DaKysha Moore, Elijah O. Onsomu
Background
Though it is not uncommon, infertility is a topic many women try to avoid, as it may have a stigma attached. The Centers for Disease Control and Prevention (CDC, 2021) define infertility as “not being able to get pregnant (conceive) after one year (or longer) of unprotected sex” (para. 1) and recommend intervention after six months for couples aged 35 and older. Infertility, in the U.S., impacts 6 to12 percent of women 15-44 (CDC, 2021). Note that a quarter of couples have health conditions related to infertility that affect both men and women (American Society for Reproductive Medicine, 2017).
Fertility declines over time especially after age 35 for women (American Society for Reproductive Medicine, 2012). However, declining fertility with age may not be common messages in the media about pregnancy among women in their 30s and 40s. One study focusing on print messages about celebrities and pregnancy found that the messages did not address the difficulty of conceiving and maintaining a healthy pregnancy at an older age, nor the possibilities of reproductive technologies, which could play a role in how women think about pregnancy at an older maternal age (Wilson, Perelman & Goldman, 2019). Knobloch-Westerwick, Willis, and Kennard (2016) found that media images swayed how women aged 21-35 thought about the number of children they wanted to have in the future. For example, the participants wanted more kids who had “exposure to mother/homemaker” messages (Knobloch-Westerwick et al., 2016, p. 653).
It is important for media messages to give an accurate representation of infertility as millions of American couples deal with infertility. Couples struggling to conceive may try assisted reproductive technology (ART) options like IVF. There are several reasons for seeking reproductive assistance. Some women might have medical conditions that might affect their fertility, such as cancer. Other women may not be ready to have a child but are concerned about their later fertility, and some motivated by lack of a partner and fear of losing fertility years (Baldwin et al., 2015; Baldwin, Culley, Hudson, & Mitchell, 2019) may try oocyte cryopreservation, or egg freezing (Mayo Clinic, 2021). Doing so without a medical reason is called “social egg freezing,” and it can be controversial (Harwood, 2015). Hodes-Wertz, Druckenmiller, Smith, and Noyes (2013) surveyed women who froze their eggs. Many reported not knowing about the procedure before conducting research and wished they had made the decision to have it completed earlier than in their mid-30s.
The infertility rate for Black women is almost twice that of White women (Chandra, Copen, & Stephen, 2014), and African American couples are often left out of the mainstream conversation. Ceballo, Graham, and Hart (2015) interviewed 50 African American women about their struggles with infertility and found they felt, not only a level of stigma, but also, they were unable to share their feelings including with family. Moreover, when they do experience infertility, Black women are significantly less likely to receive infertility treatments, such as in-vitro fertilization (IVF) (Seifer, Frazier, & Grainger, 2008).
Purpose
This exploratory study is designed to discover young Black women’s interpretations of media messages regarding infertility and egg freezing. These conversations are important as more Black women wait to become mothers.
Methods
Participants identified as Black women between the ages of 20-25, who were undergraduate college students. These parameters were chosen because typically this population of women are focusing on starting their careers as opposed to not about starting a family. After gaining Institutional Review Board (IRB) approval, data were collected during spring 2019 using a survey with more than six questions. In addition, two focus groups were conducted engaging three women in each. Although focus groups are usually conducted with at least four people to promote interaction, (Morgan, 2019), our participants shared their thoughts on the topic and engaged strongly with each other and the interviewer, so we feel our aims were accomplished.
For the research design, a phenomenological approach allowed the young women to explain their experiences with perceptions of messages about infertility and ART. This approach allows for a small number of participants before data saturation may occur in terms of similar meanings about messages (Polkinghorne, 1989). At the outset, the researcher responsible for conducting the focus groups showed a short clip from each of two videos, one from a television show episode about egg freezing and the other from a news story on egg-freezing boutiques. The videos helped to start the discussion on infertility and treatments among Black women. Each focus group took between 30 and 60 minutes and was audio-recorded. Later, researchers used an app to assist with transcription and checked the transcription for any mistakes, which were corrected along with grammatical errors. The data were then analyzed for major themes.
Results
The researchers identified three main themes: 1) not a Black female problem, 2) stigma, and 3) lack of awareness about egg freezing.
Not a Black female problem
Focus group participants reported they were not aware of infertility concerns among other Black women and did not generally think about their own future attempts to become mothers. Many felt that the media did not give messages on fertility among their population.
