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Equitable Access to Fertility Care for Black Women

This fact sheet highlights the urgent need for equitable fertility care access for Black women, who face higher infertility rates and systemic barriers. It advocates for comprehensive coverage to advance reproductive justice and health equity.

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    N A T I O N A L W O M E N ' S L A W C E N T E R \ Partnership for Southern Equity • TOGETHER W£ PJtOSPEk APRIL 2 0 2 5 I FACT SHEET The Importance of Equitable Access to Fertility Care for Black Women Fertility care is necessary reproductive health care that helps individuals and couples have children or preserve their ability to have children in the future. But these services are often prohibitively expensive, and Black women, who are both more likely to experience infertility and have fewer financial resources,, face disproportionate banners to accessing this critical cane. Comprehensive fertility coverage, which reduces financial barriers and improves access to this necessary care, is critical for the advancement o f reproductive justice for Black women. Fertility Challenges for Black Women Black women experience disproportionately high rates of infertility. In the United States, non-Hispanic Black women are almost twice as likely as either Hispanic or non- Hispanic white women to experience infertility.' Black women have higher incidences of medical conditions that can cause infertility, such as uterine fibroids, 3 a condition that can increase infertility risk and contribute t o adverse pregnancy outcomes. Black women also experience higher rates of tubal factor infertility than white women. 3 Tubal factor infertility can be caused by a range of conditions, including pelvic inflammatory disease and endometriosis. 1 Pelvic inflammatory disease is more prevalent i n Black women/ and endometriosis i n Black women is commonly misdiagnosed as pelvic inflammatory disease and inadequately treated/ likely due to implicit and explicit racial and gender bias in health cane.’ Black women are also more likely to be exposed to environmental toxins that harm fertility, such as industrial pollutants and water contaminated with lead or endocrine-disrupting chemicals/ Access to fertility care is critical for Black women across varied identities and circumstances— including forcisgender and transgender Black women and those with or without partners. - Black women may require timely referral and treatment for infertility-related conditions like uterine fibroids/ - Black women may be unable t o achieve pregnancy with their partner and require fertility medications or treatments like i n vitro fertilization (IMF) or intrauterine insemination. ■ Black women i n LGBTQ+- couples or who are single may need to use donor eggs or sperm, donated embryos, or even work with a surrogate t o achieve pregnancy. • Fertility preservation services may b e needed to protect or save eggs, sperm, or other reproductive tissue, including before medical treatments that may cause a risk of impairment to fertility, such as gender affirming care or chemotherapy or radiation for cancer. 111 • 1150 I STREET N W SUITE 7 0 0 WASHINGTON, D C 20005

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    No matter who seeks fertility care, or their reasons behind it, every person deserves to access this necessary care without cost being a barrier. Comprehensive fertility care Insurance coverage reduces financial barriers to care, thereby Improving access for Black women and other under-resourced communities. FINANCIAL BARRIERS TO FERTILITY CARE Treatments for infertility can be incredibly expensive. • On average, a single cycle of I VF can cost between $15,000 and $30,000. o For many people, out-of-pocket costs extend beyond the actual treatment, including purchasing sperm or eggs, genetic testing, medications, transportation to appointments, and fees associated with mental health support, all of which can add tens of thousands to the total cost.” Fertility preservation services can also be very expensive. For example, freezing eggs can cost as much as $15,000 and an additional $500 per year for storage.” Exorbitant fertility care costs prevent many under-resourced people from getting the care they need. People with fewer financial resources—disproportionately Black women and other women of color, women with disabilities, immigrant women, and LGBTQI+ individuals 11 —are less likely to have comprehensive fertility coverage and are less likely to afford the high costs of fertility care. 11 Black women in particular face notable wealth and wage gaps due to racism and sexism in the labor market, 15 unaffordable and inaccessible housing, food, and childcare, 1 ' and other systemic and structural barriers such as inequitable education and wealth accumulation." The resulting stark income and resource inequities” compound harm to Black women who, as discussed, experience disproportionate rates of infertility. Fertility care providersand clinics are often concentrated in metropolitan areas, leaving Black women in the rural South with even fewer options to access this care. 30 Black women in the South face heightened economic inequities due to steeper wage gaps in many Southern states” and disproportionate levels of uninsurance. 11 Southern states, including Alabama, Arkansas, Louisiana, and Mississippi, have high shares of people who lack access to abortion care and other types of pregnancy care, or specific resources that affect maternal and infant health, like broadband internet or healthy foods. 4 Comprehensive fertility care insurance requirements are particularly important to increase equitable access. For some Black women insurance coverage of fertility care could mean the difference between prompt and quality fertility care or no care at all. For decades, lawmakers across the country have championed legislation aimed at addressing financial barriers to fertility care. Currently, “ states and Washington, D.C. have passed fertility insurance coverage laws, with some of these laws in place since the ™’s.“ Only Illinois, Maryland, Montana, New York, Oklahoma, Utah, and Washington, D.C. have laws relating to Medicaid coverage of infertility treatments and fertility preservation." * 1350 I STREET MW SUITE 7 0 0 WASHINGTON, D C 20005 ■ J SdU M H U • V.'.U " I ■■ 2

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