A Step Towards Equitable Access: Understanding the Use of Fertility Services by Immigrant Women in Toronto

The authors sought to study whether there is differential access to fertility services for immigrant women in a single-payer system.

A cross-sectional quantitative survey was administered to 265 patients over 3 months. All participants were female patients in heterosexual relationships at a university-affiliated hospital-based fertility clinic in a large metropolitan city. Data on sociodemographic characteristics, reproductive history, and experience accessing fertility services were collected. Statistical analysis, including chi-square and ANOVA regression, was completed using JMP software.

The response rate of the survey was 86.6%. A total of 265 women participated, 124 (47%) immigrants and 141(53%) non-immigrants. Immigrants more commonly left questions unanswered. Long-term immigrants had a significantly longer average duration of infertility than non-immigrant women (47 months vs. 34 months; P = 0.04). There was a trend towards a delay in seeing a health care provider among long-term immigrants. The most commonly reported reasons for delaying fertility care were "not knowing there was a problem" and "treatments being too expensive." Although participants across all groups relied on their primary care provider to supply information on fertility services, a greater percentage (17%) of recent immigrants than non-immigrant participants (7%) used the Internet to obtain information.

Immigrant women addressed their fertility needs even when they had fewer resources and less social stability than did non-immigrant women. However, they experienced a delay in receiving specialized care for infertility. Immigrant women also appeared less comfortable disclosing personal information in a health care setting.