Hispanic, Black women less likely to use fertility treatment even with insurance coverage

Racial disparities persisted among women seeking fertility treatment — even among those with private insurance and residing in states that mandate coverage for those services — according to researchers.

Underrepresented ethnic groups have been less likely to seek fertility treatment than white women despite advances in assisted reproductive technologies (ART), although previous research has been unable to determine how insurance and geography contribute to these disparities, the researchers said.

“Birth certificate data from 2010 to 2017 reveal that Black and Hispanic women were close to half as likely to have a birth conceived through ART as compared to white women,” Jerrine R. Morris, MD, MPH, a third-year clinical fellow in reproductive endocrinology and fertility at the University of California San Francisco, said during the presentation at the ASRM Scientific Congress & Expo.

But in a study cohort of women who were able to access ART without cost as a barrier, Morris continued, there was a fourfold increase in utilization among Black women compared with utilization among the U.S. as a whole.

Morris and colleagues conducted a cross-sectional population-based study using data from the CDC’s Pregnancy Risk Assessment Monitoring System, which included 44,577 women who had a live birth from 2009 to 2019 in 12 states. Participants reported whether they received fertility treatment before their most recent pregnancy.

The researchers calculated weighted percentages for reported fertility treatment and compared them based on race and ethnicity, adjusting for maternal age and education, marital status, pre-pregnancy insurance status and if fertility treatment insurance coverage was mandated by the state.

The 12.6% (n = 5,608) of women in the study who had preconception fertility treatment self-identified as white (65%), Black (10%), Hispanic (9.7%) or other (15.2%).

According to a univariate analysis, Black, Hispanic and “other” women were significantly less likely to have preconception fertility treatment than white women (P < .0001).

With adjustments for demographic confounders including age, education and marital status, the multivariate analysis found that Black (adjusted OR = 0.85; P = .0022) and “other” (aOR = 0.89; P = .005) were less likely to get fertility treatment.

An examination of the women with private insurance (n = 29,622) who received preconception fertility treatment (16.2%) adjusted by mandated fertility coverage found that women who were Black (P = .0327), Hispanic (P = .0026) and “other” (P = .0002) were less likely to use such treatment. State insurance mandates were not significant predictors in the adjusted model.

“Living in a state with a mandate for fertility treatment was not significantly associated with use of fertility treatment, though there was a trend toward greater use with the presence of a mandate,” Morris said.

Morris also noted the significant interaction between race and ethnicity and insurance mandates as Hispanic women who used fertility treatment were less likely to live in a state with a mandate, whereas Black women were more likely.

The researchers said their findings provide more evidence of additional deterrents of fertility treatment use for underrepresented racial and ethnic groups even among the insured.

Also, they said, additional studies are needed to identify the factors that continue to decrease utilization among women from underrepresented groups who have insurance in states that mandate such coverage and better direct interventions to empower these populations to build their families.

“Future studies are critical to identify deterrents of fertility treatment among marginalized communities external to insurance and income status,” Morris said.