Whiteness, anti-Blackness, and Assisted Reproductive Technologies

Written by: Becca Williams, SBT Copywriter

If you’ve been following along for the last few weeks (with the exception of the most recent blog), you’ve probably noticed a theme – we’ve been talking a lot about reproductive rights and justice and the social and historical context of reproduction, particularly as it impacts Black folx as a function of White Supremacy.  I thought the blog on the origins of the reproductive justice movement would signal the end of that topic for us, and we’d move on.  But in the course of researching, I became really intrigued by a few more reproduction-related subjects so we’re going to stay here for a little while longer.

Today we’ll spend some time talking about Whiteness and Anti-Blackness in the realm of Assisted Reproductive Technologies (ARTs).  It sounds like a lot, and I promise that most of us have heard of ARTs in some form or another.   As I write this, I am undergoing an ART process myself – egg freezing to preserve my fertility – and I have noticed some elements of Whiteness in the ART spaces I’m in and the ways I occupy them; the clinic searches I conducted that yielded website results featuring a lot of White faces, the ways in which this type of reproductive “freedom” is spoken about particularly as it enables female-bodied folx to choose alternative parenting pathways including intentional solo parenting, and the Whiteness and classism that pop out from the message boards, blogs, and virtual support spaces I found myself engaging in. 

In general, despite this process being uncomfortable, emotional, costly, and time consuming I found that there was relative ease for me throughout my process.  I told most everyone (including y’all) about this as an attempt to normalize the topic.  I understand the inherent Whiteness in that, as well.  While there are stigmas around really anything fertility-related for women, which we’ll get into, I am able to move through this space unharmed and emerge feeling as though others around me view me as brave and empowered for undertaking egg freezing.  This is absolutely a measure of my Whiteness, the class privilege I have in being financially able to undergo this process, the predominantly liberal friends and family that surround me, and the acceptance of the idea that, at this time and for the last decade or so, I have chosen career-building over family-building. 

Although I rarely use social media, I decided to join a Facebook support group for this as most of the virtual meet-up groups for egg freezing in my area had been postponed.  Once in the Facebook group I was struck by how many White women were present and posting, and by how competitive the space seemed – not so much a gentle community as a place for women to compare notes in a way that immediately heightens the anxiety of everyone around them who then feel as though they aren’t doing it right.  That, and the question of one user around whether or not she should hire a personal assistant for this two-week process piqued my curiosity around who ARTs are available to, who has access to them, and who is thought of in the creation of ART spaces.  This delay in my joining the conversation of Whiteness and anti-Blackness in these spaces is another function of my Whiteness – that while this conversation has been happening for decades, I didn’t perceive it to be of interest until it was directly of interest to me. 

With that background, let’s jump in.  What exactly are Assisted Reproductive Technologies?  There are a few definitions out there, but the Centers for Disease Control and Prevention define ARTs as “all fertility treatments in which either eggs or embryos are handled.  In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman.”  Another definition, one I like a lot less, is from Medline Plus, a branch of the National Institute of Health: “ART is used to treat infertility”, and then it goes on to describe a few common processes.  Infertility carries a pretty large stigma in our society, and is generally defined as a person’s inability to become pregnant after a year of intercourse.  This is a very heteronormative definition that doesn’t include folx engaging in ARTs in order to preserve their fertility for future use for whatever reason (illness, readiness, etc). Common ART treatments are In vitro fertilization (IVF), egg freezing/oocyte cryopreservation, tubal embryo transfer (TET), and others, including the preservation and transfer of donor eggs.

(An infographic about ARTs.  Feel free to examine the Whiteness of this infographic, and the wording used.  From the SheCares website.)

From my experience, it’s pretty clear that at least in the case of egg freezing, White women are centered.  On the surface, White women are the ones I see in the brochures and injectable medication training videos, they predominantly are the folx I see not only in the waiting room at the clinic but they also are, for the most part, the clinical staff I see in the lab and exam rooms.  I live in Oregon which explains a lot of this, but this is a relatively common phenomenon.  Most of the podcasts I listened to and articles I read for this mentioned this issue of visibility in terms of Black folx not seeing people who look like them throughout this process which can lead to questions about the clinic’s capacity to care for Black women. 

ART processes are often costly, involve a lot of hormones and regular (seemingly daily) doctor’s visits, and are uniquely tied to our perception of who we are. Not seeing oneself reflected in this process is an incredible hurdle that Whiteness not only takes advantage of, but reinforces in various systemic ways.  The Association of American Medical Colleges notes that 5% of all physicians nationwide are Black, and 2.8% of those physicians identify as Black women.  And while this 2018 study looks at the experiences of Black men, the message about representation in the medical field is important:  Black men were 29% more likely to speak with Black doctors than White doctors about their health and to follow through on various health prevention measures when suggested by Black doctors.

Closely linked to issues of visibility within ART spaces are the challenges of availability, access, and stigma for Black folx throughout their fertility processes.  ART clinics tend to be geographically located in more White and affluent areas, presenting a direct barrier to ART availability. As I mentioned before, ART processes are costly and often not covered by insurance: rounds of IVF can cost between $12-$15k, not including expensive medications.   While this is not in and of itself a barrier for Black folx, keep in mind that Black women make 63% of what White men earn.  A UK study showed that Black women are 25 times less likely to access fertility treatment, and that while White patients accounted for 46,472 rounds of fertility treatment, Black patients only accounted for 1,526 rounds.  Additionally, Black women tend to drop out of fertility processes or wait for longer periods of time before beginning their fertility processes – often coming into fertility clinics or consulting with fertility doctors at a later age, which can make successful ART cycles more difficult.  Maternal race plays a significant role in the use and outcomes of ARTs, with Black, Asian American, and Latina women being overall less likely to use ARTs and, when they do, having less successful outcomes – less live births.    

