Creating a Family: Talk about Adoption & Foster Care

Racial Disparities in Reproductive Medicine

June 01, 2022 Creating a Family Season 16 Episode 22
Creating a Family: Talk about Adoption & Foster Care
Racial Disparities in Reproductive Medicine
Show Notes Transcript

In this episode, we talk with Dr. Tia Jackson-Bey about Racial Disparities in Reproductive Medicine. Dr. Jackson-Bey is a Reproductive Endocrinologist with RMA of NY. She speaks frequently on reproductive justice and increasing access to fertility care and she is a member of the Americian Society for Reproductive Medicine Diversity, Equity, and Inclusion Taskforce.

In this episode, we cover:

  • What biological reproductive health conditions that can impact their fertility are Black women more prone to.
    • Tubal or uterine abnormalities
    • PCOS
    • Fibroids
  • Racial Disparities in Infertility Treatment
    • African American women are more likely than white women to experience infertility and wait longer to seek care.
    • Women of color are less likely to access fertility treatment.
  • Racial Disparities in Other Reproductive Health Issues
    • Contraceptive use
    • Pap tests
    • Mammograms
    • Maternal mortality
    • Preterm birth
    • Low birth weight
    • Uptake of human papillomavirus vaccination
  • What are some of the social and structural challenges that contribute to these racial and ethnic disparities?
  • What can infertility nurses do to reduce racial disparities in reproductive health care?
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Please pardon the errors, this is an automatic transcription.
0:00  
Welcome, everyone to Creating a Family talk about infertility. I'm Dawn Davenport. I am the host of this show as well as the director of the nonprofit creating a family.org. Today we're going to be talking about racial disparities in reproductive medicine. We'll be talking with Dr. Tia Jackson-Bey. She is a board certified reproductive endocrinologist with RMA in New York. She is passionate about reproductive justice and increasing access to fertility care for all. And she is a member of the ASRM Diversity, Equity and Inclusion Task Force. Welcome Dr. Jackson-Bey. We're so glad to have you

0:37  
this morning. Thank you so much dawn for having me. I'm glad to be here.

0:41  
While we're not going to be talking about really the biological racial disparities that impact women's reproductive health, I do think it would be helpful to start by way of background on some of the reproductive health conditions women of color, have a higher incidence of that does impact their fertility.

0:59  
Absolutely. So one of the most important to recognize is that, you know, all races have equal opportunities for infertility, there is no one racial group that has natural higher fertility than up in another. Another important thing to recognize is race is a social construct. There is not a biological basis for how we categorize humans in this country. When you go to other countries, race or groupings or ethnicity can actually be defined in tons of different ways. This is just how we choose to define race in this country. It's mostly by skin color, and by perceived origin or lineage from other places. And so I think that's very important to remember when we think about racial disparities, because in some regard, it can give this notion that different groups of people are completely different. That is false. What is different is how different groups of people are treated in this country, and the access to different forms of healthcare that they have interactions that they have with healthcare professionals, like ourselves, or just with the community and social structure at large. And this is the crux of these differences in outcomes in terms of healthcare disparities. One thing that is very interesting is women of African descent, do have a higher risk of uterine fibroids. And this is not just seen in African American women, but also on women who currently reside in Africa, or women of African descent living all over the world. Other groups of women also have higher incidences of uterine fibroids, including Mediterranean women, and even East Asian women. But this is something that we disproportionately see in women of color. While not all fibroids equate to fertility challenges, they are a very unique medical condition that can you know, cause some issues both with trying to become pregnant and during pregnancy. And so that's one important one that I'd like to bring up. Otherwise, you know, there is a higher incidence of conditions like PCOS or polycystic ovarian syndrome in black women, the US, as well as tubal factor infertility. tubules, the fallopian tubes are actually the site of fertilization. This is where sperm and egg meet. And this is where the early embryo needs to grow until it reaches the uterus to implant and start the pregnancy. But for some reason, certain groups of women have higher rates of tubal disease. And this can come from having higher pelvic infections, or pelvic surgery, including tubal ligation for sterilization. And then finally, conditions like endometriosis, or any kind of pelvic scarring can increase the chances for tubal factor infertility. And so that's another one that we see more frequently in women of African descent.

