Demographic analysis of a low resource, socioculturally diverse urban community presenting for infertility care in a United States public hospital

Abstract

BackgroundInfertility is a prevalent disease of reproductive health that exerts an impact on an estimated 80 million people worldwide. For many, involuntary childlessness becomes a central and preoccupying issue in their lives, the impact of which is exacerbated by lack of access to basic care and treatment. These effects maybe further magnified among immigrant communities, a growing but highly marginalized population that has been shown in other areas of reproductive health to experience worse health outcomes and delays in access to care. To date, few studies have examined the unique medical and sociocultural considerations of infertility among immigrant populations in the United States.MethodsOur study is a cross-sectional analysis of women presenting for infertility evaluation at a county hospital serving a low resource, socioculturally diverse largely immigrant communities in comparison to infertile women from a largely affluent population presenting to a high resource, comprehensive fertility center. We employed surveys to evaluate demographics and socioeconomic parameters as well as abstracted data from medical records to obtain infertility diagnoses. Multivariate regression analysis was applied to examine impact of sociocultural factors as predictors of duration of untreated infertility disease burden experienced by patients.ResultsEighty-seven women were included in our analysis. In the county hospital/low resource clinic (LR), the mean age was 32.9 ± 4.9 vs 36.4 ± 6.3 years in the fee-for-service/high resource clinic (HR). The mean reported duration of infertility in LR and HR patients was 3.4 ± 3.0 vs 2.3 ± 1.5 years. 70% of LR patients were monolingual non-English speakers vs 5.4% of HR patients. 59% of LR patients reported an annual household income of less than $25,000 and 70% did not have a college degree. 81.1% of HR patients reported an income of higher than $100,000, and 81.1% had completed college or graduate school. The most common infertility diagnosis in the LR was anovulation (38%) and tubal factor (28%) compared to diminished ovarian reserve (37.8%) and male factor (51.4%) in the HR. After controlling for age at the initiation of pregnancy attempt, lower education level, lower income, and immigrant status were significantly correlated with a longer duration of infertility.ConclusionsWomen presenting for infertility care to a low resource county medical center represent immigrant communities and are generally of younger age, but with a longer duration of infertility. This study identifies lower educational level, income, and immigrant status as barriers in access to care.Electronic supplementary materialThe online version of this article (doi:10.1186/s40834-017-0044-7) contains supplementary material, which is available to authorized users.

Disparities in fertility knowledge among women from low and high resource settings presenting for fertility care in two United States metropolitan centers

“…Similar barriers to care were identified in a study of clinical vignettes of immigrant women presenting for care to a public hospital in Boston, Massachusetts [27]. Additionally, Ho et al in a study of patients at SFGH found that level of education and socioeconomic status was inversely proportionate to duration of infertility [28]. Recently, Wiltshire et al assessed infertility knowledge and treatment beliefs among African American women from an urban community in Atlanta, Georgia using a field-tested survey from the International Fertility Decision Making Study [29].…”

The Influence of Diet on Fertility and the Implications for Public Health Nutrition in the United States

“…In the U.S., women with lower income or lower educational attainment experience a higher prevalence of infertility outcomes compared to those with higher income or educational attainment, while Hispanic and non-Hispanic Black women have a higher prevalence of infertility compared to non-Hispanic white women ( 1 , 39 ). The disparity in fertility rates may partially be explained by nutritional intake, as recent data from a large cohort ( n = 7,511) of nulliparous women showed that in the months prior to conception, women with lower educational attainment or who were Hispanic or non-Hispanic Black, had a poorer general diet than women with higher educational attainment or who were non-Hispanic White ( 40 ).…”

Infertility in Muslim Refugees: A Review of the Literature

“…Fifteen states (Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia) have "infertility insurance laws" that require insurance companies to either offer or cover infertility treatment [5,16]. However, these mandates vary widely by state, and coverage often does not include ART [1]. Refugee Medical Assistance, which provides health care coverage for a maximum of eight months, does not provide any infertility coverage [5].…”

“…Infertility, defined as the inability to conceive after at least one year of regular unprotected sexual intercourse, affects approximately 70-80 million couples worldwide [1,2]. Infertile couples face a variety of psychological and social consequences, and for refugee populations the distress of infertility may be exacerbated by stressful life circumstances, the cultural importance of childbearing, and multiple barriers to treatment [3][4][5].…”