I don’t hear anything. I have a couple of social media platforms, and I can’t even count one time I’ve seen an ad or, like, a little commercial on YouTube … about Black infertility. I have seen ads about general infertility, but it’s always a White woman as the face of the ad or the commercial, like it is more of their demographic. (Participant 2)
I feel like it’s not enough. As far as explaining the importance of infertility and the different options that are out here for us to help with fertility and IVF and other options that are here. (Participant 4)
I haven’t seen either or, like, I don’t see it for Black Americans and for White women. (Participant 1)
Like she said, I don’t think it’s broadcast enough because Black women—they’re not known to be infertile from what the media says. But you know, that’s something different. But it’s not—it’s more so White women are portrayed as being infertile and stuff like that, and not more Black women. Black women are known in the media to have all these kids and all that stuff. And that’s usually not the case. (Participant 6)
However, as one participant explains, regardless of media messages, infertility is not a conversation among those in their social circles. Therefore, young Black women may have trouble thinking about the health concerns that could hurt their ability to become a mother in the future.
Now, as far as infertility, I feel like nobody discusses that because, I mean, you see so many people have kids that it’s not really a thought that comes into a woman’s mind. I mean, you know, if I’m around this person, this person, and this person, and about three people I know have a kid…. then I’m saying, okay, they have kids—one day I’ll probably have a kid … (Participant 3)
The participants believed several images of Black women could hinder how they feel about having kids. They felt that the stereotype of Black women having many kids explains why more conversations address avoiding pregnancy than future infertility.
I will have to say especially within media, they portray a Black woman as not being in tune with her health and not educated when it comes to, you know, fertility issues. Honestly, I didn’t even know African American women have fertility issues. Because on TV and stuff, we see Black women with lots of kids, and it’s so easy to have kids and get pregnant, and we don’t have fertility problems. (Participant 5)
I also think, a lot of times, it takes a while for women to find out that they aren’t fertile. For I know, for me, growing up as a young Black woman, the number one thing to do is to not get pregnant before marriage. (Participant 4)
I mean, as far as media portraying that to, like, Black women—I’ve seen birth control ads that go to, like, all woman, but like she was saying, it’s more like word of mouth. Like, it’s such a commonality, like, ‘Oh, you need to go to birth control,’ like I’ve had so many friends tell me, like, ‘You need to get on it.’ (Participant 2)
If you’re, like, sitting around your friends, and I don’t know if y’all can attest to this, but if you sit around your friends, how many of your friends do you know who are Black that are on birth control? (Participant 3)
Stigma
The comments from focus group participants show they felt media images do not demonstrate Black women’s struggles to become pregnant, but rather present a false narrative that Black women become pregnant easily. This stereotype could leave those who struggle to become a mother feeling a level of shame.
Like, if I’m getting judged by my family, why am I going to go talk about it amongst other people, too? I mean, yeah, I am going to learn about what I can do. But most people aren’t there. They are just going to be quiet and keep to themselves and think that there is something wrong with them. (Participant 1)
It’s something that’s in our culture. We—you know—we’re nurturers; we’re providers; we have children; we bear children for our men, and we bring people— we populate the Earth. That’s what we did. …Of course, you have your family. You have this expectation that you’re trying to live up to, when, really, you’re just human, and everybody’s different. (Participant 3)
Pregnancy, young, and Black are portrayed as a negative thing, and so you’re married and older. And once you do become married and older, and you can’t have kids, it’s portrayed as a negative thing. So it’s like … once I get to this point in my life, where I am ready to get ready to carry children, it’s too late. And then I have to face, you know, all these different options. (Participant 4)
Lack of awareness about egg freezing
When discussing the possible messages about IVF and egg freezing, the participants mentioned they did not see messages about the topic in traditional or new types of media.
I haven’t seen any towards our younger generation of women. I really haven’t. I wasn’t even aware about freezing eggs in that we could do that. (Participant 2)
Some of our commercials will talk about, like, selling your eggs, donating, or, like, anything except freezing. I have yet to see anything about freezing your eggs for, like, having a child later in life. I’ve yet to see that. (Participant 1)
On social media, I see a lot of pregnant women. I don’t really see any advertisements about women [who] can’t have babies at all. I didn’t even really know that you could freeze your eggs and get a baby out of it. I had no clue about that. (Participant 3)
Participants felt that learning more about egg freezing could help them to ensure their fertility if they decided to conceive later in life. They considered it a viable option as they discussed trying to achieve other goals before starting a family.
