Disparities in Seeking and Receiving Fertility Counseling and Treatment Open Access

Chin, Helen Belinda (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/2801pg55p?locale=en


In the United States an estimated 6 million women have impaired fecundity. The inability to have a baby affects the quality of life of women who desire children. Further, infertility is a disease of the reproductive system. Fertility counseling, preservation, and treatment can help some women who cannot conceive naturally to have a child; however, there is sometimes disparate access to this type of care. This dissertation examined disparities in seeking and receiving fertility counseling and treatment among participants of the FUCHSIA Women's Study, a population-based cohort study of reproductive-age women. In study one, we assessed the persistence of a black white racial disparity after accounting for intermediate variables of the association between race and seeking medical help for becoming pregnant. Compared with white women, black women were less likely to visit a doctor for fertility care, even though they were also less likely to have a child at the time of the study interview. Study two examined geographic differences in visiting a doctor for help becoming pregnant. To compare the results from the FUCHSIA Women's Study with a national sample, this association was also assessed among participants of the National Survey for Family Growth (NSFG). Among women who reported infertility, living in a suburban or small metropolitan county was associated with a greater likelihood of accessing fertility care compared with living in an urbanized or small town/rural county in both the FUCHSIA Women's Study and NSFG. Despite universal recommendations to inform reproductive-age women diagnosed with cancer about how cancer treatment could affect fertility, many women do not receive this information. Study three identified factors associated with not receiving fertility counseling at the time of cancer diagnosis. Overall, 41% of women reported receiving no information on how cancer treatment could affect their ability to become pregnant. Less educated women or women with children were less likely to receive counseling compared with nulliparous or more educated women. Collectively, these studies demonstrate disparities in the receipt of fertility counseling and care among certain groups of women. Improving access to fertility care among these groups, may help more women meet their reproductive goals.

Table of Contents

CHAPTER 1: Introduction and Overview......1

CHAPTER 2: Background and Literature Review......7

CHAPTER 3: Racial Disparities in Seeking Care for Help Getting Pregnant......24

CHAPTER 4: Differences in Women's Use of Medical Help for Becoming Pregnant by the Level of Urbanization of County of Residence in Georgia......46

CHAPTER 5: Assessing Urban-Rural Differences in Women's Use of Medical Help for Becoming Pregnant Using the National Survey for Family Growth......70

CHAPTER 6: Characteristics Associated with the Receipt of Fertility Counseling Among a Cohort of Female Cancer Survivors......81

CHAPTER 7: Summary of Findings and Future Research......122



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