Fertility and falsehoods

The silence around infertility frames it as a rare struggle, but the statistics paint a different picture. 

According to the World Health Organisation, approximately one in six couples face difficulty conceiving. For Black women, however, the challenge is even greater. Studies show that Black women are twice as likely to experience fertility issues compared to their white counterparts, but only 8% seek and receive medical support. 

The historical obsession with controlling the fertility of Black women contributes to the current reality. In 1991, a Kansas state legislator proposed paying women on welfare $500 ($1,179 today) to take Norplant - a subdermal contraceptive tool designed to prevent pregnancy for up to five years. 

A bill of this nature was no accident. In the 1990s, 53.5% of Black people in the United States lived below the poverty line and depended on “welfare.” An editorial released at the time even suggested that Norplant could be an “ invaluable tool in breaking the cycle of inner-city poverty” for those who “over-reproduce.”

Tracing back to those days, there has been a stereotype that Black women are “hyperfertile.” 

The editors of the Birth Control Review, a magazine that later evolved into today’s Planned Parenthood, wrote that “the mass of ignorant Negroes still breed carelessly and disastrously.” Margaret Sanger, the founder of Planned Parenthood, publicly aligned her birth control campaigns in the mid-1900s with eugenicist ideologies. 

“The eugenists wanted to shift the birth control emphasis from less children for the poor to more children for the rich,” she said in her autobiography. “We sought to first stop the multiplication of the unfit. This appeared the most important and greatest step towards race betterment.”

Planned Parenthood has since tried, and failed, to distance itself from these eugenic-centric origins. Still, its legacy illustrates how Black women’s reproductive choices have been controlled by policies designed to limit, rather than support, their fertility.

Above all, this falsehood of hyperfertility contributes to feelings of inadequacy and loneliness when confronted with an infertility diagnosis. Black women can often feel discouraged from speaking openly about infertility, a taboo also reinforced by harmful stereotypes of resilience and “being strong.” Without a wealth of stories of women who look like them navigating fertility treatment, the myth of hyperfertility continues unchallenged.

Several medical conditions impact the ability to conceive. The irony is, however, that these risk factors are themselves linked to racial prejudice.

Conditions like uterine fibroids, endometriosis, and polycystic ovary syndrome (PCOS) are more prevalent within the Black community. For instance, uterine fibroids affect an estimated 80% of Black women by age 50. This chronic condition can cause significant reproductive issues and complicate the process of seeking infertility treatment. 

Many of these reproductive issues often remain undiagnosed, ultimately creating a cycle where treatable conditions progress into major fertility challenges.

IVF for the few

For many seeking help, options like in vitro fertilisation (IVF) offer a lifeline. IVF involves retrieving mature eggs from a woman’s ovaries, fertilising them with sperm in a lab, then implanting the fertilised egg in the uterus. When IVF first became available, multiple pregnancies were a significant risk due to the practice of transferring several fertilised eggs. Now, clinics resort to single embryo transfer (SET) in an attempt to improve outcomes for both mothers and children. 

Since Louise Brown - the first IVF baby born in 1978 - more than 10 million children have been born in the same manner. 

Yet, research published in Fertility and Sterility found that Black women undergoing IVF treatment have significantly lower birth rates compared to their white counterparts. Another study noted that Black women have at least a 31% lower chance of successful pregnancy outcomes after using assisted reproductive technologies.

The financial burden of IVF contributes greatly to this disparity. A single IVF cycle in the UK costs an average of £7,500, and up to $20,000 in the US. As multiple cycles are often required, treatment costs can quickly escalate to the price of a house deposit, capping the chances of those from low-income backgrounds. 

Infertility does not discriminate, but access to treatment and social alienation often does.

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