By Edna Bonhomme
In a 1932 special issue on Black fertility, dubbed “A Negro Number”, the editors of the American Birth Control League’s journal. Birth Control Review claimed that “the present submerged condition of the Negro is due in large part to the high fertility of the race under disastrously adverse circumstances”.
The League, founded by Margaret Sanger, encouraged women to make conscious choices over their fertility, but it was also tied to racist and classist ideas about who should reproduce. Many members were active supporters of the eugenics movement. It therefore may not surprise readers to see its publication reproduce a long-standing myth of American racism, tied to its obsession with Black sexuality – the myth of Black hyper-fertility.
They will be more surprised, however, to read similar sentiments from as eminent and thoughtful an African American scholar as sociologist WEB Du Bois, who wrote in the same issue of Birth Control Review”the mass of ignorant Negroes still breed carelessly and disastrously”, advocating a politics of fertility mired with paternalism, and insisting upon respectability through “proper birth control”.
Despite the racist fear of Black hyper-fertility, reproduction rates for Black people declined in the era of Jim Crow, a phenomenon that persists to this day, as Professor Dorothy Roberts noted in her book Killing the Black Body. While 12 percent of women of reproductive age having impaired fertility according to the Centers for Disease Control and Prevention, Black women are two times more likely than their white counterparts to be infertile.
While some health inequalities can be attributed to the effects of social inequality (itself deeply racist), the fertility gap is visible in the study after its authors adjusted for the subjects’ social class, and risk factors like smoking. Compared with other health inequalities, like those surrounding infant mortality or the risk of death during childbirth – a subject about which Serena Williams wrote forcefully after her own difficult experience – infertility is not necessarily widely known about in the African American community. In a study of African American women in Atlanta, researchers found limited knowledge of the problem.
The causes of infertility are sometimes unclear, and vary from person to person. They include: untreated chlamydia and gonorrhoea, STDs that cause pelvic inflammatory disease; nutritional deficiency; environmental and workplace hazards. The uterine disorder of fibroids, from which Black women are significantly more likely to suffer, may contribute to infertility, yet not enough research has been done to provide a definitive link.
Low fertility can sometimes be treated by assisted reproductive technologies like in vitro fertilization (IVF). The use of such treatments has increased dramatically in recent decades, particularly in states which have mandated their inclusion as part of healthcare coverage. Here too, however, there are disparities between Black women and other populations with respect to access and success rates.
In Chicago, where IVF treatment is covered by health insurance under Illinois law, Black people make up 32 percent of the population but only 5.3 percent of people seeking IVF. Even when they have been able to access treatment and they have the same class background as white women, live births for African American women are lower than their white counterparts.
Infertility causes unique psychological stresses and anxieties, as well as affecting relationships. Professor Rosario Ceballo found that African American women coping with infertility suffered disruptions to their sense of self and even to their gender identity. Ceballo found that these challenges were exacerbated by the widespread silence around African American infertility, and the predominance of the myth of fertility.
The statistics are clear but the root cause and potential solutions are not. The latter must surely begin with a proper accounting of the problem, and a widespread acknowledgement of its status as an urgent matter of public health. Groups such as the Black Women’s Health Imperative and Fertility for Colored Girls have tried to debunk the hyper-fertility myth while also raising awareness about infertility in the Black community. We need to ensure that assisted reproductive technologies are available to everyone as part of public health policies.
Reproductive justice is about access to contraceptives and abortions, but it also means the freedom to be a parent. As a group of researchers and doctors wrote in the American Journal of Public Health, health justice requires that”every obstetrics and gynecology department [make] racial equity in known areas of disparity the priority of all quality improvement projects”.
The reproductive capacity of Black women has always been political, tied to the dark history of forced reproduction under slavery, and forced sterilisation in the era of Jim Crow. Rather than believing in a myth of Black fertility conceived in America’s history of racist paternalism, reproductive justice means understanding the actual fertility of Black folks rather than projecting stereotypes. Only then can we escape the shame surrounding strained fertility journeys and provide full access to care, as part of a broader programme for racial equity in reproductive health.
Edna Bonhomme is a Public Affairs Analyst.