(Estimated cost of some ART processes, found here.)

It's not simply the cost and geographical location of clinics that impact Black women’s choices around fertility.  Social stigma plays a huge role.  Many articles I read outlined the ways in which racist and societal expectations around womanhood, fertility, and the normalization of utilizing ARTs created an environment that made these choices seem less feasible.  Most Black women interviewed in this documentary, for example, noted the racist stigma around hyper-fertility in Black women – a stigma that has lingered from the early days of the forced reproduction of enslaved Black women. This stigma can affect a woman’s choice to seek out a fertility specialist, particularly when doctors hold much of this bias as well.  As I mentioned above, there is an inherent sense of shame in being deemed “infertile”, and that shame can be amplified given the historical context of forced reproduction, forced sterilization, and the overall continuous attempts of White Supremacist institutions to control Black populations.  

IVF and egg freezing can pave the way for women to think of intentional solo parenting, a process that for some White women is viewed with a sense of awe and power.  However, as this author writes, “Black women aren’t given the luxury of having their nontraditional choices appear to be new and radical”.  She goes on to note that Black women are often penalized for being single mothers, not only socially but by the government as well (remember the withholding of welfare benefits lest women [predominantly women of color] undergo sterilization?).

Aside from social, historical, and institutional stigmas, there are medical barriers as well.  Uterine fibroids, benign tumors either inside the uterus or in the muscle of the uterus can cause infertility and miscarriages.  Scar tissue left over from a myectomy, the surgery to remove fibroids, can also impede successful pregnancies.  Nearly a quarter of Black women between the ages of 18 and 35 develop uterine fibroids compared to 6% of white women.  By the age of 35, about 60% of Black women have developed uterine fibroids.  Black women are about twice as likely than their White counterparts to receive a hysterectomy – a surgery to remove the uterus, with many of these surgeries happening during childbearing years.  While the reasons for these disparities are still unclear and warrant more research, these differences are significant.  Doctors still believe Black folx have a higher tolerance for pain, and are less likely to believe Black women when they discuss their symptoms.  This can lead to delays in fertility treatment, dropping out of processes before completing, and overall disengagement.  Lastly, and we’ll get into this in a forthcoming blog, Black women are two to three times more likely than white women to die during childbirth.

 (Trailer for the Eggs Over Easy documentary.)

Many Black women interviewed for the Eggs Over Easy documentary mentioned how uncommon it was for them to discuss or receive support around uterine fibroids, hysterectomies, or other fertility and pregnancy-related issues, including miscarriages and stillbirths.  They mentioned a certain shame attached to these scenarios as it relates to the idea that Black women should be able to do anything, or at least pick themselves up from tragedy and keep going. 

 There are organizations and foundations that offer specialized support and care for Black folx seeking all types of fertility care.  Family Inceptions connects eggs donors to surrogates, and has resources for those wanting to become an egg donor – the organization was founded by Eloise Drane (also the host of the Fertility Café podcast). The Tinina Q. Cade Foundation provides information, support, and financial assistance to folx undergoing ARTs – their origin story is quite exceptional and I urge you to take a look.  And Fertility for Colored Girls, a nationwide organization started by Reverend Dr. Stacey L. Edwards-Dunn, offers local support groups, grants, and resources for women of color undergoing ART processes.

Fertility care and access to Assisted Reproductive Technologies are reproductive justice issues.  For a long time, these spaces have been built for and with White women in mind, once again centering Whiteness in the story about reproduction.  As we potentially enter into a post-Roe world, ideas around fertility, choice, autonomy, and when life begins are going to once again take center stage, alongside notions of control and coercion – challenges that have been present and fought back against in communities of color for centuries.  While these discussions inherently impact everyone, there is a unique context here for Black women and other women of color that needs to emerge at the forefront of the continued advocacy for reproductive justice. 

Additional Resources: 

This article nicely sums up some of the points made above, while bringing in some nuance around fertility barriers for active service members and providing some excellent recommendations.

 I highly recommend the Eggs Over Easy documentary (which can be accessed on Discovery Plus).  Here is an interview with the producer, Chiquita Lockley.

This article is written by a Black woman who describes her experience freezing her eggs during the pandemic.  

This last point could have been a whole blog post, and it just might become one.  The cells that were used to first discover and trial IVF processes are what are called HeLa cells, “immortal” cells that came from the same source and that can endlessly be multiplied in a lab.  The source of these cells is a Black woman named Henrietta Lacks, who died from cancer in 1951.  These cells have been used for decades for cancer research, to make the polio vaccine, to study stem cells, and for many other minor and major scientific discoveries.  Henrietta never provided her consent for her body to be used for research in this way and her family didn’t know about the use of her cells in science until 1973 and they have not been compensated, although the family has recently filed a lawsuit.  This ties together so much: the treatment of Black women by the medical field, the lack of transparency and accountability that White Supremacy condones, and the hypocrisy wherein a Black woman’s cells were used by White doctors to build a medical process that isn’t accessible to many Black women.