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Adhikary P, Mburu G, Kabra R, Habib NA, Kiarie J, Dhabhai N, Chowdhury R, Mazumder S. Intersectional analysis of the experiences of women who fail to conceive in low and middle income neighbourhoods of Delhi, India: Findings from a qualitative study. PLoS One 2024; 19:e0304029. [PMID: 38959201 PMCID: PMC11221677 DOI: 10.1371/journal.pone.0304029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/05/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Experiences of delayed conception and infertility have been reported among women. However, the concept of intersectionality is rarely utilised in studies of infertility, and it is particularly uncommon in research from low- and middle- income countries. RESEARCH QUESTION What are the lived experiences of women with delayed conception in low to -middle income neighbourhoods of Delhi, India? METHODS This was a qualitative study (n = 35) that recruited women who had failed to conceive after 18 months of regular unprotected sexual intercourse. Data were collected between February and July 2021. Data were collected through focus group discussions in low income to middle income neighbourhoods of Delhi, India. Analysis identified themes related to intersecting axes of inequality. RESULTS The results showed that gender intersected with economics, masculinity, patriarchal norms and class to influence the experiences of women. The intersection of gender, economics and patriarchal norms compromised women's agency to be active generators of family income, and this dynamic was exacerbated by patrilocal residence. In addition, masculinity contributed to stigmatisation and blaming of women, due to the inaccurate perception that men did not contribute to a couple's infertility. The intersection of gender and social class in medical settings created barriers to women's access to medical information. CONCLUSION Findings from this study provide representative examples of the variety of axes of inequality that shape women's experiences in the study setting. Although these findings may not be generalisable to all women who are experiencing delayed conception, they highlight a need for improved awareness and education on infertility, as well as a need to ensure the availability and accessibility of fertility care for couples in need.
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Affiliation(s)
| | - Gitau Mburu
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rita Kabra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ndema Abu Habib
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - James Kiarie
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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2
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Abdelnabi SJ. Muslim Women's Experiences with Infertility: A Literature Review. MCN Am J Matern Child Nurs 2024; 49:211-218. [PMID: 38512137 DOI: 10.1097/nmc.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Infertility affects one in six women worldwide, playing a large role on an individual's psychosocial wellbeing and quality of life. The purpose of this review was to examine the experiences of Muslim women with infertility. METHODS A Prisma-guided literature review was conducted in Scopus, CINAHL, PubMed, Embase, PsychInfo, and Google Scholar. Sample inclusion criteria included research that examined the psychosocial consequences of infertility in women, used a qualitative design, were from a Muslim majority country or specified participants were Muslim, and were published in the English-language since 2013. Thematic analysis was used to synthesize the findings into themes. RESULTS Fourteen qualitative studies that explored the experiences of Muslim women with infertility were included for analysis. Women's responses were categorized into three focus areas: (1) emotional responses, (2) interpersonal relationships, and (3) social relationships. From these focus points, six overarching themes were identified that illustrated the challenges faced by Muslim women experiencing infertility: (1) identity crisis, (2) low self-esteem and depression, (3) abuse and harassment, (4) a weakened marital bond, (5) stigma, and (6) social exclusion and isolation . CLINICAL IMPLICATIONS Review of the literature provided an initial entrée into understanding the experiences of Muslim women with infertility. Understanding the unique role of infertility within a religious community equips nurses and other providers with the knowledge that discussions surrounding infertility must be conducted with cultural sensitivity. Further research should be conducted to explore and offer culturally tailored educational materials that align with the religious preferences of Muslim women.
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Affiliation(s)
- Samia Jamal Abdelnabi
- Samia Jamal Abdelnabi is a Research Fellow, National Clinician Scholars Program, Department of Health Behavior and Biological Sciences, University of Michigan, School of Nursing, Ann Arbor, MI. Dr. Abdelnabi can be reached at
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Suarez-Balcazar Y, Buckingham S, Rusch DB, Charvonia A, Young RI, Lewis RK, Ford-Paz RE, Mehta TG, Perez CM. Reproductive justice for Black, Indigenous, Women of Color: Uprooting race and colonialism. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 73:159-169. [PMID: 36912117 DOI: 10.1002/ajcp.12650] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 07/01/2022] [Accepted: 11/25/2022] [Indexed: 06/18/2023]
Abstract
Historically, atrocities against Black, Indigenous, and Women of Color's (BIWoC) reproductive rights have been committed and continue to take place in contemporary society. The atrocities against BIWoC have been fueled by White supremacy ideology of the "desirable race" and colonial views toward controlling poverty and population growth, particularly that of "undesirable" races and ethnicities. Grounded in Critical Race Theory, this paper aims to provide a critical analysis of historical and contemporary violations of BIWoC reproductive rights; discuss interventions based on empowerment and advocacy principles designed to promote women's reproductive justice; and discuss implications for future research, action, and policy from the lenses of Critical Race Theory and Community Psychology. This paper contributes to the special issue by critically analyzing historical and contemporary racism and colonialism against BIWoC, discussing implications for future research and practice, and making policy recommendations.
