The Hidden Problem of Infertility In The African American Community
Infertility affects 1 in 6 couples seeking a pregnancy. The causes of infertility for these couples are numerous and are distributed evenly between male and female factors. Approximately 6.2 million women between the ages of 15 and 44 are diagnosed as being infertile. In 1995, the National Survey of Family Growth (NSFG) examined trends in proportions and numbers of women with impaired fecundity and those who received infertility services using data from 1982, 1988, and 1995. The study revealed a dramatic increase in the numbers of women who sought medical treatment. Of women facing infertility, 44% will seek some intervention; however, among African American women only 31% will seek treatment for this problem.
One of the most common causes for infertility in women is Pelvic Inflammatory disease (PID). The National Institute of Health indicates that women with sexually transmitted diseases (STD's) are at greater risk of developing PID. According to the Center for Disease Control (1998), half of the ten most frequently reported infections are sexually transmitted diseases, including the most common, Chlamydia (CDC, 1998) all of these STD's are associated with the complication of infertility. Most women with tubal infertility have never had symptoms of PID. Organisms such as Chlamydia trachomatis can silently invade the fallopian tube and cause scarring, which blocks the normal passage of eggs into the uterus (NIH 1999). Due to the lack of symptoms, many women frequently do not seek treatment. Those challenged with lower socioeconomic status often lack access to information, insurance and preventive health care. According to the National Institute of Allergy and Infectious Diseases, PID has also been classified as the leading cause of pregnancy loss in African American women (NIAID,1999). Annals of Internal Medicine (1998) reports that of women who get Chlamydia, 30% will get PID and of that group, 12% will end up with a problem in infertility. The United States Public Health Service's Office of Women's Health indicates that prevalence rates for African American women are significantly higher, (nearly two to three times) than for Caucasian women (1999). Conjointly, African American women are nearly three times more likely than Caucasian women to be hospitalized with acute PID and two times as likely to be hospitalized with chronic PID (DHHS, Office on Women's Health, March 1999).
The Endometriosis Association suggests that endometriosis, which is symptomatically characterized by pelvic pain, dysmenorrhea, infertility, and abnormal vaginal bleeding, has often been erroneously diagnosed in African American women as PID due to racial bias in medical textbooks that suggest they are more sexually active and promiscuous and therefore more likely to get a sexually transmitted disease (1999). Further, according to one study found by the American Journal of Obstetrics and Gynecology, 40% of the African American women who were told they had PID in reality had endometriosis (1976). Endometriosis is a chronic condition that has reproductive and health consequences.
Another frequent finding in African American women are uterine anomalies such as fibroids. According to an article written by Essence (Jan 1994) a startling 50 to 75 percent of all African American women are affected with fibroid tumors. Fibroids generally occur in women of reproductive age. They are two to three times more common in African American women than in Caucasian women. For black women the risk of developing fibroids is 50 percent compared to 33 percent chance for white women (DHHS, National Women's Health Information Center, 1999).
An additional consideration in our focus on infertility in African American women is the issue of wellness and quality of life. For example, some symptoms associated with fibroids, endometriosis and other STD's are chronic pelvic pain, back pain, dysmenorrhea, intermittent bleeding and/or persistent bleeding. Remarkably, many of the aforementioned diagnosis' that lead to infertility have been documented to be prevalent in the African American Women (NIH, DHHS, CDC, NIAID,1999).
PUBLIC AWARENESS More than many issues in the field of health within the African American Community, the issue of infertility has been least considered, researched, or even discussed among professionals within the health care community. The National Family Growth Survey, however, does indicate that Black women had lower odds than whites of reporting that they had ever sought medical help for the problems associated with infertility (1998). This pnenomenon is most likely associated with hesitancy to seek early diagnosis and treatment (Ebony, 1995), the lack of trust due to inherent racism in the health care system, and gaps in available resources and information regarding the condition of infertility.
Vanessa Northingham-Gamble, MD, Ph.D. indicates that African Americans' beliefs that their lives are devalued by white society also influence their relationships with the medical profession. (American Journal of Public Health, Nov, 1997). Dr. Northingham-Gamble sites a national telephone survey that revealed that African Americans were more likely than Whites to report that their physicians did not inquire sufficiently about their pain, did not tell them how long it would take for prescribed medicine to work, did not explain the seriouseness of their illness or injury, and did not discuss test and examination findings (American Journal of Public Health, Nov, 1997).
In addition, to the inherent institutionalized racism within the medical community, the Amercian culture portrays women of color as stoic, earth mamas, and baby making welfare queens (Kashef, Essence, 1995). This myth has bombarded our society with sterotypic information, infuencing perceptions of women of color. Despite this myth, one out of ten women will face fertility problems (Kashef, Essence, 1995). According to a study done for Ferre Institute by the College of New Jersey in 1999, men often equate fertility with potency. This perception of male virility often contributes to the persistence of the couple's infertlity due to the male's unwillingness to participate in the diagnostic process. These misperceptions perpetuate the probem and lead to a lack of information regarding fertility issues concerning this population.
The Office of Population Affairs (OPA) administer Title X for the Public Health Service Act (PHSA) grants to fund comprehensive family planning and reproductive health services (contraceptive services and supplies, basic gynecological care, cancer and general medical screening, education, counseling, referral, and infertility services) through various clinics. According to the United States Public Health Service's Coordinating Committee on Women's Health, eighty five percent of the women served by Title X clinics are members of low income families. The patients who use Title X funded family planning clinics are disproportionately women of color. Thirty eight percent of Title X patients are either African American or Hispanic (DHHS, 1999). For many of these women, Title X clinics are their primary and often sole source of reproductive health care and information.
