Racial Disparity in Healthcare Experience Among Women Seeking Fertility Care During the COVID-19 Pandemic

There are racial disparities in access and outcomes of assisted reproductive technology treatment in the USA; however, the effect of the pandemic on racial disparity within reproductive healthcare has not been extensively studied. This study aimed to identify how the pandemic has affected patient decision-making regarding fertility planning and treatment among Black versus non-Black women. The decision-making parameters that were assessed included discontinuing or changing the fertility treatment plans as well as visits to the clinic. This is a cross-sectional questionnaire study that was conducted at a university-affiliated fertility clinic between January and December 2021. A link to a survey was emailed to patients who were asked to fill out a questionnaire regarding fertility plans prior to and during the pandemic, in particular, the choice of the type of fertility treatment, exposure to COVID-19, and acceptability of the vaccine while trying to conceive, canceling or postponing the fertility treatment, and the use of telehealth during the pandemic. Out of 223 patients, the majority reported that the pandemic did not change their plans, and the minority reported either postponing or canceling their treatments with financial instability being the most reported reason. Fewer Black women were vaccinated compared to non-Black women. When asked whether the pandemic was well-handled by major healthcare systems, Black women were less likely than non-Black women to think that it met expectations. Additionally, Black women were less likely to be comfortable visiting fertility clinics in person and less interested in future at-home monitoring, if available, compared to non-Black women. Thus, among women undergoing fertility treatments during the pandemic, Black individuals were associated with a lower percentage of being vaccinated, a lower percentage of being satisfied with major healthcare systems handling the pandemic, and lesser comfort in visiting the fertility clinic physically. There is a clear need to understand the underlying reasons as to why the pandemic contributed to a racial disparity in fertility treatments.