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Affiliation(s)
| | - Sara Buckingham
- Department of Psychology, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Dana B Rusch
- Department of Psychiatry, Institute for Juvenile Research, University of Illinois Chicago, Chicago, Illinois, USA
| | - Alissa Charvonia
- Department of Psychology, Howard University, Washington, District of Columbia, USA
| | | | - Rhonda K Lewis
- Department of Psychology, Wichita State University, Wichita, Kansas, USA
| | - Rebecca E Ford-Paz
- Pritzker Department of Psychiatry and Behavioral Health; Ann & Robert H. Lurie Children's Hospital of Chicago; Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tara G Mehta
- Department of Psychiatry, Institute for Juvenile Research, University of Illinois Chicago, Chicago, Illinois, USA
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Weiss MS, Marsh EE. Navigating Unequal Paths: Racial Disparities in the Infertility Journey. Obstet Gynecol 2023; 142:940-947. [PMID: 37678890 PMCID: PMC10510808 DOI: 10.1097/aog.0000000000005354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 09/09/2023]
Abstract
Infertility is one of the most emotionally devastating conditions experienced during the reproductive window. Although not life-threatening, it significantly erodes quality of life for those with the diagnosis. Disturbingly, data demonstrate the existence of profound racial disparities that persist along the entire journey of infertility. Though most of the scientific literature emphasizes disparities in clinical outcomes after infertility treatment, it is important to recognize that these inequities are the downstream effect of a series of distinct challenges encountered by historically marginalized people on their path to parenthood. In this review, we explore the current state of knowledge concerning the inequities at each "step" in the path to overcome infertility challenges and propose solutions to create a future in which reproductive medicine is truly equitable, accessible, and supportive for everyone.
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Affiliation(s)
- Marissa Steinberg Weiss
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania; and the Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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Pawłowski P, Ziętara KJ, Michalczyk J, Fryze M, Buchacz A, Zaucha-Prażmo A, Zawitkowska J, Torres A, Samardakiewicz M. Fertility Preservation in Children and Adolescents during Oncological Treatment-A Review of Healthcare System Factors and Attitudes of Patients and Their Caregivers. Cancers (Basel) 2023; 15:4393. [PMID: 37686669 PMCID: PMC10487203 DOI: 10.3390/cancers15174393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Oncofertility is any therapeutic intervention to safeguard the fertility of cancer patients. Anti-cancer therapies (chemotherapy, radiation therapy, etc.) entail the risk of reproductive disorders through cytotoxic effects on gamete-building cells, especially those not yet fully developed. This literature review analyzes the available data on securing fertility in pediatric and adolescent populations to identify the methods used and describe aspects related to financing, ethics, and the perspective of patients and their parents. Topics related to oncofertility in this age group are relatively niche, with few peer-reviewed articles available and published studies mostly on adults. Compared to pubertal individuals, a limited number of fertility preservation methods are used for prepubertal patients. Funding for the procedures described varies from country to country, but only a few governments choose to reimburse them. Oncofertility of pediatric and adolescent patients raises many controversies related to the decision, parents' beliefs, having a partner, ethics, as well as the knowledge and experience of healthcare professionals. As the fertility of young cancer patients is at risk, healthcare professionals should make every effort to provide them with an opportunity to fulfill their future reproductive plans and to have a family and offspring. Systemic solutions should form the basis for the development of oncofertility in pediatric and adolescent populations.
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Affiliation(s)
- Piotr Pawłowski
- Student Scientific Association at the Department of Psychology, Faculty of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (P.P.); (J.M.)
| | - Karolina Joanna Ziętara
- Student Scientific Association at the Department of Psychology, Faculty of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (P.P.); (J.M.)
| | - Justyna Michalczyk
- Student Scientific Association at the Department of Psychology, Faculty of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (P.P.); (J.M.)
| | - Magdalena Fryze
- Department of Psychology, Psychosocial Aspects of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (M.F.); (M.S.)
| | - Anna Buchacz
- Youth Cancer Europe, 400372 Cluj-Napoca, Romania;
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-093 Lublin, Poland; (A.Z.-P.); (J.Z.)
| | - Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-093 Lublin, Poland; (A.Z.-P.); (J.Z.)
| | - Anna Torres
- Department of Pediatric and Adolescent Gynecology, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Marzena Samardakiewicz
- Department of Psychology, Psychosocial Aspects of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (M.F.); (M.S.)
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Racial and ethnic disparities in assisted reproductive technology: a systematic review. Fertil Steril 2023; 119:341-347. [PMID: 36682687 DOI: 10.1016/j.fertnstert.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
There is emergent scientific literature examining the disparities in reproductive care of women in the United States. Reproduction is a basic human right and there are unique challenges that racial and ethnic minorities face in accessing fertility care and assisted reproductive technology. The identification of these disparities can aid in identifying areas for interventions to improve and resolve, the inequities that exist in providing care for minority populations. A literature search was performed using PubMed to identify articles with data specific to racial and ethnic differences in study populations as it related to infertility, access to care, and treatment outcomes. The following review and collection of articles provide a comprehensive overview of the disparities that exist, the factors that contribute to these disparities, and recommendations for how providers and health care systems may begin to resolve the gaps in equitable care.