I would definitely have to say that’s very beneficial because—I know I can only speak for myself—I want to get my PhD. I want to do a lot of big things, and so having kids is kind of like on the back burner for me. And so it’s good to have a backup plan, so when I am ready to have kids, and I am married, and I have all my career goals accomplished, you know, you have that option. (Participant 5)
They might want to just focus on their career and get their life situated before they decide that they want to have a child, so I think that’s kind of like a positive thing. They could always go back and be like—maybe when they’re like 31—be like, ‘Okay, I’m ready to have a child like right now,’ so they could always go back to it, that whole process started. (Participant 6)
And a lot of times—you know—these days marriage is one of those things that’s supposed to happen once you’re much older. And we’re establishing, well, once I get to that point, it might be too late. And then what do I do? So I felt like we did have more access to information about our bodies and how important it is to be on top of these things. Maybe we can go ahead and freeze our eggs, so when we do get ready for marriage, we won’t have that issue. (Participant 4)
Many participants felt that Black women need to know more about the health problems they might encounter when trying to conceive later in life as well as their medical options.
I think if we educate Black women [about] … how, you know, it is time sensitive to have children, I think more people would be interested in the IVF process because, I mean, we just think we have forever, right? And I think it’s important that we … let people know that, so when they do get up there and age, they’re not hit in the face where they will update or even if I do get egg freezing, how many do I have to get frozen, or are they any good? (Participant 4)
Even though the participants mainly presented a positive response to the idea of possibly freezing their eggs for future motherhood, this ART process raised some concerns.
They don’t talk about, like, the emotional parts you can go through, like how you said she was depressed and, like, hormones and all that stuff, especially with the body internally … how that would affect like the monthly cycle. (Participant 6)
They don’t talk about the side effects. They don’t emphasize; they make it look easy. You don’t—you know, when you’re messing with your body, people don’t realize there’s some type of side effect that’s going to happen. I just wish they’d emphasize that a little bit more. (Participant 5)
Discussion
Overall, the participants’ comments suggested a lack of messaging about infertility in the Black community. They did not know much about the subject or its implications for their reproductive health, in line with previous research showing that Black women, in some situations, are less knowledgeable about infertility than other women (Wiltshire et al., 2019).
Most participants noted that the media messages they see about Black women and pregnancy are, in some cases, based on stereotypes. A few felt that the idea of infertility contradicted family members’ insistence on the importance of both not getting pregnant when young but having a family later in life. Despite these discrepancies, research has shown that Black women have a higher rate of infertility than White women (Craig, Peck, & Janitz, 2019; Wellons et al., 2008) and over twice the rate of infant mortality (DHHS, Office of Minority Health, 2019).
Like women of other racial and ethnic backgrounds, Black women are giving birth at an older age (Livington, 2018; Sweeney & Raley, 2014). A study conducted by the Pew Research Center shows that as women become more educated, they have fewer children (Livingston, 2015a). Furthermore, for women with advanced degrees, more than 50 percent did not have a child until they were in their 30s (Livingston, 2015b). Even though one participant in the current study has a child, others indicated they would prefer to wait until they accomplish more personal and professional goals, such as obtaining advanced degrees. As women wait to start families, their fertility may become problematic, which is one reason why younger women are starting to freeze their eggs for even nonmedical reasons.
Interestingly, the participants in this study shared that they had seen and received messages about egg donation to help other women who cannot use their own but heard little about the topic of egg freezing, and the information was not detailed. Barbey (2017) explains that advertisements about freezing eggs should give more information about risks and successful outcomes. Moreover, participants who had encountered messages about egg freezing did not feel included as Black women in the visual or verbal cues. According to the American Society for Reproductive Medicine (ASRM, 2020), during 2014-2016, approximately 66 percent of the women who used egg freezing were White and only 7 percent Black, which shows that Black women could be disproportionately disadvantaged as it pertains to the option to help assure the future possibility of becoming a mother.
The participants emphasized that they would be interested in learning more about egg freezing but expressed concerns about physical or emotional side effects. Research supports this apprehension as Campo-Engelstein et al. (2018) analyzed print media information on social egg freezing and found the medical procedure was oversimplified as a tool to help women advance in their careers. Bayefsky (2021) also raised some concerns about how egg freezing is advertised in the media. Overall, the participants in the current study thought the procedure could help them if they waited to have a baby.