4:15  
Okay. And I think we would agree that you can't reach racial equity in any form of medicine, including reproductive medicine, without understanding where the current racial and ethnic gaps exist. So let's start talking with the area of infertility. What are some of the ethnic and racial gaps that you see for both not just African American women but African American women, as well as Hispanic women and Asian women, East Asian women?

4:46  
So it's very interesting in my training, I think it was easy to assume that infertility was a disease of white women, particularly of wealthy white women. It is because that is who can access the care to treat their infertility. Because for so long, and even until today in fertility, health care in terms of evaluation, treatment, we think of things like in vitro fertilization is not often covered by health insurance. And so this means that this evolved as a cash industry, and only people who could afford it could see the treatment. As a result, the clinics tend to be situated in areas where the people could afford it. And so these were usually not very racially diverse areas or socio economically diverse areas. And so I think that for many people, they may also have that misconception that infertility is confined to certain groups. So if there's one thing I want to leave you with is that's absolutely not true. Everyone can be affected by infertility, men, women, gender non conforming, there are many different ways that Infertility can affect each of us. Now, for certain minority groups, there are absolutely barriers to fertility care. And one of the most important is access to evaluation and diagnosis. And therefore treatment. There are some studies that have shown that the rate of infertility may actually be higher in African American women, or at minimal equivalent, but therefore they are seeking care less, or they initiate care at a later age or at a more of longer duration of infertility, and may also be more likely to discontinue care before the intended outcome, which for most people is a pregnancy.

6:49  
And you know, that makes sense. Let me pause for a moment that makes sense. And from what what else you have said earlier, is that if women are waiting later to seek care, then then they have the age impact as well. So that makes their likelihood of success. If women are having to travel further, are women and men, I should say travel further to get to clinics, that makes it more likely that they will just continue treatment, we're going to talk about insurance in a bit. That also impacts also all of this. And is the reason that they have potentially a slightly higher rate or a higher rate of infertility is that due to the greater incidence of fibroids, PCOS and Tubal or uterine abnormalities, it can

7:39  
be due to any number of those things, you know, the etiology of infertility is one, the age at which you seek care is a very significant factor in your outcomes of fertility treatment. And so those are important as well, you know, something else that we talk about in terms of access to care is who received a referral for a fertility specialist who does not. And so there have been some studies that have shown that African Americans receive less referrals for the same complaint from their primary care providers, women's health providers, and the like. And so that's why it's so important to teach providers on what constitutes infertility and when to send the appropriate referral, but also for us to challenge our biases of who has infertility, and who would be willing to seek the treatment that we know that they deserve and need. So those are some of the factors that may play into these differences. What

8:45  
are some of the other factors that women have that would make women of color less likely to access fertility treatment, you've talked about the practical ones as far as access to the actual clinics, easy access, and the realization that they're not getting referred as often, which and that's how most people how most patients realize they need to see a specialist is because they're being referred usually by their gynecologist or primary care doctor. That is all make good sense then as to why we're seeing fewer, what are some other reasons?

9:16  
Some other ones may be stigma, or just a lack of understanding of what infertility actually is. If you are having unprotected intercourse over the course of a year or two years and no resulting pregnancy, even though you feel like you're trying, you know, that constitutes infertility, but for some people, they don't realize that there's an issue there. There's also you know, misunderstandings, I've talked about this at the level of the provider in terms of recognizing that there's an issue identifying that issue when the patient comes with a complaint and for you know, sending them on for the appropriate care, but then also for patients to recognize what's Going along with them. And to present that as an issue to their physicians, you know, there is some mistrust of, you know, certain communities, especially with the health care system. And sometimes, you know, we can all recognize as providers, it's all how you hear the story. And so it's important to one engage the populations about what their reproductive plans are. Are you trying? Are you on birth control, number of control? Okay, well, let's talk about, you know, what this would look like and what the expectations are. Another thing is this concept that can be internalized, even for black women about being hyper fertile. And so not realizing that they too can have infertility, and therefore not seeing it as a problem, or not seeing enough people around them in their communities who talk about fertility issues, who, you know, recount their own struggles with family building. And so when there's this kind of social isolation, lack of visibility included with, you know, your own perceptions that are really rooted in stereotypes, particularly in this country, but with other populations as well, then that can also perpetuate this issue of, you know, just this delay in care,

