Investigating Socioeconomic Disparities in Patient Experiences of Infertility in the US

Abstract

Infertility is a common problem in the US, affecting approximately 1 in 8 couples of childbearing age, or over 7 million women nationwide. But while infertility affects women from across the socio-economic spectrum, it is by no means egalitarian in its distribution, nor uniform in its lived experience. Rather, evidence shows significant disparities by race, income, and educational status, in terms of overall prevalence of infertility, drivers and underlying causes of infertility, access to infertility services, and success rates after receiving infertility treatments.

This dissertation seeks to examine some of the specific mechanisms and pathways by which these disparities arise and persist. First, I report findings from a document review of online reproductive health materials, concluding that information about the risks of infertility is differently available and targeted to different sectors of the population. This can lead to disadvantaged women having less information about strategies to prevent infertility, as well as being less likely to have symptoms of an infertility-causing condition diagnosed and treated in a timely way. The second paper builds upon and extends these hypotheses, investigating through key informant interviews how such targeted provision of infertility information comes to affect lived patient experiences of infertility. Finally, the third paper examines disparities in the way patients find and receive social support during an infertility journey. It undertakes a “cyber-ethnography” of an online infertility patient forum, examining how the forum’s discourse produces dominant and counter narratives of infertility, and enforces categories of belonging that impact how support is offered to users of the site.