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Morris JR, Kawwass JF, Hipp HS. Physical intimate partner violence among women reporting prior fertility treatment: a survey of U.S. postpartum women. Fertil Steril 2023; 119:277-288. [PMID: 36347311 DOI: 10.1016/j.fertnstert.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the prevalence of physical intimate partner violence (IPV) among postpartum women reporting preconception fertility treatment compared with those who conceived without the use of assisted reproduction. DESIGN Retrospective cross-sectional population-based study. SETTING Not applicable. PATIENT(S) Postpartum respondents of the Centers for Disease Control Pregnancy Risk Assessment Monitoring System survey. INTERVENTION Preconception fertility treatment utilization. MAIN OUTCOME MEASURES Physical IPV. RESULTS Of the 43,999 respondents included in this analytic sample, roughly 2% reported physical IPV. Respondents reporting preconception fertility treatment (12.6%) were less likely to endorse physical IPV than those who conceived without fertility treatment exposure (odds ratio, 0.5; 95% confidence interval, 0.4-0.7). In the multivariate regression model, the odds of physical IPV were similar among postpartum women regardless of the fertility treatment exposure (adjusted odds ratio, 1.2; 95% confidence interval, 0.8-2.0). Residing in a household with an income under the federal poverty level and increased preconception stressors were predictive of reported physical IPV. There was no difference in the type of fertility treatment and report of physical IPV. Among women exposed to fertility treatment, predictors of physical IPV included self-identification of Black or Hispanic race and ethnicity as well as report of 4 or more stressors in the 12 months before the most recent delivery. CONCLUSION The use of fertility treatment did not confer greater risk of physical IPV within this postpartum population. However, there are many individuals with infertility who never present for an assessment, proceed with treatment, or are unsuccessful, thus the extent to which infertility and fertility treatment exposure is associated with physical IPV remains to be elucidated. Women reporting a greater number of stressors may be uniquely at risk despite the access and exposure to fertility treatment. The preconception period, inclusive of encounters with infertility specialists, represents a novel opportunity to screen and counsel all women for IPV.
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Affiliation(s)
- Jerrine R Morris
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, California.
| | - Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Emory University School of Medicine, Atlanta, Georgia
| | - Heather S Hipp
- Division of Reproductive Endocrinology and Infertility, Emory University School of Medicine, Atlanta, Georgia
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8
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Henderson I, Lacey L, Akhtar MA, Quenby S. Ethnic group and reason for assisted reproductive technology failure: analysis of the Human Fertilisation and Embryology Authority registry data from 2017 to 2018. Fertil Steril 2023; 119:241-249. [PMID: 36370887 DOI: 10.1016/j.fertnstert.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To understand how the risk of different assisted reproductive technology (ART) failure types varies by ethnic group and explore the role of mediation by maternal age and suspected etiology. DESIGN An observational study of 48,750 women who undertook treatment with ART in the United Kingdom between January 2017 and December 2018. SETTING The Human Fertilisation and Embryology Authority national ART registry of the United Kingdom. PATIENT(S) Women who commenced a first cycle of ART for the purpose of primary fresh embryo transfer using their own oocytes were included. INTERVENTION(S) Maternal ethnic group. MAIN OUTCOME MEASURE(S) The ART failure types were modeled on the maternal ethnic group using the Poisson regression to produce relative risks (RRs) with 95% confidence intervals. The potential indirect effects of maternal age and etiology of subfertility were estimated, and the RRs with 95% confidence intervals were produced. RESULT(S) Black women were at greater risk of treatment failure with respect to live birth than women who were white: cycle cancellation, RR of 2.15 (1.78-2.62); failed fertilization, RR of 2.36 (1.90-2.93); unintended freeze-all, RR of 1.71 (1.43-2.05); failed implantation, RR of 1.23 (1.12-1.34); and pregnancy loss, RR of 1.38 (1.15-1.64). Women who were Asian were at moderately increased risk: RRs of 1.31 (1.17-1.47), 1.60 (1.42-1.80), 1.25 (1.14-1.38), 1.11 (1.07-1.16), and 1.13 (1.03-1.23), across the same outcomes, respectively. Inequality may have been reduced had women of all ethnicities initiated treatment at the same age. CONCLUSION(S) Black women were at greatest risk of all failure types, and women who were Asian were at intermediate risk compared with women who were white. Some of the risks among women who were black may be mediated by maternal age.
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Affiliation(s)
- Ian Henderson
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.
| | - Lauren Lacey
- Warwick Medical School, University of Warwick, Coventry, United Kingdom; Department of Obstetrics and Gynaecology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Muhammad Ahsan Akhtar
- St Mary's Hospital Manchester, Manchester University Foundation Trust, Oxford Road, Manchester, United Kingdom; Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, United Kingdom
| | - Siobhan Quenby
- Warwick Medical School, University of Warwick, Coventry, United Kingdom; Department of Obstetrics and Gynaecology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
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Tierney K, Urban A. ‘I just think it’s weird’: the nature of ethical and substantive non-ethical concerns about infertility treatments among Black and White women in U.S. graduate programmes. HUM FERTIL 2022:1-13. [DOI: 10.1080/14647273.2022.2136014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Katherine Tierney
- Department of Sociology, Western Michigan University, Kalamazoo, MI, USA
| | - Amber Urban
- Department of Sociology, Western Michigan University, Kalamazoo, MI, USA
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10
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Aksoy Derya Y, Altıparmak S, Karakayalı Ay Ç, Özşahin Z. Determining the Cultural Care Needs of Infertile Couples in Turkey: A Qualitative Study Guided by the Cultural Competence Model. JOURNAL OF RELIGION AND HEALTH 2022; 61:2855-2875. [PMID: 34687404 DOI: 10.1007/s10943-021-01445-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 06/13/2023]
Abstract
The cultural competence model is an ethnographic model created to improve the cultural understanding of people's status in the context of health, health promotion and illness. This study aimed to use the Purnell Model for Cultural Competence for determining the cultural care needs of couples undergoing infertility treatment. This study with a qualitative design was conducted at a private in vitro fertilization center in eastern Turkey. The sample of the study consisted of 10 infertile couples with unexplained infertility problems (n = 20). The 12 cultural domains were used as a basis in determining the cultural care needs of the infertile couples, and these domains formed the themes. Data were collected using the method of interpretative phenomenological analysis. The emotions defined in the "spirituality" theme were "seeing it as destiny or seeing it as a test to be passed in terms of religion" and "visiting holy tombs, applying to faith healers and making vows." The first three emotions that came to the fore in the "pregnancy and childbearing" theme were "feelings of deficiency/illness/stigmatization," "deterioration in body image" and "unsatisfactory inability to feel love for own child." In the "healthcare practitioners" theme, it was determined that compliance with treatment was partially sufficient, but the religious-cultural influence was high.