11:24  
insurance, but it doesn't make sense in some ways that insurance would be where your insurance is a problem for everyone, then seeking treatment for fertility issues. Is there a disparity between access to insurance availability of insurance, depending on the race of the woman or man,

11:46  
it's not always access to health insurance, because even though there are huge disparities in terms of who has insurance, and what types of plans, what the insurance covers can make a big difference. And so we've seen that in there are about 19 states in the country right now that have some sort of mandate to say that, you know, employers in this state have whatever stipulations that the government, the state government provides need to provide health insurance for infertility. But think about that, that's 19 out of 50. States, less than half right, either of those mandates, they're not all comprehensive, they don't all include IVF, they may have certain hoops that patients have to go through. But trying for this amount of time, the A man and a woman be under a certain age or over a certain age. And so those things can be very restricting, even though the goal is to increase access. So even with health insurance coverage, there can still be differences in terms of what is covered. And that's where there's a big kind of disparity in terms of who has the coverage for health insurance, in states that are have this mandate, they have actually shown that there can still be issues of access for African American women, even in mandated states. And so that lets you know that the coverage is not equal. But one thing that we have seen in mandated states is this increase in access for everyone. So at a population level, there's increased access, New York just got a mandate for insurance coverage in the year 2020. And we've seen a huge amount of patients there New York City, who may not have otherwise have had access, but now have it in that's great.

13:42  
Yes, that is another push in general is to try to get more states to mandate if you're going to provide insurance you need to provide it to cover the disease of infertility. What are some of the reasons that you had said earlier that African American women are more likely to drop out of treatment before they receive it before they have a successful outcome a successful cycle? Why is that we talked about a few of them and that would have won that primary one is convenience, location to clinics and stuff. What are some of it is that the only one are there other reasons,

14:16  
fertility care can be quite demanding.

14:20  
That may be the understatement of the year.

14:23  
It can be demanding on your time, including time away from work and flexibility with your work schedule. Anyone who's been through fertility treatments know that we often have periods where you have to be seen frequently for testing for monitoring for procedures. Very frequently. This is in the morning. Sometimes it may require a whole day off of work. And so that can be a limiting factor for some people, particularly if they have to go a distance in order to access their fertility clinic. Clinics tend to be concentrated on the coasts, West Coast and East Coast. To enlarge cities, and so we I know of patients who've had to drive 100 miles or more to get to a fertility clinic. And if you can imagine being able to do that several times a week, or several times a month, that can be a big strain. insurance coverage, as we mentioned, is is a big help, but it's not the total picture. And so sometimes patients drop out of care because their insurance coverage runs out, and they can't afford any additional treatment beyond what their insurance covers. Or if they're paying out of pocket, the money runs out, you know, a big misconception in care is that, you know, once you get to the treatment stage, you do want treatment, and it's over. And that we know that that's not a very typical course, it may require several rounds of treatment that may be months, it may be tears, for some people, it doesn't mean it, that's the role. But that is something that is needed to kind of get to the goals of treatment for some couples. And so that is can be a big limiting factor. Another one I think, is the social support is, you know, we talked about how taxing fertility treatment can be. But one thing that's understated is the emotional toll toll on an individual on relationships, on your family dynamics, even. And so you know, for groups that are again, feeling very isolated in the community at large in society, maybe not disclosing to people at their job within doing so there's a lot of tension there in terms of being covert or using PTO for their visits and things like that. This can place a lot of financial hardship in the household or in couples, in addition to maybe other pressures that they're feeling people around them are getting pregnant so easily, things like that. And then just the lack of support have a place that they can turn to with people who they feel comfortable with people who can help encourage you to keep going when you really feel down. And so that lack of social support in the form of representation in formalized counseling in social groups can be a big part of why these patients discontinued care sooner.

