Despite common misconceptions, Black women experience the highest rates of infertility among all ethnic groups. Yet many face significant delays in diagnosis and treatment due to systemic barriers, provider bias, and a complex history with reproductive healthcare. As healthcare professionals, understanding these challenges is essential to providing effective, culturally responsive care.
The Myth of Hyperfertility
One of the most harmful misconceptions about Black women’s reproductive health continues to be the stereotype of hyperfertility. As Donna Adams-Pickett, MD, PhD, explains, “The biggest misconception is that Black women don’t grapple with infertility. There is this stereotype of the hypersexual, hyper fertile Black woman who’s able to give birth to as many babies as she likes whenever she wants. But what many people don’t realize is that Black women have the highest infertility rate out of all ethnicities.”
This misconception directly impacts care, leading to delayed diagnosis and treatment. Faith Ohuoba, MD, MPH, FACOG, notes that “these systemic biases predispose Black women to having a delay in diagnosis and treatment.”
Barriers to Timely PCOS Diagnosis
Polycystic ovary syndrome (PCOS) patient Rhiannon Cook’s experience illustrates the consequences of these delays. Despite showing early signs of hormonal dysregulation, her symptoms were dismissed: “I showed signs very, very young of having a dysregulated hormonal system, particularly pain. And when I was taken to the doctor, it was like, ‘Let’s make sure she’s on birth control.’ I felt like my symptoms were being ignored and being covered over, and nobody had an explanation for why I had dysregulation in the first place.”
This experience is compounded by another harmful stereotype—that Black women have higher pain thresholds. “If I say my pain’s a seven, [providers think] she can take it. Here’s an Advil,” Cook shared.
Building Patient Trust Through Communication
Medical mistrust significantly impacts fertility care access. Healthcare providers must recognize this challenge and intentionally create safe spaces for open communication. Dr. Adams-Pickett emphasizes the importance of properly explaining treatment options: “Her providers really did not explain the biology and the physiology of the disease process to explain that even though these medications are called birth control pills, in this context, they were not being used for birth control. They were used to help with hormonal control.”
Dr. Ohuoba recommends “education is a big thing. Understanding what you want your family planning or your contraceptive health to look like and then working backwards. Sometimes you go to the office and you’re just told this, but you can actually present with ‘this is what I want for myself.'”
Provider Body Language Matters
Healthcare providers should be mindful that their communication style and body language can significantly affect patient trust. When asked about provider body language during her appointments, Cook described it as “absolutely authoritarian and authoritative. You’re half-dressed sometimes, sitting on a table, and they’re fully dressed in professional, white lab coat kind of situation. I believe they were standing as well. I remember just feeling cold and really disconnected from anything that felt comfortable for me.”
Holistic Approach to Reproductive Health
It’s essential to emphasize that reproductive health extends beyond fertility. As Cook points out, “I think the biggest most important thing is that your hormonal and reproductive health matters whether or not you intend to ever carry and have a pregnancy. The point of reproductive health is not necessarily fertility. In my body, fertility has been a healthy expression that everything’s working as it should.”
Practical Recommendations
- Take time to explain reproductive conditions and treatment options without assuming patients are only concerned with birth control.
- Acknowledge the historical context of reproductive injustice while providing comprehensive care options.
- Create a comfortable environment where patients feel seen and heard.
- Offer multiple treatment approaches and involve patients in decision-making.
- Recognize that fibroids, PCOS, and other reproductive conditions disproportionately affect Black women and require proactive screening.
- Consider how body language and communication style might affect patient trust.
By addressing these barriers with cultural competence, healthcare providers can help ensure Black women receive timely, appropriate care for reproductive health conditions, including PCOS and fertility concerns.