title: Cultural factors contributing to health care disparities among patients with infertility in Midwestern United States.
abstract: OBJECTIVE
  To identify cultural differences in access to infertility care.
  
  
  METHODS
  Cross-sectional, self-administered survey.
  
  
  METHODS
  University hospital-based fertility center.
  
  
  METHODS
  Thirteen hundred fifty consecutive women who were seen for infertility care.
  
  
  METHODS
  None.
  
  
  METHODS
  Details about demographic characteristics, health care access, and treatment opinions based on patient race or ethnicity.
  
  
  RESULTS
  The median age of participants was 35 years; 41% were white, 28% African American, 18% Hispanic, and 7% Asian. Compared with white women, African American and Hispanic women had been attempting to conceive for 1.5 years longer. They also found it more difficult to get an appointment, to take time off from work, and to pay for treatment. Forty-nine percent of respondents were concerned about the stigma of infertility, 46% about conceiving multiples, and 40% about financial costs. Disappointing one's spouse was of greater concern to African-American women, whereas avoiding the stigmatization of infertility was of greatest concern to Asian-American women.
  
  
  CONCLUSIONS
  While the demand for infertility treatment increases in the United States, attention to cultural barriers to care and cultural meanings attributed to infertility should be addressed. Enhanced cultural competencies of the health care system need to be employed if equal access is to be realized as equal utilization for women of color seeking infertility care.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Missmer
authors.forename: David B
authors.initials: DB
authors.lastname: Seifer
authors.forename: Tarun
authors.initials: T
authors.lastname: Jain
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D015984:Causality; D003430:Cross-Sectional Studies; D003469:Culture; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data*; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy*; D008875:Middle Aged; D015146:Midwestern United States / Q000453:epidemiology; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D055815:Young Adult