Friday, February 26, 2021

Solomon Center Hosts Panel on Racial Equity in Fertility Care

On February 22, 2021, the Solomon Center for Health Law and Policy, the Yale Health Law and Policy Society, and the Yale Black Law Students’ Association hosted the second event in their series exploring racial disparities in medicine — a panel discussion on racial equity in fertility care. This event was also co-sponsored by the Program for the Study of Reproductive Justice (PSRJ) and the Department of Obstetrics, Gynecology and Reproductive Sciences at Yale School of Medicine.

The panel, “Racial Equity in Fertility Care: Legal and Clinical Perspectives,” featured Dr. Tarun Jain, Associate Professor of Obstetrics and Gynecology at the Northwestern University Feinberg School of Medicine and Medical Director of Fertility & Reproductive Medicine-West Region; Professor Michele Bratcher Goodwin, Chancellor’s Professor of Law and founding director of the Center for Biotechnology and Global Health Policy at University of California, Irvine, and executive committee member of the American Civil Liberties Union; and Dr. Michael A. Thomas, Professor and Chair of Obstetrics & Gynecology at the University of Cincinnati College of Medicine and Vice President of the American Society for Reproductive Medicine.

Jain opened the event with his presentation, “Disparities in Fertility Care,” which included both a qualitative and an empirical analysis of disparities in both access to infertility care and in vitro fertilization (IVF) outcomes. Jain discussed the problematic ways in which health plans refuse to cover infertility care, often due to an incorrect belief that it is “not medically necessary.” He added that even the Affordable Care Act does not require coverage for IVF, setting the United States apart from many of its peers that do mandate such care, including Australia, France, Germany, and Belgium. Jain noted that the high cost of care, side effects, and risks all serve as barriers to access, particularly for people of color. Jain then presented evidence from various empirical studies to demonstrate quantitatively that people of color undergoing IVF have significantly lower live birth rates than their white peers. Jain concluded his presentation by noting that more research needs to be done and action needs to be taken to correct these disparities.

Goodwin then traced the fraught history of social and legal attitudes towards fertility in the U.S. She began by emphasizing that slavery entailed kidnapping, trafficking, and sexually assaulting women of color. This provided the context for early matriliny and hypodescent laws as well as for the broader ways in which institutions exploited the bodies of women of color through the capitalism of slavery, she said. Goodwin explained that this meant “establishing systems where you have very limited, if any, control over your bodies, and we know, none, if you happened to be a black woman.” She then discussed the sanctioning of eugenics laws by Justice Oliver Wendell Holmes in the 1920s, touching on the forced sterilization of women of color as young as ten or eleven years old in Virginia. Goodwin closed by highlighting the ways in which the development of the field of obstetrics and gynecology around the Civil War shifted control of the practice from women to men. She noted that there was a prevailing attitude following the Civil War that white women should “spread their loins” so as to stave off fears of increased diversity in the U.S. She emphasized that this history is critical to understanding modern issues of racial equity in fertility care and how they came to be.

Finally, Thomas closed out the presentations by providing an overview of the findings and recommendations of the American Society for Reproductive Medicine’s Diversity, Equity, and Inclusion (DEI) Taskforce. Thomas laid out the two charges of the taskforce: 1.) enhancing opportunities to increase and support diversity and equity, and the inclusion of underrepresented minority populations, in the profession and leadership of reproductive medicine and 2.) reducing and eventually eliminating health disparities in access and outcomes to reproductive care. He also highlighted the DEI Taskforce recommendations — including promoting inclusive terminology, addressing stigma, advocating for inclusive education, and more. Thomas concluded by discussing the various barriers that people of color may face in seeking fertility care, including high prices, inaccessibility, delays in care, and implicit bias.

The panel then opened up to questions from the audience and dived further into issues of access, agency, intersectionality, the importance of terminology, and the need for federal mandates to ensure equitable access to fertility care.

This series will continue with a panel on the Black Lives Matter movement and health activism in New Haven. Please check back on the Solomon Center website for more details.