- Email: [email protected]
Introduction: health disparities in infertility
SPECIAL CONTRIBUTIONS: DISPARITIES IN INFERTILITY TREATMENT Introduction: health disparities in infertility Rosalind Berkowitz King, Ph.D.,a and Joan Davis, M.D., M.P.H.b a Demographic and Behavioral Sciences Branch and b Reproductive Sciences Branch, Center for Population Research, National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland
A scientific workshop, entitled “Health Disparities in Infertility,” was held on March 10 –11, 2005 at the National Institutes of Health in Bethesda, Maryland. Several evolving directions in infertility research that deserve increased emphasis were presented during the workshop; joint work between clinician scientists and social scientists in this area will lead to improved strategies for the prevention and treatment of infertility in different racial, ethnic, and socioeconomic status populations. (Fertil Steril威 2006;85:842–3. ©2006 by American Society for Reproductive Medicine.)
A scientific workshop, entitled “Health Disparities in Infertility,” was held on March 10 –11, 2005 in Bethesda, Maryland. Sponsored by the National Institute of Child Health and Human Development (NICHD), the Office of Behavioral and Social Sciences Research, and the Office of Research on Women’s Health of the National Institutes of Health and the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, the meeting was convened to explore the multiple dimensions of inequality surrounding the experience of infertility by Americans. We brought together social scientists and clinician scientists to discuss the current state of knowledge on the sources of health disparities in the likelihood of encountering infertility during the reproductive life course, in obtaining access to the different types of treatments, and in the response to and outcome of that treatment. An additional purpose was to encourage future interdisciplinary collaborations between social scientists and clinician scientists. Infertility is a major public health problem, affecting up to 10% of Americans of reproductive age. However, very few studies have looked at the prevalence and receipt of infertility services by minority and low-income populations. In the United States, the costs of infertility treatments are borne primarily by couples, including an estimated 85% of the cost of IVF. Emerging evidence also suggests that there might be variation in treatment response to assisted reproductive technologies and that causes of infertility might vary by racial or ethnic group.
Received January 20, 2006; revised and accepted January 21, 2006. Reprint requests: Rosalind Berkowitz King, Ph.D., National Institute of Child Health and Human Development, Demographic and Behavioral Sciences Branch, 6100 Executive Boulevard, Room 8B07, Bethesda, Maryland 20892-7510 (FAX: 301-496-0962; E-mail: [email protected]).
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Health disparities do not simply occur; they develop over time as natural biological and behavioral forces interact with such factors as poverty and discrimination, and are modified by a variety of community, social, and economic forces. Closing the health disparities gap demands an in-depth understanding of these processes and mechanisms as they interact over the lifespan. As part of closing the health disparities gap, the NICHD has as one of its goals the support of research on the factors leading to infertility among minority men and women and the reasons for lower levels of use of infertility services in minority populations. Infertility-related disparities are likely to exist at multiple levels. First, disparities in the likelihood of facing infertility problems might be generated by disparities in age patterns of childbearing, number of children desired, and lifetime history of sexually transmitted infection acquisition and treatment. Second, disparities by income and race or ethnicity might exist in diagnosis (subfecund vs. sterile). Third, disparities might be generated by differences in access to health insurance with relevant benefits and income with which to purchase treatment services. Fourth, disparities might exist in the types of treatment available and in the response to and outcome of that treatment. This workshop was a unique effort to stimulate and enhance research in infertility that cuts across the social and clinical sciences. But scientific collaborations between the social sciences and the biological sciences, particularly with clinician scientists, have been rare. We firmly believe that joint work between clinician scientists and social scientists in this area will lead to improved strategies for the prevention and treatment of infertility in different racial, ethnic, and socioeconomic status populations. Several evolving directions in infertility research that deserve increased emphasis were presented during the workshop. The following is a
Fertility and Sterility姞 Vol. 85, No. 4, April 2006 Copyright ©2006 American Society for Reproductive Medicine, Published by Elsevier Inc.
0015-0282/06/$32.00 doi:10.1016/j.fertnstert.2006.01.007
collection of articles developed from specific research topics presented by the invited speakers. Acknowledgments: This special issue of Fertility and Sterility is a collection of articles developed from some of the presentations at a scientific workshop, “Health Disparities in Infertility,” that was supported by the National Institute of Child Health and Human Development (NICHD), the Office of Behavioral and Social Sciences Research (OBSSR), and the Office of Research on Women’s Health (ORWH) of the National Institutes of Health (NIH) and the Agency for Healthcare Research and
Fertility and Sterility姞
Quality (AHRQ) of the U.S. Department of Health and Human Services (DHHS). Organizing Committee, Health Disparities in Infertility, March 10 –11, 2005: Joan Davis, M.D., M.P.H., from the Reproductive Sciences Branch, and Rosalind Berkowitz King, Ph.D., from the Demographic and Behavioral Sciences Branch, NICHD, NIH, DHHS. Deborah Olster, Ph.D., at OBSSR, Vivian Pinn, M.D., at ORWH, and Susie Meikle, M.D., M.S.P.H., at AHRQ, were instrumental in obtaining support. Christine Bachrach, Ph.D., Phyllis Leppert, M.D., Ph.D., and Susan Newcomer, Ph.D., of the NICHD, provided scientific advice. Susie Meikle, M.D., M.S.P.H., of the AHRQ, also provided important leads in identifying key speakers for this conference.
