Black women are being failed by fertility treatment — I’m not surprised

Black fertility patients have the lowest birth rates of all ethnic groups, new data has found, among other startling racial disparities in fertility care.

The findings, which were published today in a damning report by the UK’s fertility regulator the Human Fertilisation and Embryology Authority (HFEA), found fertility treatment outcomes varied widely for Black, Asian and ethnic background patients compared to white patients.

The average IVF birth rate per embryo transferred has increased across all ethnic groups, however Black and Asian patients aged 18-37 had the lowest birth rates at 23% and 24% respectively, compared to white patients (32%) between 2020 and 2021.

Single Black and Asian patients are also accessing fertility treatment far later than their white counterparts, which can have a huge impact on success rates. The study shows that these women started fertility treatment at 38-39 years of age, compared to 36.2 years for white single patients.

And the report nods to other disparities in access. The majority (77%) of IVF patients are white, while Asian patients make up 15% and Black patients account for just 3%. (The latest ONS data found 4.2% of the overall population identify as Black while 3% identify as ‘mixed or multiple ethnic’.)

Worryingly, Black mothers who did conceive via fertility treatment were also the most likely to have multiple births (twins, triplets or more), which carry a higher risk of complications for both mother and baby.

Vanessa Haye, a 36-year-old from the East Midlands who campaigns for better healthcare for women of colour, says she’s sadly ‘not surprised’ by the findings.

The writer and reproductive health advocate felt she personally faced barriers related to being a Black woman trying to access fertility treatment.

Vanessa had two cycles of IVF when she was 29 in 2016 and 2017. The first round resulted in a miscarriage, but she gave birth to her son after the second cycle. She now has two children and two angel babies.

‘Assisted conception isn’t typically marketed to appeal to ethnic minority groups,’ she tells Metro.co.uk.

‘Outside of femtech startups, clinics for example very much seemed to convey the message that IVF is for white families, hence subconsciously projecting an image for one type of group. This then feeds into how marketing and information can inform health-seeking behaviours in different ethnic minority groups.’

The mum points to separate data showing that Black mothers are more likely to die from childbirth and have a 43% higher chance of miscarriage, as per a report by baby loss charity Tommy’s.

The latest findings, published in the Ethnic Diversity in Fertility Treatment 2021 report, show Black patients continue to have the highest rates of multiple births at 9%, compared to 7% for white patients in 2017-21.

‘Black women are already more at risk during pregnancy and having multiple pregnancies may exacerbate this,’ says Vanessa.

Crucially, Black, Asian and other ethnic minority patients need investment into research about why they’re experiencing fewer births overall yet more multiples, as the current data on the topic is inconclusive.

‘We need more context on what’s causing the high multiple births,’ Vanessa says.

‘Is it a choice Black women are making to transfer more than one embryo when undergoing IVF? Or is it that Black women are more likely to have a failed initial cycle and therefore advised to transfer two embryos in the hope of a subsequent successful cycle? There’s a lot to unpack here.’

In an attempt to improve outcomes, the HFEA has established the Multiple Births Stakeholder Group and launched the One at a Time campaign based on the recommendation that transferring one embryo is better to ensure a safer birth. 

The HFEA, the Royal College of Obstetricians and Gynecologists and the British Fertility Society and Fertility Network UK have called for action to ensure Black, Asian and ethnic minority patients and their partners have adequate access to fertility treatment. 

Professor Geeta Nargund, member of the Human Fertilisation and Embryology Authority, added: ‘There is no room for the health inequalities that exist within fertility treatment.

‘It shows that there is a need for meaningful changes so that Black, Asian and ethnic minority fertility patients and their partners are not left behind in access to and experience of fertility treatment.’

But what would ‘meaningful change’ actually look like?

Vanessa says there’s no one solution – this is a complex issue that deserves a multi-layered approach.

‘Black women are not a monolith,’ she says, ‘So it’s not an easy thing to fix unless we start by understanding the intersectional challenges they face and how that informs Black women’s health seeking behaviours.’

For some Black women, attitudes towards IVF or IUI may be influenced through the lens of gender roles and religion, she says.

‘The implications of seeking treatment to achieve pregnancy may not be an easy decision [if] a women believes that motherhood can only be achieved through God’s blessing, and anything outside of that is seen to be “playing” with God’s will,’ she says.

‘On the other hand this low uptake can be attributed to medical establishments and the role of gaslighting and stereotyping. Perhaps Black women are not being referred or taken seriously when reporting fertility issues due to being perceived as being hyperfertile.’

Clearly, there’s a lot of work still needed.

MORE : The truth about infertility, egg freezing and Black women

MORE : Black and Asian mothers face ‘deep inequalities’ in postnatal mental healthcare

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