People who study the fertility business have been concerned for years over the fact that racial minorities utilize fertility treatments at a lower rate than whites. One easy explanation is the distribution of wealth in the U.S. Fertility care is expensive and often not covered by insurance, and some people in racial minority groups do not seek care because they are priced out of the market. But, this explanation is incomplete because even in states where insurance covers fertility treatments, African American and Hispanic women are underrepresented among those seeking fertility treatments.
Another concerning possibility is that some sort of conscious or unconscious racist norms operate within the business. As law professor Dorothy Roberts pointed out in an important essay over 15 years ago, however, the problem is that "[e]vidence is hard to come by." Last summer, several research assistants and I tried to uncover some evidence by looking at virtually every U.S. fertility clinics' website to see what these websites say about the cultural norms present in the fertility industry. Despite going into the project knowing about the concerns of other scholars, I was surprised by what we found.
The first thing we looked at was the race of the babies in the pictures that are prominently featured on most clinics' websites. Looking just at first page that pops up when we typed in the website address, we recorded the races of the babies we saw. Of the 294 websites that presented images of babies, 62.93 percent presented pictures of only white babies. Contrast that number with the number of websites that had pictures exclusively of another race: 1.02 percent of websites presented images of only a black baby; 0.34 percent had an image of only a Latino baby; and 1.02 percent had a picture of only an Asian baby. Some websites had pictures of babies from multiple races, and if you count those, 97.28 percent of websites with pictures of babies have pictures of white babies.
The number of reproductive endocrinologists in the U.S. who are racial minorities mirrors the pictures of babies, suggesting racial minorities are underrepresented in the field. Of the 1,124 reproductive endocrinologists' races we recorded on clinics' websites, 79.89 percent were white, 2.14 percent were black, 4.27 percent were Latino, 8.27 percent were Asian, and 5.43 percent were of other races.
So what do these numbers tell us about why members of racial minority groups do not use ART as often as whites? Part of the answer is that racial minorities might not see fertility care as welcoming to minorities or as a treatment to which they have access. Social psychologists tell us that we often make decisions based on what we see other people doing. It is called the social proof principle -- think of laughing at an inane sitcom when you hear the laugh track run. And, we are most likely to follow the behavior of people who are most similar to us. It is possible that pictures of white babies and pictures of white doctors give social proof to white individuals considering fertility care but not to people who are of other races, driving up the number of white patients and driving down the number of patients from other races.
Here is where the law or self-regulation in the fertility industry could help. For instance, fertility clinics or the trade association to which these clinics belong could make a conscience effort to include more pictures of babies of different races in their marketing efforts. It is also possible lawmakers could intervene. The Fair Housing Act, as an analogy, allows courts to order rental businesses who have engaged in discrimination to integrate different races into their advertising, and similar provisions could be enacted here to ensure that clinics' pictures represent the entire US population.
But, until someone steps up to fix this problem, we are left with a deeply troubling reality -- the picture of fertility care in our country is predominantly a picture of white parents using treatments to have white babies with the help of white doctors.
The full results of my paper and the methodology can be downloaded for free here.