ASRM Today: Industry Sponsored Episode: Importance of Equity in Fertility Care & FertilityEquity™ Module Launch

In this episode of ASRM Today, host Jeffrey Hayes discusses inequities in fertility care, particularly for Black women, with guests Lasha Clarke, Gloria Richard-Davis, and Michael Thomas. They explore barriers faced by Black women, including provider bias and delayed referrals, and introduce a new e-learning module aimed at supporting equitable fertility care. The conversation highlights the need for culturally responsive care and comprehensive reproductive health education. The project is supported by ASRM, Ferring, and Engaged MD.

Welcome to ASRM Today, a podcast that takes a deeper dive into the current topics in reproductive medicine. I'm Jeffrey Hayes, and today on the show, we're talking about the importance of equity and fertility care and fertility equity module launch. Joining me in this discussion is Lasha Clarke, Gloria Richard-Davis, and Michael Thomas.

Everyone, welcome to ASRM Today. Thank you. Thanks, Jeff.

Great to be here. I'll open with a general question, and I'll let whoever wants to jump in first to answer it. Inequities in healthcare have long been an issue faced by underrepresented communities.

We see current day examples, such as the maternal mortality crisis in the U.S., and we're also seeing inequities in fertility care. What are the challenges that underrepresented communities are facing when seeking fertility care? I think the trends, when we look at care for women of color, we hear a lot of the same, right? The barriers that exist, that they don't feel like they're seen, that they're heard, and that they are included, right, in our healthcare landscape. We're not really paying attention to the needs.

And so, that really creates a barrier to entry, because they're hesitant to come into care, and we see that in their delay of seeking care. But in addition to that, once they're in our care realm, they tend to discontinue at greater rates, not necessarily advance through treatment, you know, they'll quit. And so, it's important for us, and that was the emphasis of this project, is really to understand what some of those barriers are, and how we can mitigate against them.

I know one of the things that has been shown in research, and one of the things that I've talked about when I've talked around the country, is the fact that, you know, there are a number of multiple barriers that people of color, particularly women of color, have that some don't. And a lot, sometimes, we talk about the fact that they're not taken seriously when it comes to their fertility journey, or the start of their fertility journey, because a number of their OBGYNs, just the general OBGYNs, because to get to the fertility clinics, or the fertility provider, you have to go through your OBGYN, usually. So because of that, the OBGYN has to take this person who presents with them, presents to them with a problem, seriously.

And unfortunately, what we found, and a number of research studies have found, that women of color tend to go to the fertility expert later, because there may be this preconceived notion by the general OBGYN that, oh, they're black, I just passed a bunch of black kids as I was driving here, therefore, black people don't have a fertility problem, therefore, I don't need to send them now, they just need to keep trying. And that keep trying can go on from age 30 to age 35 to age 37. And unfortunately, the data clearly shows that even if you have fertility coverage, the referral to an expert who could get you there sooner does not occur much later in their lives.

And but then there's also the barriers that women of color may have on their own, whether it's themselves or their partners, whether it's a cultural stigma, whether it's a religious stigma, there are other things that they may perceive, or their family members may put up a barrier to them and say things to them, because you don't need to do this, you don't need to do that. So I think that those things are there. And those are truly things that won't allow our patients of color to come see us sooner.

And piggybacking off of that, so we've been running the fertility equity study at Morehouse School of Medicine for a few years now. And in the qualitative data, the interview data that we've collected, a major refrain is, I don't know what I don't know. So we have all of these Black women who, until they get to the point where they've been struggling with infertility for a number of years now, didn't even realize that infertility was something that they could struggle with.

So they weren't equipped with the knowledge that they needed to ask the right questions earlier on in their reproductive health life course, and then to get the information that they would need to step in front of and be proactive about many of the issues that they're experiencing later in life. And so we need not only our OBGYNs and primary care physicians to help educate people, really, not just women, not just men, all people about our reproductive health. We need that to happen even earlier in life.

We're getting sex ed, sex ed maybe needs to be a little bit more comprehensive and include really just education on our bodies. How do our bodies work? How complicated is conception? And carrying a pregnancy to term are things that maybe we all deserve to understand. And it's a basic knowledge level so that we're equipped with that information that can really help us make informed decisions as we're getting older.

So then based on the data, are women of color the most impacted community? I don't know that I would say they're the most impacted community. However, the data definitely do show that there are racial disparities in infertility diagnosis, treatment and outcomes. And so some data do suggest to kind of put some some numbers or some quantification around it.

Data do suggest that Black women are twice as likely to report fertility as compared to white women, but half as likely to present for care. We don't have as much data, but really across the chiasm of women's health, what we know is that the data has been fairly consistent for women of color, right, that there's been these barriers, that there's been worse outcomes, whether it's health outcomes or whether it's pregnancy outcomes. Right.

