Equitable Access to Fertility Care for Black Women

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N A T I O N A LW O M E N ' SL A W C E N T E R\ Partnership for Southern Equity•TOGETHER W£ PJtOSPEkAPRIL 2 0 2 5IFACT SHEETThe Importance of Equitable Accessto Fertility Care for Black WomenFertility care is necessary reproductive health care that helps individuals and couples have childrenorpreserve their ability to have children in the future. But these services are often prohibitively expensive, andBlack women, who are both more likely to experience infertility and have fewer financial resources,, facedisproportionate banners to accessing this critical cane. Comprehensive fertility coverage, which reducesfinancial barriers and improves access to this necessary care, is critical for the advancement o f reproductivejustice for Black women.Fertility Challenges for Black WomenBlack women experience disproportionately high rates of infertility.In the United States, non-Hispanic Black women are almosttwice aslikelyas either Hispanic or non-Hispanic white women to experience infertility.' Black women have higher incidences of medicalconditions that can cause infertility, such as uterine fibroids,3a condition that can increase infertility riskand contribute t o adverse pregnancy outcomes. Black women also experience higher rates of tubal factorinfertility than white women.3Tubal factor infertility can be caused by a range of conditions, includingpelvic inflammatory disease and endometriosis.1Pelvic inflammatory disease is more prevalent i n Blackwomen/ and endometriosis i n Black women is commonly misdiagnosed as pelvic inflammatory diseaseand inadequately treated/ likely due to implicit and explicit racial and gender bias in health cane.’ Blackwomen are also more likely to be exposed to environmental toxins that harm fertility, such as industrialpollutants and water contaminated with lead or endocrine-disrupting chemicals/Access to fertility care is critical for Black women across varied identities andcircumstances—including forcisgender and transgender Black women and those with orwithout partners.-Black women may require timely referral and treatment for infertility-related conditions like uterinefibroids/-Black women may be unable t o achieve pregnancy with their partner and require fertilitymedications 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, donatedembryos, 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 reproductivetissue, including before medical treatments that may cause a risk of impairment to fertility, such asgender affirming care or chemotherapy or radiation for cancer.111•1150 I STREET N WSUITE 7 0 0WASHINGTON, 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 withoutcost being a barrier.Comprehensivefertility care Insurancecoverage reduces financial barriers to care, therebyImproving accessfor Black womenand other under-resourcedcommunities.FINANCIAL BARRIERSTO FERTILITY CARETreatments for infertility can be incredibly expensive.•On average,a single cycle of I VFcancost between $15,000 and $30,000.oFor many people, out-of-pocket costs extend beyond the actual treatment, includingpurchasing sperm or eggs, genetic testing, medications, transportation to appointments, andfees associated with mental health support, all of which can add tens of thousands to the totalcost.”Fertility preservation services can also be very expensive. For example, freezing eggs cancost asmuchas $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 fewerfinancial resources—disproportionately Black women and other women of color, women with disabilities, immigrantwomen, and LGBTQI+individuals11—are less likely to have comprehensive fertility coverage and are less likely to afford thehigh costs of fertility care.11Black women in particular face notable wealth and wage gaps due to racism and sexism in thelabor market,15unaffordable and inaccessible housing, food, and childcare,1' and other systemic and structural barriers suchas inequitable education and wealth accumulation." The resulting stark income and resource inequities” compound harmto Black women who, as discussed, experience disproportionate rates of infertility.Fertility care providersand clinics are often concentratedin metropolitan areas,leaving Blackwomen in the rural South with even fewer options to accessthis care.30Black women in the South face heightened economic inequities due to steeper wage gapsinmany Southern states”and disproportionatelevelsof uninsurance.11Southern states, including Alabama, Arkansas, Louisiana,and Mississippi,have highsharesofpeople who lack accessto abortion care and other types of pregnancy care, or specific resourcesthat affect maternaland infant health, like broadband internet or healthyfoods.4Comprehensive fertility care insurance requirements are particularly important to increase equitable access. For some Blackwomen insurance coverage of fertility care could mean the difference between prompt and quality fertility care or no careat all. For decades, lawmakers across the country have championed legislation aimed at addressing financial barriers tofertility care. Currently, “ states and Washington, D.C. have passed fertility insurance coverage laws, with some of theselaws in place since the ™’s.“ Only Illinois, Maryland, Montana, New York, Oklahoma, Utah, and Washington, D.C. have lawsrelating to Medicaid coverage of infertility treatments and fertility preservation."*1350 I STREET MWSUITE 7 0 0WASHINGTON, D C 20005■J SdU M H U•V.'.U" I■■2

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