The Fight For Fertility Equity: Expanding Access To Reproductive Health Services

Fertility equity is about ensuring that all women, regardless of race, socioeconomic status, or geographic location, have equal access to fertility treatments and reproductive health services. However, the reality is far from equitable. High costs, limited insurance coverage, and systemic racism in healthcare disproportionately affect women of color and those in lower-income communities.

Dr. Leia Belt, health data fellow at AcademyHealth, said obstetric racism is one of the biggest barriers to achieving fertility equity.

“Racism is one of the biggest factors impacting Black women’s outcomes,” she said. “Even when we account for socioeconomic status, education, or the neighborhoods they live in, racism remains a significant predictor of poor reproductive outcomes.”

For many women of color, the journey to motherhood is fraught with challenges that go beyond financial barriers.

Leia said obstetric racism leads to delayed diagnoses for conditions like uterine fibroids and polycystic ovarian syndrome, which disproportionately affect Black women. According to the National Institutes of Health (NIH), more than 80% of Black women are likely to suffer from uterine fibroids. 

“We hear cases, or can see in the data, that there’s neglect or dismissal,” she said.

High-profile cases, such as those of Serena Williams and Beyoncé, underscore how even wealth and fame cannot protect Black women from being dismissed or coerced in medical settings.

The financial burden of fertility treatments is another significant barrier. IVF can cost upwards of $15,000 per cycle, a cost that is out of reach for many. Only about 42% of U.S. employers offer some form of fertility benefits, leaving a significant gap in coverage.

Medicaid coverage for infertility treatments is expanding, but Leia said it’s currently available in only a handful of states, including New York, Utah, and Washington, D.C.

“We can see the conversation moving, but less than 16% of states offer this coverage,” she said.

Efforts to expand fertility equity are gaining momentum. The Black Maternal Health Momnibus Act, a significant piece of legislation introduced by the Black Maternal Health Caucus, focuses on expanding Medicaid coverage for postpartum care and diversifying the medical workforce. However Leia said the act falls short of directly addressing fertility treatment access.

“This policy doesn’t talk about fertility,” she said. “They’re working on Momnibus Act 2 to hopefully address this gap.”

The challenges extend beyond policy. Geographic disparities further complicate access, with many women living in maternity care deserts where the nearest OB-GYN may be hours away. Approximately 35% of U.S. counties are considered maternity care deserts, impacting over 5 million women of reproductive age, according to the March of Dimes. Leia’s research in Iowa, for example, highlights how long commutes and limited healthcare options act as significant barriers for women seeking fertility care.

Local organizations and community health workers play a crucial role in advancing fertility equity.

Leia said doulas, midwives, and community birth centers often fill gaps left by larger healthcare systems, providing essential reproductive health services in underserved areas. However, these organizations face sustainability challenges, from inadequate funding to burnout. According to the findings from the Mama Glow Foundation, 77% of doulas reported feeling unwelcome and disrespected in hospital settings, and 37% struggled with unpaid labor and poor working conditions, contributing to high rates of burnout. ​

“Training more Black doulas and midwives is essential, but without infrastructure and support, we risk burnout and turnover,” she said.

Leia also advocates for deeper partnerships between policymakers, researchers, and community organizations.

“True community partnership and collaboration are the only way we can move past these systemic barriers,” she said. “Research methods that amplify the voices of those directly impacted, such as Photo Voice, are part of her work to make healthcare policy more responsive and inclusive.”

Fertility equity is a multifaceted issue that requires comprehensive policy changes, increased insurance coverage, and a dismantling of structural racism within healthcare systems.

Leia said addressing the intersectional barriers that women of color face is crucial for making real progress. Black women are three times more likely to die from pregnancy-related complications than white women, according to the CDC , highlighting the urgent need for systemic changes.

“There are so many structural and institutional factors that target Black women,” she said. “This isn’t about individual behavior but about changing the systems that fail us.”

Achieving fertility equity will require not only legislative action but also a commitment to listening to and uplifting the voices of those most affected. Until then, the fight for fertility equity continues.