Risk for Infertility as a Function of Sexual identity, Sexual Behavior, and Race Among Women in the United States

Infertility affects approximately ten percent of women in the United States every year. There has been consistent evidence indicating that sexually transmitted infections (which are commonly cited risks for infertility) disproportionately affect non-White women, and racial minority women are nearly twice as likely as White women to experience infertility issues. However, comparable research that addresses the prevalence of sexually transmitted infections and/or infertility among sexual minority women is limited and inconsistent. Varied reports are due in part to researchers’ restricted focus on behavior rather than identity-based approaches to sexual minority women’s health experiences. The dearth of information is exacerbated by the operating definition of infertility (i.e., the failure to conceive following 12 months of heterosexual intercourse), which does not typically apply to sexual minority women. A framework of stratified reproduction, which takes into account the contribution of systemic inequities to minority women’s reproductive health, may help reveal and explain disparities in risk for infertility among racial and sexual minority-identified women. Moreover, stratified reproduction also suggests that an underlying social experience common to both racial minority and sexual minority women (such as adolescent housing instability), may partially explain disparities in risk for infertility. The present study examined the sexually transmitted infection prevalence and overall risk for infertility among women in the United States as a function of race, sexual identity, and—so as to better differentiate the role of identity versus behavior—sexual behavior.
The present study thus had three aims. The first aim was to establish the rates of various sexually transmitted infections that can threaten women’s fertility as a function of sexual identity, sexual behavior, and race. The second aim was to determine how other commonly studied risk factors for infertility, (i.e., certain reproductive illnesses, alcohol consumption, tobacco use, and high or low bodyweight) might also be associated with sexual identity, sexual behavior, and race. These factors were examined in conjunction with findings about sexually transmitted infections to construct a novel Risk for Infertility measure that allowed for a comparative risk assessment among women as a function of their racial identity, sexual identity, and sexual behavior. The third and final aim of this study was to test whether adolescent housing instability—for which sexual minority and racial minority individuals have both been at increased risk—might mediate the disparity in risk for infertility that emerged as a function of sexual identity, sexual behavior, and race among participants.
The sample consisted of 4,990 women (representative of over 53 million women in the United States), ages 15-44, who participated in the 2011-3013 National Survey of Family Growth. As expected, sexual behavior was the clearest predictor of sexually transmitted infections. It was also the clearest predictor other risks for infertility. However, sexual identity and race also demonstrated important effects on women’s fertility risk. The Risk for Infertility measure revealed that Bisexual women and women who have sex with both men and women had the highest overall Risk for Infertility scores compared to peers. Contrary to expectations, Black and White women experienced risk for infertility at equivalent rates. Women’s experiences with adolescent housing instability provided some explanation for disparate experiences in overall fertility risk as a function of sexual identity and sexual behavior, but did not explain differences that emerged as a function of race. Results suggested that adolescent experiences of housing instability may play an important role in women’s long term reproductive health. Furthermore, the contemporary construct of infertility may exclude many women who are at increased risk for reproductive issues. An alternative assessment of infertility may be instrumental in researchers’, physicians’, and policymakers’ future efforts to reduce reproductive health disparities among women in the United States.