Implications
Media messages about infertility and assisted reproductive technology should include young Black women and educate them about infertility and options to start a family in the future. Young women should be aware of the potential health consequences if they decide to undergo procedures, such as egg freezing. Messages about infertility in the Black community should also address cultural stereotypes and stigma. The current exploratory study was designed to open a discussion of the problems that could affect young Black women who hope to become mothers in the future. The number of participants was small, so the results cannot be generalized.
References
American Society for Reproductive Medicine. (2012). Age and fertility: A guide for patients revised 2012. https://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/Age_and_Fertility.pdf
American Society for Reproductive Medicine. (2017, March 8). Quick facts about infertility. https://www.reproductivefacts.org/faqs/quick-facts-about-infertility/
American Society for Reproductive Medicine. (2020, October 19). New study showcases trends in egg freezing among racial/ethnic groups. https://www.asrm.org/news-and-publications/news-and-research/press-releases-and-bulletins/new-study-showcases-trends-in-egg-freezing-among-racialethnic-groups/
Baldwin, K., Culley, L., Hudson, N., Mitchell, H., & Lavery, S. (2015). Oocyte cryopreservation for social reasons: Demographic profile and disposal intentions of UK users. Reproductive BioMedicine Online, 31(2), 239–245. https://doi.org/10.1016/j.rbmo.2015.04.010
Baldwin, K., Culley, L., Hudson, N., & Mitchell, H. (2019). Running out of time: Exploring women’s motivations for social egg freezing. Journal of Psychosomatic Obstetrics & Gynecology, 40(2), 166–173. https://doi.org/10.1080/0167482X.2018.1460352
Barbey, C. (2017). Evidence of biased advertising in the case of social egg freezing. The New Bioethics, 23(3), 195–209. https://doi.org/10.1080/20502877.2017.1396033
Bayefsky, M. J. (2021). Legal and ethical analysis of advertising for elective egg freezing. The Journal of Law, Medicine & Ethics, 48(4), 748–764. https://doi.org/10.1177/1073110520979386
Campo-Engelstein, L., Aziz, R., Darivemula, S., Raffaele, J., Bhatia, R., & Parker, W. M. (2018). Freezing fertility or freezing false hope? A content analysis of social egg freezing in U.S. print media. AJOB Empirical Bioethics, 9(3), 181–193. https://doi.org/10.1080/23294515.2018.1509153
Ceballo, R., Graham, E. T., & Hart, J. (2015). Silent and infertile: An intersectional analysis of the experiences of socioeconomically diverse African American women with infertility. Psychology of Women Quarterly, 39(4), 497–511. https://doi.org/10.1177/0361684315581169
Centers for Disease Control and Prevention. (2021, April 13). Reproductive health. https://www.cdc.gov/reproductivehealth/infertility/index.htm
Chandra, A., Copen, C. E., & Stephen, E. H. (2014). Infertility and impaired fecundity in the United States, 1982–2010: Data from the National Survey of Family Growth (National Health Statistics Reports 67) Hyattsville, MD: National Center for Health Statistics.
Craig, L. B., Peck, J. D., & Janitz, A. E. (2019). The prevalence of infertility in American Indian/Alaska Natives and other racial/ethnic groups: National Survey of Family Growth. Pediatric and Perinatal Epidemiology, 33(2), 119–125. https://doi.org/10.1111/ppe.12538
DHHS, Office of Minority Health. (2019, November 8). Infant mortality and African Americans. https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=23
Harwood, K. A. (2015). On the ethics of social egg freezing and fertility preservation for nonmedical reasons. Medicolegal and Bioethics, 5, 59–67. https://doi.org/10.2147/MB.S66444
Hodes-Wertz, B., Druckenmiller, S., Smith, M., & Noyes, N. (2013). What do reproductive-age women who undergo oocyte cryopreservation think about the process as a means to preserve fertility? Fertility and Sterility, 100(5), 1343–1349. https://doi.org/10.1016/j.fertnstert.2013.07.201
Knobloch-Westerwick, S., Willis, L. E., & Kennard, A. R. (2016). Media impacts on women’s fertility desires: A prolonged exposure experiment. Journal of Health Communication, 21(6), 647–657. https://doi.org/10.1080/10810730.2016.1153757
Livingston, G. (2015a, May 7). Childlessness falls, family size grows among highly educated women: Family size among mothers. Pew Research Center. https://www.pewresearch.org/social-trends/2015/05/07/childlessness-falls-family-size-grows-among-highly-educated-women/#:~:text=Childlessness%20Falls%2C%20Family%20Size%20Grows%20Among%20Highly%20Educated%20Women,-By%20Gretchen%20Livingston&text=Among%20women%20in%20the%20United,over%20the%20past%20two%20decades.
