Economic and racial differences in women's infertility experiences

Riegle, Adrienne
Major Professor
Susan D. Stewart
Committee Member
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Infertility has been identified as a highly significant social issue and a public health priority. However, those experiencing infertility are typically thought of and portrayed by the media as middle-class White women and couples seeking medical treatment. In fact, the majority of social science literature regarding infertility has focused on this same population while demographic differences in infertility experiences, particularly by economic status and race, have not been the subject of comprehensive study.

Guided by the concepts of stratified reproduction, intersectionality, and an infertility helpseeking framework, this dissertation examined the relationships between economic status, race/ethnicity, and four types of infertility experiences using nationally representative cross-sectional data from the National Survey of Fertility Barriers. The sample is drawn from women who meet the medical definition of infertility of having regular, unprotected sex for twelve months or more without conceiving (N = 2,443). The literature suggests that infertility may be experienced differently by marginalized groups as they are embedded in classist and racist contexts and that being non-White, with access to fewer economic resources, may have multiplicative effects on women's infertility experiences, both medical and non-medical.

Results indicate that the demographic picture of infertility includes women of all economic statuses and race/ethnicities at similar levels. Furthermore, there are significant relationships between economic status, race/ethnicity, and women's infertility experiences. Joint effects explain fewer differences in experiences than an index of economic status indicators (income/poverty status, insurance status, receipt of public assistance, and economic hardship). Controlling for various life course, fertility history, and certain predisposing and enabling conditions reduces the differences in infertility experiences between Whites, Blacks, and Hispanics.

Multivariate results suggested that neither economic status nor its joint effects with race were significantly associated with fertility salience (the thoughts, feelings, and plans infertile women have about having children). However, analyses indicated significant racial differences in certainty of pregnancy intent, importance of motherhood (both higher among Whites) and messages from parents (higher among Blacks and Hispanics than Whites). Economic status explained greater differences in self-perception of infertility and the propensity for medicalized infertility experiences (both outcomes were positively associated with economic status) than did race, with the exception that infertile White women were significantly more likely to think of themselves as having trouble getting pregnant than infertile Black and Hispanic women. Results indicated no significant joint effects of economic status and race on self-perception and level of medicalized infertility help (i.e. talking with a doctor, testing, and treatment). Finally, no significant economic or racial differences in childlessness distress were found. However, analysis indicated support for hypothesized joint effects in that positive association between economic status and childlessness distress is weaker among White women than among Black women. This final result should be interpreted with caution, however, as this subsample was limited to 295 childless women.

This research has important implications for both extending the notion of stratified reproduction as well as broadening our understanding of the demography of infertility. The present findings are useful for both the social sciences/public health and the medical and helping professions focused on addressing unmet needs across the infertile population.