Barriers to fertility care for racial/ethnic minority groups: a qualitative systematic review

Abstract

Objective

To characterize patient-reported barriers to equitable fertility care for racial/ethnic minority groups

Evidence Review

We conducted a systematic review of the following 6 databases based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines: Ovid Medline, Embase, CINAHL, Cochrane Library, ClinicalTrials.Gov, and PsycInfo. Citations of full-text articles were also manually searched in the Scopus database. Original research studies were eligible for inclusion if they reported patient-reported outcomes regarding racial/ethnic equity or cultural competence in fertility care. All racial and ethnic groups, including Black, Hispanic, South/East Asian, Pacific Islander, and Indigenous groups, were eligible for inclusion. Screening, extraction, and appraisal were completed in duplicate by 2 independent reviewers. The Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices and the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research were used to assess the risk of bias and methodological quality.

Results

Of 2,921 original database citations, we included 17 studies, which encompassed 3,743 patients from racial/ethnic minority and immigrant/refugee groups. The key patient-reported barriers included stigmatization of fertility care, lack of infertility knowledge, language barriers, discrimination, and lack of institutional trust. These barriers can create psychological distress for patients as well as prevent help-seeking for infertility. As such, the different approaches for equitable care included provision of multilingual services, involvement of physicians of diverse backgrounds, incorporation of preferred traditional healers, awareness of religious beliefs, and screening for psychosocial services. However, it is important to ensure that fertility providers do not inadvertently stereotype patients or rely on blanket assumptions. An open-ended approach to cultural humility is recommended.

Conclusions

It is important for healthcare providers to consider the unique barriers for fertility care for racial and ethnic minority groups. This review describes a number of implementable solutions for equitable fertility care.