Cultural factors contributing to health care disparities among patients with infertility in Midwestern United States

Objective: To identify cultural differences in access to infertility care. Design: Cross-sectional, self-administered survey. Setting: University hospital-based fertility center. Patient(s): Thirteen hundred fifty consecutive women who were seen for infertility care. Intervention(s): None. Main Outcome Measure(s): Details about demographic characteristics, health care access, and treatment opinions based on patient race or ethnicity. Result(s): The median age of participants was 35 years; 41% were white, 28% African American, 18% Hispanic, and 7% Asian. Compared with white women, African American and Hispanic women had been attempting to conceive for 1.5 years longer. They also found it more difficult to get an appointment, to take time off from work, and to pay for treatment. Forty-nine percent of respondents were concerned about the stigma of infertility, 46% about conceiving multiples, and 40% about financial costs. Disappointing one's spouse was of greater concern to African-American women, whereas avoiding the stigmatization of infertility was of greatest concern to Asian-American women. Conclusion(s): While the demand for infertility treatment increases in the United States, attention to cultural barriers to care and cultural meanings attributed to infertility should be addressed. Enhanced cultural competencies of the health care system need to be employed if equal access is to be realized as equal utilization for women of color seeking infertility care.