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Affiliation(s)
- Yeşim Aksoy Derya
- Department of Midwifery, Faculty of Health Sciences, Inonu University, 44280, Malatya, Turkey
| | - Sümeyye Altıparmak
- Department of Midwifery, Faculty of Health Sciences, Inonu University, 44280, Malatya, Turkey
| | - Çiğdem Karakayalı Ay
- Department of Midwifery, Faculty of Health Sciences, Inonu University, 44280, Malatya, Turkey.
| | - Zeliha Özşahin
- Department of Midwifery, Faculty of Health Sciences, Inonu University, 44280, Malatya, Turkey
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Rasouli MA, Sagun BK, Verma K, Duke CM. Black infertility and social media engagement: a mixed methodology analysis. F S Rep 2022; 3:55-61. [PMID: 35937449 PMCID: PMC9349246 DOI: 10.1016/j.xfre.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 01/20/2023] Open
Abstract
Objective To study social media engagement on Black infertility to better understand why there is lower utilization of in vitro fertilization by Black women despite higher infertility rates. Design The online analytics module BuzzSumo was used to quantify total engagements with the search term “Black infertility” across the commonly used social media platforms. The 10 article links with the highest engagement were selected from periods in 2020 and 2021. Sources cited in each article were reviewed to identify those that had citations of scientific peer-reviewed journals or national medical organizations. The contents of each article were reviewed for accuracy by comparing the article information against available scientific research and consensus data. Patient(s) Not applicable. Intervention(s) Not applicable. Main Outcome Measure(s) Not applicable. Result(s) After applying the exclusion criteria, nine article links remained in each date range. The highest engagement with the term “Black infertility” was found on Facebook for both 2020 and 2021. Ten percent of content regarding Black infertility in 2020 compared with 50% of content regarding Black infertility in 2021 referenced original studies in peer-reviewed journals. Links with greater social engagement were more likely to have academic sources in 2021 than in 2020 (odds ratio, 1.30). The highest user engagement was found for articles discussing the emotional toll of Black infertility. Conclusion(s) Social media users encounter misleading or inaccurate information regarding Black fertility at similar rates to accurate content. Social media can propagate misinformation, and this study identifies social media as an opportunity to improve education directed toward Black women to increase the utilization of in vitro fertilization services.
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Affiliation(s)
- Melody Ava Rasouli
- Department of Obstetrics and Gynecology, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (UNLV), Las Vegas, Nevada
- Correspondence: Melody Ava Rasouli, M.D., M.B.A., Department of Obstetrics and Gynecology, Kirk Kerkorian School of Medicine at UNLV, 1701 W Charleston Blvd., Ste. 290, Las Vegas, Nevada 89102.
| | | | - Kajal Verma
- Department of Obstetrics and Gynecology, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (UNLV), Las Vegas, Nevada
| | - Cindy M. Duke
- Department of Obstetrics and Gynecology, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (UNLV), Las Vegas, Nevada
- Nevada Fertility Institute, Las Vegas, Nevada
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12
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Wiltshire A, Jackman JM, Moreta L, Ghidei L. Changing the Narrative, Starting With Us. Reprod Sci 2022; 29:2067-2070. [DOI: 10.1007/s43032-022-00915-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
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Dongarwar D, Mercado-Evans V, Adu-Gyamfi S, Laracuente ML, Salihu HM. Racial/ethnic disparities in infertility treatment utilization in the US, 2011-2019. Syst Biol Reprod Med 2022; 68:180-189. [PMID: 35345953 DOI: 10.1080/19396368.2022.2038718] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
With delayed child-bearing age, there has been an increase in infertility rates globally and in the United States (US). Unsurprisingly, there has been a concomitant substantial increase in the number of individuals seeking infertility treatments over the last decade. This study aimed to examine the relationship between race/ethnicity and the utilization of different infertility treatments over the previous decade. We conducted this retrospective cohort study using the United States (US) Birth data files 2011-2019. We calculated the rates of infertility treatment and its subtypes over the study period. Descriptive statistics were utilized to examine the sociodemographic and birth characteristics for overall births and those associated with any infertility treatment and each of its subtypes. We calculated the level of association between race/ethnicity and utilization of infertility treatment and the subtypes using adjusted logistic regression models. We found that the rate of infertility treatments for all subtypes considered, had steadily increased by 63.7% within the past decade. In contrast, fertility enhancing drugs or Intrauterine Insemination (IUI) increased by 134%, and in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT) treatments increased by 40% over the 9-year study period. Non-Hispanic (NH) Asian women had the highest rate of any infertility treatment with a rate of 25 per 1000 births whereas Hispanic women had the lowest rate of any infertility treatment at 5.8 per 1000 births. When compared with NH-White women, NH-Asian women had a modest 7% lower likelihood (OR = 0.93, 95% CI = 0.92-0.94) of receiving any infertility treatment while NH-Black and Hispanic women had about 70% lower likelihood of receiving any infertility treatment. Our report of increased assisted reproductive technology (ART) utilization rates, and marked racial/ethnic differences in ART utilization highlight the importance of expanding knowledge of inequities that continue to impact marginalized groups, a critical step for informing actionable strategy formulations (i.e., advocacy, policy change, patient education, provider training) to address these inequities.
