we are not seen in the debate for conception.”

“Women, acknowledge that infertility will be emotionally difficult for you and your partner,” advised Palm. “Its not sexy, but you can come through it even stronger than ever.”