Mapping fertility trajectories: An endarkened narrative inquiry of Black women's fertility experiences and pathways through infertility treatment

While existing literature has documented barriers and facilitators to Black women’s access to infertility treatment, scholars have a limited understanding of the experiences of Black women who have initiated medically assisted reproduction (MAR), including medicated timed intercourse, intrauterine insemination, and in vitro fertilization. Informed by Black feminism and reproductive justice, this endarkened narrative inquiry leveraged data from the Fertility Equity Study at Morehouse School of Medicine to characterize 41 Black women’s infertility treatment outcomes and examine their trajectories through fertility care and infertility treatment. Our analysis provides greater nuance and understanding to Black women’s experiences navigating systems of care to address challenges related to conceiving or maintaining a pregnancy. The results indicate a lack of fertility benefits and out-of-pocket expenses as significant barriers at each stage of the treatment pathway. There is a need for legislation that mandates private and public (e.g., Medicaid) health insurance coverage for fertility treatments and associated costs, inclusive of medication, genetic screening (and other ancillary testing), and donor gametes. Additionally, integration of culturally congruent providers (including mental health practitioners), addressing reproductive health conditions, and providing fertility awareness counseling throughout the life course may optimize Black women’s fertility care and MAR experiences.