Racial/Ethnic Differences in the Utilization of Infertility Services: A Focus on American Indian/Alaska Natives

OBJECTIVES. Previous studies have identified racial/ethnic disparities in infertility care, but patterns among American Indian/Alaska Natives (AI/AN) have not been reported. Our objective was to evaluate infertility services use in the US by race/ethnicity using data from the National Survey of Family Growth (NSFG). METHODS. We analyzed female respondent data from the pooled NSFG cycles 2002, 2006–2010 and 2011–2013. Respondents reported use of infertility services and types of services. We calculated weighted crude and adjusted prevalence proportion ratios (PPR) and 95% confidence intervals (95% CI) using modified Poisson regression with robust error variances accounting for the complex survey design to compare infertility services use across race/ethnicities. RESULTS: Overall, 8.7% of women reported using medical services to get pregnant. The prevalence of using any medical service to help get pregnant was lower for American Indian/Alaska Native (AI/AN) [PPR: 0.60, 95% CI: 0.43, 0.83] and black [PPR: 0.53, 95% CI: 0.44, 0.63] compared to white women and in Hispanic compared to non-Hispanic women [PPR: 0.57, 95% CI: 0.48, 0.67]. The prevalence of accessing treatment, testing, and advice also differed by race and ethnicity. CONCLUSIONS FOR PRACTICE: We observed disparities in accessing services to get pregnant among AI/AN and black women and reduced use of advice among Asian/Pacific Islanders compared to whites. We also observed reduced service utilization for Hispanic compared to non-Hispanic women. Differential utilization of specific services suggests barriers to infertility care may contribute to reproductive health disparities among underserved populations.