Livingston, G. (2015b, January 15). For most highly educated women, motherhood doesn’t start until the 30s. Pew Research Center. https://www.pewresearch.org/fact-tank/2015/01/15/for-most-highly-educated-women-motherhood-doesnt-start-until-the-30s/
Livingston, G. (2018, January 18). They’re waiting longer, but U.S. women today more likely to have children than a decade ago. Pew Research Center. https://www.pewresearch.org/social-trends/2018/01/18/theyre-waiting-longer-but-u-s-women-today-more-likely-to-have-children-than-a-decade-ago/
Mayo Clinic. (2021, April 23). Egg freezing. https://www.mayoclinic.org/tests-procedures/egg-freezing/about/pac-20384556.
McQuillan, J., Greil, A. L., Shreffler, K. M., & Bedrous, A. V. (2015). The importance of motherhood and fertility intentions among U.S. women. Sociological Perspectives, 58(1), 20–35. https://doi.org/10.1177/0731121414534393
Morgan, D. (2019). Introducing focus groups. In D. L. Morgan (Eds.), Basic and advanced focus groups (pp. 3–16). SAGE Publications, Inc. https://dx.doi.org/10.4135/9781071814307.n1
Polkinghorne, D. E. (1989). Phenomenological research methods. In R. S. Valle & S. Halling (Eds.), Existential-phenomenological perspectives in psychology: Exploring the breadth of human experience (pp. 41–60). Plenum Press.
Seifer, D. B., Simsek, B., Wantman, E., & Kotlyar, A. M. (2020). Status of racial disparities between Black and White women undergoing assisted reproductive technology in the US. Reproductive Biology and Endocrinology, 18, 113. https://doi.org/10.1186/s12958-020-00662-4
Seifer, D. B., Frazier, L. M., & Grainger, D. A. (2008). Disparity in assisted reproductive technologies outcomes in black women compared with white women. Fertility and Sterility, 90(5), 1701–1710. https://doi.org/10.1016/j.fertnstert.2007.08.024
Seifer, D. B., Zackula, R., & Grainger, D. A. (2010). Trends of racial disparities in assisted reproductive technology outcomes in black women compared with white women: Society for Assisted Reproductive Technology 1999 and 2000 vs. 2004–2006. Fertility & Sterility, 93(2), 626–635. https://doi.org/10.1016/j.fertnstert.2009.02.084
Sweeney, M. M., & Raley, R. K. (2014). Race, ethnicity, and the changing context of childbearing in the United States. Annual Review of Sociology, 40, 539–558. https://doi.org/10.1146/annurev-soc-071913-043342
Wellons, M. F., Lewis, C. E., Schwartz, S. M., Gunderson, E. P., Schreiner, P. J., Sternfeld, B., Richman, J., Sites, C. K., & Siscovick, D. S. (2008). Racial differences in self-reported infertility and risk factors for infertility in a cohort of black and white women: The CARDIA Women’s Study. Fertility and Sterility, 90(5), 1640–1648. https://doi.org/10.1016/j.fertnstert.2007.09.056
Wennberg, A-L. (2020). Social freezing of oocytes: A means to take control of your fertility. Upsala Journal of Medical Sciences, 125(2), 95–98. https://doi.org/10.1080/03009734.2019.1707332
Willson, S. F., Perelman, A., & Goldman, K. N. (2019). “Age is Just a Number”: How celebrity-driven magazines misrepresent fertility at advanced reproductive ages. Journal of Women’s Health, 28(10), 1338–1343. https://doi.org/10.1089/jwh.2018.7433
Wiltshire, A., Brayboy, L. M., Phillips, K., Matthews, R., Yan, F., & McCarthy-Keith, D. (2019). Infertility knowledge and treatment beliefs among African American women in an urban community. Contraception and Reproductive Medicine, 4, 16. https://doi.org/10.1186/s40834-019-0097-x
- JourMS - 