Women of all races and backgrounds struggle to become pregnant, but most infertility studies focus only on wealthy white or European women. Why? Because studies typically look only at women actively seeking treatment—which can cost tens of thousands of dollars—and most of these women happen to be white.
Research has shown that black women are less likely than white women to seek medical help for infertility, and thus, their struggles are often overlooked by both the media and academic community.
In a new study, however, researchers from the University of Michigan sought to begin to close the infertility race gap, so to speak, by conducting in-depth interviews with 50 black women about their past or present experiences with infertility. The women, aged 21 to 52 years, came from a diverse set of social and economic backgrounds. Twenty-eight had college degrees, 19 graduated from high school, and 3 did not graduate from high school. Thirty-six percent reported household incomes under $50,000 per year.
After interviewing the women, the researchers discovered several common themes faced by black women while dealing with infertility, including silence and isolation, feeling abnormal, feeling like less than a woman, and encountering lack of help from medical professionals.
Nearly every woman interviewed (96 percent) reported feeling isolated and lonely during their efforts to get pregnant, and many felt the need to take on the burden all by themselves—keeping friends and family in the dark. Their reasons for staying silent varied, but often, it boiled down to personal shame, as Stephanie, a woman trying to get pregnant for six years, said:
"I didn’t even tell my close friends. I didn’t even tell my mother, we were very close, or my sister. My sister’s a year younger than me. I didn’t even tell her." Adding "I hid it for so long … keeping it as a shameful secret."
The women also referenced cultural barriers, such as a stigma against talking about one's personal business or the expectation that black women should be strong and resilient enough to handle problems on their own. As Marlene, 32, described it:
"It was something I had to sort out within myself and deal with it. … I dealt with a lot of issues on my own."
Many women reported carrying the burden themselves, not wanting to bother partners or spouses. Lani, 37, had been trying to conceive for ten years, explaining that she rarely spoke with her partner about it:
"He didn’t really want to talk about it a lot. I guess ‘cause to him, he said if he kept talking about it or thinking about it, it would make him sad. The opposite of that was, I told him, that talking about it for me was comforting."
Lastly, many women stayed silent because they felt abnormal for not being able to get pregnant in a community stereotypically known for its fertility. Many felt infertility was something that happened to white rich people exclusively.
"Fueling the sense of isolation described by the women in our sample was the internalization of stereotypes about African American women’s hyper-fertility or belief in a Black fertility mandate, claiming that all Black women are invariably fertile," wrote the researchers.
For example, Eleanor, 46, explained: "I think they [Black women] have a problem with not having so many [babies], but not with getting pregnant." Samantha, 36, echoed this sentiment:
"I didn’t think there were that many African American women out there that were having this problem. I mean, you know, because nobody talks about it and you know, there’s nothing ever on the media about it. I mean, the media represents us as popping out babies left and right. You know, we’re welfare mothers, we’re this and that, you know, so I didn’t think there was a problem with us," Samantha said to the researchers during her interview.
Many women felt alone even while seeking treatment. Shelly, 30, who had been trying to conceive for over a year and a half, said she never saw similar faces in the waiting room, making her feel more isolated. "I felt alone out there, you know. And so with me, every time I went to the doctor’s office, I was like the only [black] one in there."
Across every race, women who deal with infertility often find themselves up against what the researchers call the "motherhood mandate," or the idea that every woman should have children—and those who cannot are somehow lesser women. Within the sample, 32 percent of the women interviewed struggled with this perception, feeling deeply ashamed for not being able to have a child. Tracy, who was 31 years old and had been trying to get pregnant for nine years, described it like this: "Emotionally, I felt that I was not complete, because I had not had a child. I didn’t feel like I was a complete woman."
Tracy wasn't alone—infertility left a huge dent in many women's sense of self-worth. Sue, a 36-year-old nurse, felt that getting pregnant should be a simple task, and not being able to pregnant meant she couldn't perform a basic feminine act:
"It does a lot to your self-esteem. That’s a hurt feeling, that you can’t do something, in my mind, as simple as have a baby. I mean, there are a lot of women that don’t have college degrees or a lot of women that don’t drive. There are a lot of women that can’t do math. Have a baby, I mean, that’s not a lot to ask."
But perhaps Effie, a 51-year-old college professor with a Ph.D., summed up these feelings of inadequacy best by explaining how not being able to have a child made her feel like a bad woman and a bad wife:
"I was not a good woman. Good women got pregnant," she said. "Good women, I married a Southern person, so there’s a lot of stuff wrapped up in this geographic regional difference thing. You didn’t ask questions. You did what you were told. And you certainly produced an heir, within the next year."
Part of why black women are less likely than white women to seek out fertility treatments is both a lack of resources and tense relationships with medical professionals. As the researchers explain, doctors act like gatekeepers when it comes to treatments. "Medical professionals control the implementation of policies dictating who will and will not receive medical assistance to conceive children."
For the women in the study who did undergo fertility treatments or seek medical help for their infertility issues, many felt that doctors didn't have a desire to help them, rarely gave them options, and in some cases, took control away from them completely.
Bethany, now 35 and married, shared a gut-wrenching story of how, when she was 21 years old, a doctor "tied her tubes" (performed tubal ligation) without fully explaining to her that that meant sterilization. Being young, she assumed they could easily be untied when she wanted children.
"I thought that when they say, 'tie your tubes,' I thought they just tied them or clamped them [so they could later be untied]. They never educated me. … I was starting to just can’t stand men. You know, they treat you so bad. Then, when I meet someone that’s nice and treats me good, then maybe I can go ahead and have the surgery and have it reversed, and we can have children."
Of course, it's not that easy. Bethany also reported speaking to a white woman, 25 years old at the time, who had seen the same doctor. According to the woman, the doctor had refused to preform a tubal ligation on her, even when she asked for the procedure, because she might meet a nice man and get married someday.
"When Bethany was sterilized, she was disadvantaged by several aspects of her identity, namely, her age, gender, race, and social class. In effect, she had limited social support, little access to educational resources or medical information, and relatively few life experiences to draw upon," write the researchers.
More than a quarter of the women interviewed said they had felt discriminated against by doctors, regardless of their socioeconomic status or education. As Mary, a 41-year-old health professional, pointed out, "I don’t think they [the doctors] had that concern for me as a Black woman trying to get pregnant." Effie, the college professor added, "You didn’t get to talk. You, the patient. You got to lie on the table, let them play with you," while describing her experience with doctors.
Black women are just as likely to face infertility or problems conceiving as white women, but their feelings and situation are often overlooked. From not fulfilling cultural expectations to facing discrimination while seeking medical treatment, many black women feel like no one cares if they can't have a child. As a result, they go through an already difficult process alone.
"For virtually all the women in our sample, silence emerged as a defining and painful feature of their experience; this was true irrespective of women’s income, education, and involvement with medical interventions," write the authors in the study.
"Similarly, endorsement of the motherhood mandate, equating being a woman with motherhood, occurred across income and educational levels, explaining, in part, why infertility impaired women’s sense of gender identity."
According to the authors, this study is the first of its kind to highlight the key issues faced by black women trying to conceive. They conclude that more should be done so these women do not feel alone, are educated about resources and treatments, and are given just as much help as women of other races.
"Care should be taken to display images of women from many different racial groups on educational and medical materials regarding infertility," they write. "Clinically, the importance of normalizing the experience of African American women who face infertility is paramount."
Taryn Hillin is Fusion's love and sex writer, with a large focus on the science of relationships. She also loves dogs, Bourbon barrel-aged beers and popcorn — not necessarily in that order.