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Affiliation(s)
- Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA
| | - Vicki Mercado-Evans
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA.,Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA
| | - Sylvia Adu-Gyamfi
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA
| | - Mei-Li Laracuente
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA.,Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA.,Department of Family Medicine, Baylor College of Medicine, Houston, TX, USA
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14
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Leath S, Wright P, Charity-Parker B, Stephens E. Exploring Black Women's Pathways to Motherhood Within a Reproductive Justice Framework. QUALITATIVE HEALTH RESEARCH 2022; 32:694-709. [PMID: 34984946 DOI: 10.1177/10497323211066869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Amidst the increasing push to address racial disparities in maternal health equity, fewer studies have considered Black women's perspectives on their needs, concerns, and priorities regarding family planning care. Such evidence might help address the lack of support and information that many Black women report in patient-provider encounters, and broaden empirical knowledge on the contextual factors that influence Black women's reproductive decisions. In the present qualitative study, we explored Black women's pathways to motherhood within a reproductive justice framework. We drew on individual, semi-structured interview data from 31 Black mothers (25-50 years, Mage = 35 years) across the United States. Using consensual qualitative research methods, we elaborated on three themes: (1) intentional family planning, (2) unintended pregnancy, and (3) othermothering. The findings challenge deficit-based stereotypes of Black mothers' reproductive choices and illuminate how health practitioners can facilitate humanizing conversations that prioritize Black women's family planning goals and decision-making.
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Affiliation(s)
- Seanna Leath
- Psychology Department, 2358University of Virginia, Charlottesville, VA, USA
| | - Patrice Wright
- Sociology Department, 2358University of Virginia, Charlottesville, VA, USA
| | | | - Erica Stephens
- Psychology Department, 2358University of Virginia, Charlottesville, VA, USA
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Cebert-Gaitors M, Shannon-Baker PA, Silva SG, Hart RE, Jahandideh S, Gonzalez-Guarda R, Stevenson EL. Psychobiological, Clinical, and Sociocultural Factors Influencing Black Women to Seek Treatment for Infertility: A Mixed Methods Study. F S Rep 2022; 3:29-39. [PMID: 35937441 PMCID: PMC9349229 DOI: 10.1016/j.xfre.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To provide a comprehensive and multidimensional description and conceptualization of the experiences of Black women seeking treatment for infertility. Design Convergent parallel mixed-methods study combining retrospective chart review data and semistructured interview data. Setting Private infertility clinic. Patient(s) African American/Black women between 18 and 44 years of age who presented for an initial infertility evaluation with a male partner between January 2015 and September 2019 at an infertility clinic in the metropolitan Washington D.C. area. Intervention(s) None Main Outcome(s) Treatment seeking. Measure(s) Psychobiological, clinical, and sociocultural factors. Result(s) Along with the psychobiological, clinical, and sociocultural domains, we understood that Black women who sought treatment for infertility were older and overweight, had complex gynecological diagnoses, and experienced infertility for long periods of time. The delay in seeking treatment was possibly because of a low perceived risk of infertility, poor understanding of treatment options, inadequate referral patterns of primary care providers, and limited social support. Further, Black women experienced delays in seeking treatment because they attempted lifestyle-based self-interventions before considering medical interventions. Facilitators to care included psychological distress, complex gynecological medical history, and finding culturally competent providers. Conclusion(s) The study findings show that Black women in the United States are vulnerable to disparities in healthcare delivery, especially within reproductive endocrinology. Our findings highlight areas where Black women are experiencing missed opportunities for teaching, early identification, and early referrals for infertility-related concerns. Future studies should seek to reduce barriers to infertility treatment at the clinical and policy levels.
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Affiliation(s)
- Christine Ekechi
- Race Equality Taskforce, The Royal College of Obstetricians and Gynaecologists, London, UK; Queen Charlotte's and Chelsea Hospital, Imperial Healthcare NHS Trust, London W12 0HS, UK.
