Years of research have revealed that the health of people of colour is negatively impacted by racism:

• Immigrants from racially minoritised groups are exposed to higher levels of air pollution, linked to respiratory illnesses and other diseases.

• Black and other racially minoritised communities are at increased risk of suffering mental ill health.

• Black women are 2.9 times more likely to die during pregnancy or up to six weeks afterwards than their white counterparts.

These racialised health inequalities are shocking, but they're not new. In the wake of the COVID-19 pandemic, researchers and policymakers have confirmed long-standing health inequalities among Britain's different ethnic groups. And the fertility care sector is no exception, as multiple BioNews comment pieces and news articles have documented (see BioNews 1262, 1110, 1033 and 689).

The Human Fertilisation and Embryology Authority (HFEA) has consistently found racial disparities in fertility treatment access and outcomes, including IVF birth rates and the age at which treatment is first accessed (see BioNews 1110). The HFEA has also published reports detailing the additional difficulties that patients of colour experience when attempting to access donated eggs or sperm. While egg and sperm donations have increased over the years, the demand for eggs and sperm from black donors still outstrips the supply (see BioNews 1033).

In a new pilot research project, I explore how these and other factors shape black families' experiences of fertility care in the UK. This focus on black families is a response to the gap in race and fertility research. Existing research has highlighted disparities in the US context and in the UK, among South Asian communities (see BioNews 689), but few have investigated the unique experiences of black people in Britain.

The research is primarily informed by interviews with self-selecting representatives of three groups: donors, intending parents and professionals in the sector. The pilot's focus on patient experience makes an important contribution to the ongoing conversation about racial disparities in fertility care. We know that black patients are less satisfied with the fertility treatment they receive and that they seek treatment later than their white counterparts, but we don't know why (see BioNews 1110). This project aims to (at least partially) answer this question, capturing the diverse ways that blackness shapes and informs fertility treatment.

Early findings from the research suggest that, as in other sectors, the causes of racial disparities in fertility care are complex and systemic. Here, I focus on two significant, related themes repeated across interviews: fertility awareness and racist interactions with medical professionals. These themes are told through the experiences of one intending parent interviewed for this project: Adele (not her real name).

During interviews with intending parents and professionals, many have highlighted the negative impact that a poor understanding of reproduction has on both individuals and communities. Many intending parents told me that menstruation was not openly discussed during their childhoods, leaving many of them uncertain about what constituted 'normal' and when to seek help or medical intervention.

Adele was one example. After starting to experience inconsistent menstrual cycles in her late 30s, Adele was surprised to learn that her mother had gone through early menopause. Adele was frustrated that her mother had not shared this vital medical history because she thought she might have pursued motherhood earlier, had she known about this potential inheritance.

Treating reproduction as taboo is not unique to racially minoritised communities, but the existence of stigma in these groups can be weaponised to explain racial health disparities. Black and other minoritised communities are sometimes represented as less progressive or modern, creating a convenient explanation for lower rates of engagement with technological innovations such as IVF.

Understanding why reproduction is taboo is a complicated task. It requires taking many factors into account, such as opportunities to discuss stigmatised topics in purportedly neutral healthcare settings. But are these settings neutral?

In their most recent patient survey, the HFEA found that 77 percent of patients speak to a GP about their fertility options before pursuing treatment. This is understandable given that the process for accessing NHS-funded fertility treatment requires a referral from a GP. Interactions between GPs and patients thus play an essential role in managing access to fertility care. However, in interviews with black intending parents, some reported discouraging experiences with GPs and other healthcare professionals. Adele told me that it took over two years to get doctors to recognise her unpredictable cycle as a serious problem.

There are, of course, many factors that contributed to the inconsistent care that Adele received, but most poignant was Adele's sense that, because she was a black woman, healthcare professionals weren't especially motivated to help her become a mother. Towards the end of our interview, she told me: 'It's like our babies are not wanted. It feels like [medical professionals are saying] "We don't want any more of your babies"'.

So why do black patients start fertility care later? Stigma in black communities plays a role, but we must also address the impact of racist interactions with healthcare providers, whether actual or expected. For some of the women I interviewed, the anticipation of mistreatment was just as effective at discouraging them from accessing treatment as personal experiences of healthcare discrimination.

After the multiple visits and the dismissive attitudes of (white) healthcare professionals, Adele was planning to pursue treatment at a black-led fertility clinic where she expected that she would be treated, in her words, 'as a human'.

As my research captures, black patients have fought to access appropriate fertility treatment. They have conducted their own research, formed their own support groups and advocated for themselves to achieve the same standard of care as their white counterparts.

Black professionals in the industry, too, have spent years committing time, energy and resources to addressing racial disparities in fertility care. They've hosted podcasts, launched awareness campaigns and worked with community organisations to encourage understanding about fertility. But their efforts need support, particularly from the institutions that have the resources and the power to enact the systemic change required, the kind of change that addresses funding disparities and ensures equitable access to fertility care. We still have more to explore before these inequities can be eradicated.