June 26, 2025

Infertility is a reproductive justice issue

by Jade S. Sasser, PhD and Calondra McArthur

Infertility, defined as an inability to conceive a pregnancy after one year of unprotected sex, is a global health problem affecting millions of people around the world; in fact, one in six individuals will experience infertility in their lifetime. These global dynamics are also reflected closer to home: according to the Centers for Disease Control, as many as one in eight couples in the U.S. are affected by infertility. That’s around 6.7 million people each year. 

But did you know/do you recognize that infertility is an issue of social and racial inequality? 

Rates of infertility follow broader patterns of racial health disparity, and access to fertility treatment is more difficult for women and gender-expansive people of color to attain. In order to effectively address infertility, we need to address it as the human rights and reproductive justice issue that it is, as stated in Ms. Foundation for Women’s report, The Color of Infertility: Race, Infertility, and Reproductive Justice in the U.S.

Infertility in the U.S. is marked by deep disparities in race, gender, ethnicity, and class. Black women are twice as likely as white women to experience infertility, even after adjusting for socioeconomic status, age, smoking, pregnancy intent and other factors. Black and Latina women on average spend 1.5 years longer than white women trying to conceive, as well as facing obstacles in getting treatment appointments, taking time off from work, and paying for treatment. Asian American patients have lower rates of pregnancy and live birth even after receiving treatment, while Native or Indigenous communities living on toxic polluted land have disproportionately elevated levels of toxic chemicals in blood and breastmilk. 

Structural racism, exposure to environmental pollutants including endocrine disrupting chemicals, and diminished access to high quality health care have long impacted health status in low income communities and communities of color. Research increasingly shows that these conditions are impeding communities of color from having the families they want.

When women and gender-expansive people of color do seek out fertility treatment, they are met with a further range of barriers, from biases against single women and LGBTQ+ patients seeking fertility services, to overcoming a range of access issues including basic knowledge about infertility and its treatment, cost of treatment interventions, location of fertility centers, ability to take time off from work, challenges securing treatment for disabled people, and a sense of racial and cultural isolation throughout. 

Add to that the ever increasing expansion of regressive politics into reproductive life: last year, Alabama’s Supreme Court issued a first of its kind decision stating that embryos hold the same legal protection as children, a decision that made it possible to take legal action against medical professionals who perform in vitro fertilization. While the Alabama legislature passed a bill protecting IVF providers from liability, it highlights the ongoing efforts to roll back reproductive rights in the wake of the Dobbs vs. Jackson Women’s Health Center decision.

The average IVF cycle can cost up to $20,000, which many insurance plans do not cover, leaving individuals and couples to pay out of pocket. Currently, 22 states require private insurers to cover or offer coverage for fertility services, however these laws differ widely and leave significant gaps, particularly for single women and LGBTQ+ couples. 

Many private employers do not cover fertility treatments, nor provide time off for employees to access appointments. For those who are covered by Medicaid, only four states cover some aspect of fertility treatment, however none cover IVF, intrauterine insemination (IUI), or egg and sperm freezing—the most expensive fertility treatments. 

As the fight for abortion rights continues, the movement for “reproductive justice” has been in more conversations; it’s important to note that the reproductive justice framework, coined by Black women activist over 30 years ago, supports the rights to have wanted children, not have unwanted children, and raise the children we do have in safe and healthy environments. 

Access to treatment for infertility supports the first pillar of that framework and we all have key roles to play in creating awareness of infertility and including it in discussions  about the reproductive justice movement.

We need stronger basic education to increase knowledge and awareness about fertility, pregnancy, miscarriage, stillbirth, and the range of health conditions impeding fertility; next, we need policy analysis and research into costs and benefits of providing fertility treatment in public and private health insurance plans; we need more research on equity, the impacts of financial barriers to treatment private grants and other funding sources, and other barriers to using fertility treatment services; we need more advocacy around supporting legislation that would establish a statutory right to access assisted reproductive technology (ART), including IVF, in every state in the U.S.; and we need philanthropists and movement leaders to invest in and recognize the holistic, full spectrum work that reproductive and birth justice communities and organizations such as Kuluntu Reproductive Justice Center, The Broken Brown Egg, Fertility for Colored Girls + Guys, and more are doing to provide and advance comprehensive fertility care.

Infertility is a matter of deep social and racial health disparity, but it doesn’t have to be.  

The ability to create a family is a human right. Comprehensive education, policy change, research, and funding for holistic reproductive justice programs will move us in the right direction and help more people of all backgrounds create the families they desire.