So that much we can reassure is an issue. And when you think about the problem, the complexity of it, I mean, what you're hearing is there there's the patient side barriers, there's the provider side barriers, and then there's the community. Right.

And all of those things are adding to the delay in care and worsening the outcome, because what we know about fertility is age is critical in terms of the prognosis. And the later they come into care, the lower their success rates. Lasha, I want to turn back to you for a moment.

Can you tell us more about the abstract that you presented here at ASRM and how that research informed the development of a new initiative? Absolutely. So the abstract I presented earlier today at ASRM was around designing culturally responsive solutions. And we're talking about Black women's experiences.

And so we did this study that I mentioned called our Fertility Equity Study, really wanting to understand in Black women's own voices, what is your experience navigating your fertility and infertility? And we did that because, one, those lived experiences are hugely important to center and amplify. And two, if we listen to people, we end up really oftentimes getting a lot of the information that we need for our next steps. And we can put our resources behind making the things that they know from their experience they need happen.

And so that's really what these fertility equity e-learning modules are. We heard from so many of our participants that they need more support, whether that's from their clinicians, clinical staff, their families, their friends, their partners. They need more support along this journey because on top of the physiological challenges that they're finding that they have, they also are compounded or those are also compounded by these psychosocial challenges.

There's a mental health burden here. There's grief, there's loss, there's isolation. So many factors that really go along with this journey that are sometimes beyond what might be happening in that clinical setting and in the clinical appointment.

And so we wanted to create these modules based on what our women said that they needed, which is more support from, in this case, their clinicians and the clinical staff around this journey. And what many women said was that in many instances, their clinical teams don't understand the unique needs of Black families and Black patients who are coming to them. And so in these modules, that's really what we're providing.

And we're providing that socio-historical, socio-contextual context for why is this the experience for Black women? How does this kind of how does our history here in the United States present these present day problems that we're going through? How do things like implicit bias, medical racism, obstetric racism come to bear in our lives such that and in such a way that our medical teams really need to understand our experiences? And additionally, what those modules also do is provide strategies and really clear steps for how our clinical teams can create more inclusive and equitable clinical environments for their patients. Well, that's why things like this are just so important, what she talked about as far as the module is concerned, you know, ASRM working with our partner Faring and trying to come up with ways to make sure that patients understand and also to make sure that our providers understand what needs to be done in this patient population. But that also goes to some of the work that Dr. Gloria Richard-Davis is doing and that ASRM has done early on when it comes to the DI task force and even finding the thoughts that we need more providers of color who can also understand the community.

The patients will feel more comfortable in talking to those folks. So trying to come up with programs that will increase the chances that patients will be able to see someone that they can talk to, they feel comfortable with, along with also providing them with the education. And I do think it's also important to raise the issue of provider bias, right? I mean, as a black female REI, I was still astounded at the data and my own bias.

When we talk about black women and barriers to entering fertility care, some of the things that our team highlighted is most of the women, probably 77 percent of our women were college educated, had terminal degrees, their salary was over $110,000, right? So they're not lower socioeconomic women, but yet their experience is the same. And so we come into this realm with certain biases, as Dr. Thomas talked about, the bias and the profile or the belief that black women are hyperfertile. All of those things contribute to the issues that we're dealing with now.

If you're interested on more information about the Fertility Equity eLearning module, you can go to resources.engagedmd.com backslash fertility-equity. We will, of course, put that link in our show notes so that people can easily just scroll down and click on that. Thank you all so much for your time today.

I know we're recording here at ASRM 2024 and everybody is very busy. I really appreciate everyone taking time out of their schedule to be with us today. Thank you.

Thank you, Jeff. And I do want to just make sure we underscore we've been talking about providers, but we really are talking about the entire realm of care. So the entire fertility team can benefit from this.

And I also want to make sure that we thank not only ASRM, the providers that do this work, but also Ferring, who are helping us, allowing us to do this and understanding the focus that needs to take place on women of color. Absolutely. I'll echo that.

We're so proud at Morehouse School of Medicine Center for Maternal Health Equity to have been supported by Ferring in this work and to have also been supported by Engaged MD, who's powering the platform that these modules are on. So thank you to those teams. It's awesome.

Check it out. It's awesome. Check it out.

You heard it here. Until next time, I'm Jeffrey Hayes. And this is ASRM Today.

This concludes this episode of ASRM Today. For show notes, author information and discussions, go to ASRMToday.org. This material is copyrighted by the American Society for Reproductive Medicine and may not be reproduced or used without express consent from ASRM. ASRM Today series podcasts are supported in part by the ASRM Corporate Member Council.

The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and its affiliates. These are provided as a source of general information and are not a substitute for consultation with a physician.