843
A scientific workshop, entitled “Health Disparities in Infertility,” was held on March 10 –11, 2005 at the National Institutes of Health in Bethesda, Maryland. Several evolving directions in infertility research that deserve increased emphasis were presented during the workshop; joint work between clinician scientists and social scientists in this area will lead to improved strategies for the prevention and treatment of infertility in different racial, ethnic, and socioeconomic status populations. (Fertil Steril威 2006;85:842–3. ©2006 by American Society for Reproductive Medicine.)
A scientific workshop, entitled “Health Disparities in Infertility,” was held on March 10 –11, 2005 in Bethesda, Maryland. Sponsored by the National Institute of Child Health and Human Development (NICHD), the Office of Behavioral and Social Sciences Research, and the Office of Research on Women’s Health of the National Institutes of Health and the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, the meeting was convened to explore the multiple dimensions of inequality surrounding the experience of infertility by Americans. We brought together social scientists and clinician scientists to discuss the current state of knowledge on the sources of health disparities in the likelihood of encountering infertility during the reproductive life course, in obtaining access to the different types of treatments, and in the response to and outcome of that treatment. An additional purpose was to encourage future interdisciplinary collaborations between social scientists and clinician scientists. Infertility is a major public health problem, affecting up to 10% of Americans of reproductive age. However, very few studies have looked at the prevalence and receipt of infertility services by minority and low-income populations. In the United States, the costs of infertility treatments are borne primarily by couples, including an estimated 85% of the cost of IVF. Emerging evidence also suggests that there might be variation in treatment response to assisted reproductive technologies and that causes of infertility might vary by racial or ethnic group.
Received January 20, 2006; revised and accepted January 21, 2006. Reprint requests: Rosalind Berkowitz King, Ph.D., National Institute of Child Health and Human Development, Demographic and Behavioral Sciences Branch, 6100 Executive Boulevard, Room 8B07, Bethesda, Maryland 20892-7510 (FAX: 301-496-0962; E-mail: [email protected]).
842
Health disparities do not simply occur; they develop over time as natural biological and behavioral forces interact with such factors as poverty and discrimination, and are modified by a variety of community, social, and economic forces. Closing the health disparities gap demands an in-depth understanding of these processes and mechanisms as they interact over the lifespan. As part of closing the health disparities gap, the NICHD has as one of its goals the support of research on the factors leading to infertility among minority men and women and the reasons for lower levels of use of infertility services in minority populations. Infertility-related disparities are likely to exist at multiple levels. First, disparities in the likelihood of facing infertility problems might be generated by disparities in age patterns of childbearing, number of children desired, and lifetime history of sexually transmitted infection acquisition and treatment. Second, disparities by income and race or ethnicity might exist in diagnosis (subfecund vs. sterile). Third, disparities might be generated by differences in access to health insurance with relevant benefits and income with which to purchase treatment services. Fourth, disparities might exist in the types of treatment available and in the response to and outcome of that treatment. This workshop was a unique effort to stimulate and enhance research in infertility that cuts across the social and clinical sciences. But scientific collaborations between the social sciences and the biological sciences, particularly with clinician scientists, have been rare. We firmly believe that joint work between clinician scientists and social scientists in this area will lead to improved strategies for the prevention and treatment of infertility in different racial, ethnic, and socioeconomic status populations. Several evolving directions in infertility research that deserve increased emphasis were presented during the workshop. The following is a
Fertility and Sterility姞 Vol. 85, No. 4, April 2006 Copyright ©2006 American Society for Reproductive Medicine, Published by Elsevier Inc.
0015-0282/06/$32.00 doi:10.1016/j.fertnstert.2006.01.007
collection of articles developed from specific research topics presented by the invited speakers. Acknowledgments: This special issue of Fertility and Sterility is a collection of articles developed from some of the presentations at a scientific workshop, “Health Disparities in Infertility,” that was supported by the National Institute of Child Health and Human Development (NICHD), the Office of Behavioral and Social Sciences Research (OBSSR), and the Office of Research on Women’s Health (ORWH) of the National Institutes of Health (NIH) and the Agency for Healthcare Research and
Fertility and Sterility姞
Quality (AHRQ) of the U.S. Department of Health and Human Services (DHHS). Organizing Committee, Health Disparities in Infertility, March 10 –11, 2005: Joan Davis, M.D., M.P.H., from the Reproductive Sciences Branch, and Rosalind Berkowitz King, Ph.D., from the Demographic and Behavioral Sciences Branch, NICHD, NIH, DHHS. Deborah Olster, Ph.D., at OBSSR, Vivian Pinn, M.D., at ORWH, and Susie Meikle, M.D., M.S.P.H., at AHRQ, were instrumental in obtaining support. Christine Bachrach, Ph.D., Phyllis Leppert, M.D., Ph.D., and Susan Newcomer, Ph.D., of the NICHD, provided scientific advice. Susie Meikle, M.D., M.S.P.H., of the AHRQ, also provided important leads in identifying key speakers for this conference.
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