Correcting Reproductive Health Disparities in Women: An Opportunity to Improve the Health of Future Generations

Alicia Brooks Armstrong, MD

James H. Segars, MD

Reproductive problems pose a significant public health problem for women across all age groups, ethnic, and socioeconomic backgrounds. Women of color, women with few resources, women with limited education, and women from groups such as immigrants, and gay and lesbian who have traditionally faced discrimination, are disproportionately affected. By whatever definition one uses for race and ethnicity, unequal access to care, differences in the pathophysiology of disease, and a disparate response to treatment are all factors that collectively contribute to health disparities in women. Even physiologic processes such as puberty, ovulation, conception, and menopause vary between different ethnic and socioeconomic groups. Of note, reproductive problems are not solely a result of issues related to access to health care. Evidence from the medical literature supports disparities in infertility treatment outcomes and an increased prevalence of problems such as preterm birth, sexually transmitted infections, unintended pregnancy, uterine fibroids, and estrogen-deficiency states.[1] In this issue of Seminars in Reproductive Medicine, we focus on these important disparities in reproductive health of women by considering health disparities across the lifespan of women. The guest editors believe preconception and pregnancy represent an unparalleled window of opportunity for intervention(s) that will impact not just the mother and infant but also future generations.

• References

• 1 Fujimoto VY, Jain T, Alvero R , et al. Proceedings from the conference on Reproductive Problems in Women of Color. Fertil Steril 2010; 94 (1) 7-10
• 2 Barouki R, Gluckman PD, Grandjean P, Hanson M, Heindel JJ. Developmental origins of non-communicable disease: implications for research and public health. Environ Health 2012; 11: 42
• 3 Swanson JM, Entringer S, Buss C, Wadhwa PD. Developmental origins of health and disease: environmental exposures. Semin Reprod Med 2009; 27 (5) 391-402
• 4 Harlan WR, Harlan EA, Grillo GP. Secondary sex characteristics of girls 12 to 17 years of age: the U.S. Health Examination Survey. J Pediatr 1980; 96 (6) 1074-1078
• 5 Armstrong A, Plowden TC. Ethnicity and assisted reproductive technologies. Clin Pract (Lond) 2012; 9 (6) 651-658
• 6 Seifer DB, Frazier LM, Grainger DA. Disparity in assisted reproductive technologies outcomes in black women compared with white women. Fertil Steril 2008; 90 (5) 1701-1710
• 7 Feinberg EC, Larsen FW, Catherino WH, Zhang J, Armstrong AY. Comparison of assisted reproductive technology utilization and outcomes between Caucasian and African American patients in an equal-access-to-care setting. Fertil Steril 2006; 85 (4) 888-894
• 8 Sharara FI, McClamrock HD. Differences in in vitro fertilization (IVF) outcome between white and black women in an inner-city, university-based IVF program. Fertil Steril 2000; 73 (6) 1170-1173
• 9 McCarthy-Keith DM, Schisterman EF, Robinson RD, O'Leary K, Lucidi RS, Armstrong AY. Will decreasing assisted reproduction technology costs improve utilization and outcomes among minority women?. Fertil Steril 2010; 94 (7) 2587-2589
• 10 Lamb JD, Huddleston HG, Purcell KJ , et al. Asian ethnicity is associated with decreased pregnancy rates following intrauterine insemination. Reprod Biomed Online 2009; 19 (2) 252-256
• 11 Purcell K, Schembri M, Frazier LM , et al. Asian ethnicity is associated with reduced pregnancy outcomes after assisted reproductive technology. Fertil Steril 2007; 87 (2) 297-302
• 12 Langen ES, Shahine LK, Lamb JD , et al. Asian ethnicity and poor outcomes after in vitro fertilization blastocyst transfer. Obstet Gynecol 2010; 115 (3) 591-596
• 13 Shahine LK, Lamb JD, Lathi RB, Milki AA, Langen E, Westphal LM. Poor prognosis with in vitro fertilization in Indian women compared to Caucasian women despite similar embryo quality. PLoS ONE 2009; 4 (10) e7599
• 14 Fujimoto VY, Luke B, Brown MB , et al; Society for Assisted Reproductive Technology Writing Group. Racial and ethnic disparities in assisted reproductive technology outcomes in the United States. Fertil Steril 2010; 93 (2) 382-390