Bridging the Gap: Towards Reproductive Justice in Infertility Care – ACOG Recommendations

Diagnostic tests and treatments for infertility must be accessible to all individuals requiring these services. Discrepancies in infertility rates and obstacles to obtaining assisted reproductive technology should be recognized and tackled within the context of reproductive justice. Drawing from the guidelines established in this Committee Statement, the American College of Obstetricians and Gynecologists (ACOG) presents recommendations and insights concerning infertility within historically marginalized and deliberately excluded communities.

Disparities in Accessing Infertility Services

The paper focuses on the disparities in accessing infertility services and the importance of addressing these inequities within a reproductive justice framework. It highlights the need for diagnostic testing and treatment for infertility to be available to all individuals in need. The paper emphasizes that health care professionals should identify specific populations at risk, advocate for insurance coverage for infertility services, policy changes, and evidence-based, affordable treatment options.

Infertility as a Medical Disease

The paper stresses that infertility is a medical disease and not merely a social condition, urging health care professionals to provide medically and ethically sound care tailored to the patient's diagnosis. Obstetrician-gynecologists are recommended to inquire about reproductive planning and attempts at pregnancy, refer patients to subspecialists when necessary, and understand the specific barriers different populations face in accessing infertility care.

Disparities Highlighted in Infertility Care

Furthermore, the paper highlights disparities in both infertility prevalence and access to services. It mentions that certain racial and ethnic groups, such as Black women and Asian American patients, may have higher rates of infertility. It also discusses lower utilization of infertility services among Hispanic women and American Indian/Alaska Native populations. The paper points out the need for continuing research to improve outcomes, particularly in communities facing obstacles in accessing infertility services.

Reproductive Justice and Fertility Options

Reproductive justice, developed in the 1990s, emphasizes reproductive autonomy and the right to fertility options. Health care professionals are encouraged to address social determinants of health, mitigate biases, collaborate with support agencies, offer patient education on fertility, and advocate for insurance coverage for infertility services. The paper underlines the importance of recognizing and addressing biases in health care delivery, especially related to systemic racism and cultural beliefs affecting access to care.

Economic Barriers in Infertility Treatment Access

Moreover, the paper discusses economic barriers hindering infertility treatment access, particularly for marginalized communities. It calls for comprehensive insurance coverage for fertility treatment and the promotion of evidence-based, cost-effective treatment options. The importance of patient education on fertility, addressing health literacy disparities, and the need for inclusive research reporting to better understand disparities in infertility care are also highlighted.

Promoting Equitable Infertility Care

Overall, the paper emphasizes the significance of promoting access to infertility services, advocating for policy changes, and ensuring equitable care for all individuals, regardless of race, ethnicity, socioeconomic status, or gender identity, to achieve reproductive justice in the realm of infertility care.

Key Points

1\.*Disparities in Accessing Infertility Services\*\*: The paper highlights the importance of addressing inequities in accessing infertility services within a reproductive justice framework. It advocates for diagnostic testing and treatment to be available to all in need and stresses the role of health care profess*ionals in identifying at-risk populations and advocating for insurance coverage and policy changes.

2. Infertility as a Medical Disease*: Infertility is depicted as a medical disease rather than solely a social condition. The paper urges healthcare professionals to provide ethically sound care tailored to each patient's diagnosis. Obstetrician-gynecologists are recommended to inquire about reproductive planning, refer patients to subspecialists as needed, and understand the unique barriers different populations face in accessing infertility care.

3. *Disparities Highlighted in Infertility Care*: Disparities in infertility prevalence and service access are discussed, with certain racial and ethnic groups, such as Black women and Asian American patients, identified as having higher infertility rates. Lower utilization of infertility services is noted among Hispanic women and American Indian/Alaska Native populations, emphasizing the need for further research to improve outcomes, especially in communities facing barriers to infertility services.

4. *Reproductive Justice and Fertility Options*: The concept of reproductive justice, emphasizing reproductive autonomy and the right to fertility options, is introduced. Health care professionals are encouraged to address social determinants of health, mitigate biases, collaborate with support agencies, provide patient education on fertility, and advocate for insurance coverage for infertility services. Recognizing and addressing biases in healthcare delivery, particularly related to systemic racism and cultural beliefs impacting care access, is highlighted.

5. *Economic Barriers in Infertility Treatment Access*: Economic barriers that hinder access to infertility treatment, particularly for marginalized communities, are discussed. Comprehensive insurance coverage for fertility treatment, promotion of evidence-based and cost-effective treatment options, patient education on fertility, addressing health literacy disparities, and inclusive research reporting to better understand disparities in infertility care are emphasized.

6. *Promoting Equitable Infertility Care*: The paper underscores the importance of promoting access to infertility services, advocating for policy changes, and ensuring equitable care for all individuals regardless of race, ethnicity, socioeconomic status, or gender identity. This inclusive approach aims to achieve reproductive justice in infertility care, emphasizing the need for fairness and equality in accessing and receiving infertility services.

Reference –

Infertility: Disparities and Access to Services: ACOG Committee Statement No. 14. Obstet Gynecol. 2025 Jan 1;145(1):e51-e57. doi: 10.1097/AOG.0000000000005769. PMID: 39666991.