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Fikslin RA. Toward an Intersectional Psychological Science of Reproductive Norms: Generating Research Across the Natalism Spectrum. PSYCHOLOGY OF WOMEN QUARTERLY 2021. [DOI: 10.1177/03616843211011716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pronatalism is the belief system that encourages parenthood and reproduction, supporting the notion that a woman’s value is rooted in her ability to give birth to and parent children. Pronatalist expectations are disproportionately applied to high-status women in the United States, prescribing not only that women are supposed to reproduce, but which women are supposed to reproduce. Those who deviate from this hegemonic idea of a prototypical mother may disproportionately encounter antinatalist norms that prescribe that they should not bear or parent children. In the present article, I advocate for an intersectional psychological study of reproductive norms across the natalism spectrum, grounded in interdisciplinary insights and an understanding of systems of power and oppression. I discuss three common areas of interdisciplinary research related to reproductive norms: (a) pronatalism as a limit to women’s freedom, (b) racism and the control of Black women’s reproduction, and (c) queer perspectives on reproduction. Informed by intersectionality and stigma frameworks, I propose a generative model and six research questions that serve as a research agenda for the psychological study of reproductive norms across the natalism spectrum.
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Affiliation(s)
- Rachel A. Fikslin
- Basic and Applied Social Psychology PhD Program, Department of Psychology, The Graduate Center, City University of New York, NY, USA
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McCray N, Thompson L, Branch F, Porter N, Peterson J, Perry MJ. Talking About Public Health With African American Men: Perceptions of Environmental Health and Infertility. Am J Mens Health 2021; 14:1557988320901375. [PMID: 31973636 PMCID: PMC6984439 DOI: 10.1177/1557988320901375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
While the past two decades have seen rapid advances in research demonstrating links between environmental health and reproductive capacity, African American men have largely been overlooked as study participants. To give voice to the perceptions of urban African American men, the present qualitative study conducted focus groups of men recruited from street- and internet-based advertisements in Washington, DC. Participants were asked for their perspectives on their environment, reproductive health and fertility, and factors that would influence their participation in public health research. Participants expressed concern about ubiquitous environmental exposures characteristic of their living environments, which they attributed in part to gentrification and urban development. Infertility was seen as a threat to masculinity and a taboo subject in the African American community and several participants shared personal stories describing a general code of silence about the subject. Each group offered multiple suggestions for recruiting African American men into research studies; facilitators for study participation included cultural relevance, incentives, transparent communication, internet- and community-based recruitment, and use of African Americans and/or recruiters of color as part of the research team. When asked whether participants would participate in a hypothetical study on fertility that involved providing a sperm sample, there was a mixed reaction, with some expressing concern about how such a sample would be used and others describing a few facilitators for participation in such a study. These are unique perspectives that are largely missing from current-day evidence on the inclusion of African American men in environmental health and reproductive health research.
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Affiliation(s)
- Nathan McCray
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Lance Thompson
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Francesca Branch
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Nicholas Porter
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - James Peterson
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Melissa J Perry
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Grabe S. Research Methods in the Study of Intersectionality in Psychology: Examples Informed by a Decade of Collaborative Work With Majority World Women's Grassroots Activism. Front Psychol 2020; 11:494309. [PMID: 33192755 PMCID: PMC7658295 DOI: 10.3389/fpsyg.2020.494309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/28/2020] [Indexed: 11/19/2022] Open
Abstract
Very few theories have generated the kind of interdisciplinary and international engagement that marks the intellectual history of intersectionality, leaving some authors to suggest that intersectionality is the most important theoretical contribution that the field of women’s studies has made thus far. Yet, consideration of intersectionality as a research paradigm has yet to gain a wide foothold in mainstream psychology. The current article uses a program of multimethod research designed in partnership with, and intending to center the intersectional experiences of, majority world women to propose a research agenda for the empirical study of intersectionality. Specifically, it is suggested that a research agenda rooted in intersectional understandings requires that: (1) researchers think carefully about social categories of analysis and how their methodological choices can best answer those questions, (2) psychologists reposition their research questions to examine processes by which structural inequities lead to power imbalances and gender-based norms that sustain women’s experience of marginalization and oppression, and (3) we understand how intersectional experiences can be applied toward change. Intersectional investigations hold a key to interrupting the structural dimensions of power that result in egregious consequences to peoples’ social, economic, and political lives, but only if we radically restructure what we think about knowledge, our roles, and the products of our research.
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Affiliation(s)
- Shelly Grabe
- Department of Psychology, University of California, Santa Cruz, Santa Cruz, CA, United States
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Tierney K. Is there evidence of weathering among women seeking fertility treatments?: Evidence and insights. Soc Sci Med 2020; 247:112816. [PMID: 32014735 DOI: 10.1016/j.socscimed.2020.112816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 11/28/2022]
Abstract
Racial disparities in outcomes of assisted reproductive technologies (ART) are well-documented, and evidence of racial disparities in other forms of fertility treatments has also been observed. To date, much of the research on these disparities has focused on individual-level causes. This paper contextualizes these disparities using the weathering hypothesis. Using the National Survey of Family Growth and exploratory analyses of the National Health and Nutrition Examination Survey, this study evaluates whether there is evidence of weathering among women of color seeking fertility treatments. The study finds inconsistent evidence of weathering among these groups. However, the study is limited by weaknesses in the available data. The paper demonstrates the promise and limits of the available data to answer empirical questions regarding disparities in fertility treatments that have spurred a national public health action plan and numerous commentaries from scholars and professional organizations. The paper concludes with a discussion of other possible causes of these disparities and a description of next steps needed in the field to better understand both the "under the skin" and social processes that underlie disparities in fertility treatment outcomes.
