title: Racial Disparities in Seeking Care for Help Getting Pregnant.
abstract: BACKGROUND
  Fertility counselling and treatment can help women achieve their desired family size; however, disparities exist in the utilisation of this care.
  
  
  METHODS
  This study examines the persistence of a racial disparity in visiting a doctor for help getting pregnant by estimating the direct effect of this association using data from the Furthering Understanding of Cancer Health and Survivorship in Adult Women's Study, a population-based cohort study. This cohort included 1073 reproductive age women (22-45 years) with 28% reporting infertility. We fit log binomial models to quantify the magnitude of the racial difference in reported care seeking after adjustment for hypothesised mediators using inverse probability weighting.
  
  
  RESULTS
  Compared with white women, black women were less likely to visit a doctor in the total population [adjusted risk ratio (RR) 0.57, 95% confidence interval (CI) 0.41, 0.80] and in the subgroup of women with infertility [RR 0.75, 95% CI 0.56, 0.99]. In addition, black women waited twice as long, on average, before seeking help compared with white women.
  
  
  CONCLUSIONS
  There were notable racial differences in visiting a doctor for help getting pregnant in this study although reports of infertility were similar by race. These differences may be mitigated through improved communication about the range of counselling and treatment options available.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Helen B
authors.initials: HB
authors.lastname: Chin
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Penelope P
authors.initials: PP
authors.lastname: Howards
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Michael R
authors.identifier: http://orcid.org/0000-0002-6372-6170
authors.initials: MR
authors.lastname: Kramer
authors.affiliation: Department of Pediatrics, Aflac Cancer Center, Emory University School of Medicine, Atlanta, GA.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Mertens
authors.affiliation: Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA.
authors.forename: Jessica B
authors.initials: JB
authors.lastname: Spencer
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D037001:Directive Counseling / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology*; D057226:Information Seeking Behavior; D016017:Odds Ratio; D016742:Preconception Care / Q000458:organization & administration*; D011247:Pregnancy; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
keywords: care seeking; disparities; infertility; race