Psychobiological, Clinical, and Sociocultural Factors that Influence Black Women to Seek, Initiate, and Complete Treatment for Infertility: A Mixed Methods Study

Abstract

Black women in the U.S. have twice the prevalence of infertility (14%) than non-Hispanic white women (7%) yet are twice as less likely to seek initial evaluation for infertility. Disparities in infertility treatment use among Black women are crucial to address in order to promote health and wellness in this population. Childbearing is a culturally central component of Black families and Black women with infertility experience notable alterations to their self and gender identity, high levels of isolation, silence, and negative medical experiences related to their fertility status. Despite these negative experiences among Black women, the literature fails to highlight reasons for lower uptake of infertility treatment beyond highlighting the sociodemographic characteristics of those who seek, initiate, and complete treatment as mainly affluent, highly educated, and older Non-Hispanic White women. Research on the health seeking process for Black women with infertility is scarce and provide incomplete understanding of their reproductive experiences. Since little is known about what factors influence the processes of seeking, initiating, and completing treatment for infertility for Black women, the purpose of this dissertation was to generate knowledge of the multi-dimensional influences that Black women may experience during the their journey to family building. The aim of this dissertation study was to understand the psychobiological, clinical, and sociocultural factors that influence Black women’s decisions to seek, initiate, and complete the recommended treatment plan for infertility within three different chapters. Chapter 2 reviewed the state of the science regarding the psychobiological, clinical, and sociocultural factors that influenced women in the U.S to seek treatment for their infertility symptoms and experiences. Chapter 3 analyzed and described psychobiological, clinical, and social data collected from a retrospective cohort chart review that examined 391 Black women who sought a reproductive endocrinology evaluation and determined what factors influenced initiation and completion of the recommended treatment plan for infertility. In, Chapter 4, quantitative data from Chapter 3 was merged with qualitative data from 13 semi-structured interviews in a convergent parallel mixed methods study to provide a comprehensive understanding of what psychobiological, clinical, and sociocultural experiences influenced Black women to seek and initiate treatment for infertility. Psychobiological, clinical, and sociocultural factors are associated with seeking, initiating, and completing infertility treatment among Black women. Multi-dimensional barriers across these domains influence the entire health seeking process for women causing delays in access, reduced uptake in treatment, and ultimate completion of treatment. Black women would benefit from future research that target modifiable factors by way of intervention development and policy modifications that increase safe, affordable, and culturally sensitive access to reproductive endocrinology services to reduce these disparities affecting Black women with infertility.