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Affiliation(s)
- Katherine Tierney
- Department of Sociology, University of North Carolina at Chapel Hill, Campus Box 3210, Chapel Hill, NC, 27599-3210 , USA.
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21
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Ebrahimzadeh Zagami S, Latifnejad Roudsari R, Janghorban R, Mousavi Bazaz SM, Amirian M, Allan HT. Iranian infertile couples' strategies to manage social interactions after unsuccessful treatment with assisted reproductive technologies. HUM FERTIL 2019; 24:341-352. [PMID: 31621448 DOI: 10.1080/14647273.2019.1677950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many infertile couples feel vulnerable after failed treatment cycles and find insensitive remarks or inappropriate support distressing. They fear that the stress of failed treatment cycles may affect their marriage and lead to marriage breakdown. This study explored the strategies a sample of infertile couples used to manage social interactions after unsuccessful treatment with assisted reproductive technologies. A descriptive qualitative study was conducted with 34 participants including nine infertile couples, nine infertile women and two infertile men with primary infertility, two relatives, and three fertility clinic staff. The participants were selected through purposive sampling at an infertility centre in Iran, between 2016 and 2017. Data were collected using semi-structured face-to-face interviews and analysed by qualitative content analysis approach. Participants found some social interactions after failed assisted reproductive treatment cycles to be distressing and painful. They described tolerating painful emotions which cause them sadness and sorrow as well as feeling embarrassed. As a result, they found they needed to maintain their adopting concealment strategies with their families through not permitting speculation, selective disclosure, not giving details and hiding the truth. This study showed that social interactions following failed assisted reproductive cycles can be upsetting for infertile couples. Couples use different strategies to manage potentially distressing social interactions. Healthcare providers and psychologists may provide a space for safe social interactions in order to help couples to use appropriate strategies in these circumstances.
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Affiliation(s)
| | | | - Roksana Janghorban
- Maternal-Fetal Medicine Research Centre, Shiraz University of Medical Sciences , Shiraz , Iran
| | | | - Maliheh Amirian
- Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences , Mashhad , Iran
| | - Helen T Allan
- Department of Adult Child and Midwifery, School of Health and Education, Middlesex University , London , UK
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Women with infertility complying with and resisting polygyny: an explorative qualitative study in urban Gambia. Reprod Health 2019; 16:103. [PMID: 31307488 PMCID: PMC6633655 DOI: 10.1186/s12978-019-0762-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/26/2019] [Indexed: 12/04/2022] Open
Abstract
Background In many low-and middle-income countries women with infertility are often in polygynous marriages. From a human and women’s rights perspective, the practice of polygyny is commonly understood as harmful. Studies indicate that polygyny aggravates negative life circumstances of women with infertility with respect to their health and social well-being. The purpose of this qualitative study is to explore how women with infertility experience polygyny and to understand their decision-making regarding these marriages. Methods An explorative qualitative study was conducted among women with infertility in the urban communities of the West Coast region of The Gambia using in-depth interviews (30). Data analysis involved an emergent and partially inductive thematic framework and was carried out using NVivo 11. Results With the exception of some women with infertility who described positive experiences within polygynous marriages, most women emphasised conflicts that exist within polygynous households and reported financial and emotional difficulties. Thematic analysis identified several strategies of women with infertility to cope with and resist polygynous marriages, including overcoming childlessness, addressing conflict, spending time outside the compound, looking for social support, kanyaleng kafoolu, living separately and initiating divorce. Moreover, the experiences and decision-making power of women with infertility when it comes to polygynous marriages was found to be closely related to their socio-demographic background. Conclusion This work highlights how women with infertility in polygynous marriages are in a precarious situation in urban Gambia. Women utilize a mix of compliance, coping and resistance strategies to navigate the challenges of polygynous marriages in a structurally constraining context.
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Luna Z. Black celebrities, reproductive justice and queering family: an exploration. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2018; 7:91-100. [PMID: 30949593 PMCID: PMC6430721 DOI: 10.1016/j.rbms.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/25/2018] [Accepted: 12/07/2018] [Indexed: 06/01/2023]
Abstract
Decades ago, political theorist Cathy Cohen reflected on the meaning and possibilities of coalition among groups as diverse as gay men and single mothers. This article focuses on Black women's fertility struggles as they navigate controlling images and the Black fertility mandate. I compare accounts of how celebrities and non-celebrities have discussed making families through reproductive technology, and whether we can read these narratives as attempting to redefine and even 'queer' family. Ultimately, while the horizons of reproductive technology are ever expanding, those of us who care about justice would do well to ask if and how, in the everyday operations of our life, the technology does anything to change how the particular society in which we are embedded views people on the reproductive margins, such as single mothers and others who 'queer' typical narratives of reproduction.
