Self-reported barriers to accessing infertility care: patient perspectives from urban gynecology clinics.
PURPOSE
(1) To test the hypothesis that under-represented minority women, including Hispanic/Latina and African American or Black women, will be more likely to report greater socioeconomic and cultural barriers to infertility care compared with white women. (2) To identify gaps in knowledge that can guide future educational interventions.


METHODS
A cross-sectional survey was completed by 242 women, ages 18-44, at five gynecology clinics in the greater Boston, Massachusetts area from February 27, 2018, to February 25, 2019.


RESULTS
Of the respondents, 61.4% identified as Hispanic/Latina, 24.5% as white, and 6.6% as Black or African American. Cost was the most commonly reported barrier to care (62.8%) regardless of race/ethnicity or insurance status. Only 8.9% of participants were aware of personal insurance coverage for infertility treatment. Compared with white patients, Hispanic/Latina patients were less likely to know if their own insurance covered infertility treatment: 14.3% vs 6.8%; aRR 0.36 (95% CI 0.17-0.74), after adjusting for a personal history of infertility.


CONCLUSION
Cost was the most commonly reported barrier to care. Most women were unaware of their insurance coverage despite the state insurance mandate to cover infertility treatment in Massachusetts. Education and outreach will be instrumental in helping address disparities in access to care.
['Insogna|Iris G|IG|http://orcid.org/0000-0002-4961-7584', 'Lanes|Andrea|A|', 'Hariton|Eduardo|E|', 'Blake-Lamb|Tiffany|T|', 'Schilling|Susan|S|', 'Hornstein|Mark D|MD|']
D000293:Adolescent D000328:Adult D003430:Cross-Sectional Studies D005260:Female D007722:Health Knowledge, Attitudes, Practice D006297:Health Services Accessibility D006801:Humans D007246:Infertility D007348:Insurance, Health D008875:Middle Aged D057566:Self Report D012959:Socioeconomic Factors D014481:United States D014505:Urban Population D055815:Young Adult
Infertility Disparities Access to care