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'I am always crying on the inside': a qualitative study on the implications of infertility on women's lives in urban Gambia. Reprod Health 2018; 15:151. [PMID: 30208896 PMCID: PMC6134751 DOI: 10.1186/s12978-018-0596-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is an increasing awareness that infertility in Sub-Saharan Africa constitutes a severe social and public health problem. Few of the existing studies on infertility explicitly take into account the differences between women. However, how women experience infertility is formed by their various social positions. This research explores the implications of infertility on women’s lives in urban Gambia and aims to provide an in-depth understanding of how this relates to gender and cultural norms as well as different social positions. Methods Qualitative data were collected through interviews (33), group discussions (13), participatory observations (14) and informal conversations (31). Purposive and snowball sampling techniques were used to identify participants. The data was analysed thematically using NVivo 11. Results Results showed that there was strong social pressure on urban women in The Gambia to procreate. Unable to conform to their gender role, women with infertility were confronted with financial problems, social stigma, as well as emotional and physical violence in their marriage. All women expressed feelings of trauma, stress and sadness. The intersectional approach used in this study highlighted how different positions influenced women’s experiences of infertility. Urban women with a high socio-economic status had a more powerful position within their marriages and the broader community, due to their financial position, professional career and, sometimes, their educational background. In contrast, women from a lower socio-economic background were more likely to be harshly confronted with the social stigma of infertility. Conclusion The lives of most women with infertility in The Gambia are characterized by social suffering resulting from gender and pro-natal norms, cultural beliefs and moral concerns, cultural practices and limited access to health care. An intersectional approach is an effective tool to inform public health and social policy since it highlights how, in specific situations, certain groups are more vulnerable than others.
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Lee M. Don't Give Up! A Cyber-ethnography and Discourse Analysis of an Online Infertility Patient Forum. Cult Med Psychiatry 2017; 41:341-367. [PMID: 28063090 DOI: 10.1007/s11013-016-9515-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Infertility affects women across the socioeconomic spectrum; however, it is by no means egalitarian in its distribution, nor uniform in its lived experience. Evidence shows striking disparities by income, race, and education in infertility prevalence, access to infertility services, and success rates after receiving infertility treatments. However, few studies so far have investigated disparities in patients' access to psychological support during the infertility journey. This paper undertakes a cyber-ethnography of the online patient forum, "Finding a Resolution for Infertility," hosted by RESOLVE: The National Infertility Association. It also draws from interviews with 54 infertility patients recruited from the forum. Our aim was to examine how social support operates within this virtual realm, by examining how the forum's language, norms, and values create and enforce categories of deserving and belonging among site users. We find that the forum's discourse privileges an infertility narrative we term the "persistent patient," in which a patient exhaustively researches treatment options, undergoes multiple cycles of treatment despite repeated failures, and ultimately achieves success (a healthy baby). Meanwhile, there is little to no discursive space for discussion of the financial and social resources necessary to act in accordance with this script. Thus, women without such resources can be alienated, silenced, and denied mental health support by this online community.
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Affiliation(s)
- Mihan Lee
- Department of Health Policy, Harvard Graduate School of Arts & Sciences, 14 Story St, Cambridge, MA, 02142, USA.
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26
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Sormunen T, Aanesen A, Fossum B, Karlgren K, Westerbotn M. Infertility-related communication and coping strategies among women affected by primary or secondary infertility. J Clin Nurs 2017; 27:e335-e344. [PMID: 28677273 DOI: 10.1111/jocn.13953] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 12/21/2022]
Abstract
AIM AND OBJECTIVES To explore infertility-related communication and coping strategies among women affected by primary or secondary fertility problems. BACKGROUND Infertility is a worldwide problem and is experienced as psychologically stressful. Communication about infertility varies depending on clinical aspects, personal relationships and culture. METHODS A quantitative cross-sectional study design was used. One hundred and ninety-nine women affected by primary and secondary infertility were recruited from one fertility clinic in Stockholm. A structured self-administered questionnaire was used to collect data. The answers were compared across the two groups using the chi-squared test for independence. RESULTS The majority of the women discussed infertility-related subjects with intimate friends and/or relatives and did not discuss the results of examinations and tests with people outside of the family. There were significant differences between the two groups. Twice as many women with secondary infertility acknowledged that they never talk about the causes or results of the tests and examinations with other people, compared with women with primary infertility. Approximately 25% of the women with primary infertility used distraction techniques, such as turning to work, as a coping strategy compared to women with secondary infertility (10%). Some women did not discuss the inability to conceive and reasons why they were childless with their spouses. Twelve percentage of the women reported that they left the room when the subjects of children were being discussed. Approximately 30% of the participants did not ask friends or relatives for advice and a few were not able to discuss how tests and treatments affected them emotionally. CONCLUSION This study indicates that a majority of infertile women discuss about infertility-related subjects with their spouses. However, they are less likely to discuss the reason for infertility and results of tests and examinations with people outside the family. RELEVANCE TO THE CLINICAL PRACTICE The result of the current study can be useful regarding interventions for women affected by primary or by secondary infertility. The healthcare staff must be alert and attentive to pay attention to these possible challenges. Identification of women at risk of developing emotional problems due to communication difficulties regarding infertility-related issues merits close attention.
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Affiliation(s)
- Taina Sormunen
- Sophiahemmet University, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | | | - Bjöörn Fossum
- Sophiahemmet University, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Klas Karlgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,Department of Research, Education, Development and Innovation, Södersjukhuset, Stockholm, Sweden
| | - Margareta Westerbotn
- Sophiahemmet University, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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Affiliation(s)
- Leah R. Warner
- Department of Psychology, Ramapo College of New Jersey, Mahwah, NJ, USA
| | - Isis H. Settles
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Stephanie A. Shields
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
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Bell AV. The margins of medicalization: Diversity and context through the case of infertility. Soc Sci Med 2016; 156:39-46. [DOI: 10.1016/j.socscimed.2016.03.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 11/15/2022]
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