17:17  
Do you see it going to your point about social support? Do you see a distinction? Or have you read research? Or do you see anecdotally in your patients, a distinction based on race and ethnicities and cultures, and the willingness to talk about fertility struggles, and that could certainly impact your support?

17:40  
Absolutely. And so there's been some anecdotal data about the shame and the burden of stigma of infertility. And actually, there was one report that I remember, and the highest burden is actually in Chinese women, that, you know, the stress of this diagnosis was just so astounding, especially in terms of how other people view them, because of the diagnosis. And so it's definitely something that's kept very quiet and private. And so you know, that's, that's a huge, you know, part of it is feeling comfortable enough to talk to other people about it. I have patients who come in my office, and they're still whispering, because they are that ashamed of what's happening to them. And so I have to remind them, we're here were four walls, the doors closed, everything, you know, but that's, that just shows you the level of shame of carrying this, you know, diagnosis this burden around and how they think they'll are perceived publicly.

18:50  
Interviewed once a it was she was a US citizen, but she had been born in China, and she said, I can't tell anyone. She was just beginning her infertility journey. And she said, are beginning treatment. She said, I can't tell anyone, because in case I have to use donor sperm in her case, it would be donor egg donor gammy. She said that will have to always be hidden. And therefore I can't tell anyone that I'm even going in to just even seek treatment because the there's both misunderstanding about what IVF is anyway in general and and I thought, oh gosh, and that so she is so alone in this and that makes it easier to drop out. It's one thing if you see success stories if you're if you're experiencing infertility, but you have talked with someone who you know, it took them three cycles, and they you know, have now a bouncing baby boy or girl and then you see the success but if you're keeping it a secret you don't necessarily know in your community. So yeah,

19:54  
it does it kind of, you know, it's a little bit of Chasing Your Tail. If you are not willing to share, then you could be building community through the sharing right. But then if people don't see community, then they're less likely to disclose as well. So it can be pretty difficult.

20:16  
Yeah, absolutely. When you follow or subscribe to the creating a family.org podcast, you also gain access to our extensive archive on topics related to reproductive medicine. Over the last 15 years, yes, we have been doing this for 15 years. So needless to say, we have a large archive, and we have interviewed many leading experts in topics of infertility treatment that matter to you. So you will have plenty of content from which to choose when you subscribe or follow to our podcast. So please do. Alright, now we've talked about infertility. But I think that we need to also cover some of the other reproductive health issues where there are disparities, depending on the race or ethnicity of the patient. Do you see a distinction? I'm just going to go through a couple of them. You tell me whether or not that there has been research that are they to know of? Let's say, in any of these areas? Let's start with contraceptive use, is there a distinction on contraceptive use, based on the race of the patient of the woman or man?

21:20  
Yes, so there has been some data that African American women and Hispanic women are less likely to use hormonal contraception, and in different, what do we call kind of survey studies about you know, how effective different forms of contraception are, they tend to overestimate the effectiveness of things like barrier methods like condoms. And this is actually you know, something that is seen it at multiple different levels that even did some studies of women in the military, where you would think they actually all have access to a good form of health care, just an in that it's universal. And even amongst those persons still having these ideas of you know, decreased contraceptive use overstating the effectiveness of things like condoms, belief that things like tubal sterilization is reversible, even though we try to make sure that people understand that this should be a permanent decision. And so those things can, you know, have other reproductive health outcomes? Absolutely. There are things you know, some screening tests, like pap smears and mammograms, colonoscopies, all of these different things may have different uptakes by different groups. And really, it comes down to access, but also education. And this is something that we talk about a lot in terms of the sexual health or reproductive health education at the school age level, at college level, you know, unless you sought it out yourself. I don't remember any classes in college that taught you about sexual health unless you were a biology major, or you were specifically taking an anatomy class in nursing school. And so that's a really a huge misfortune. Because there are other required curricular classes English 101 sure to take a math class requirement for these kind of sexual reproductive health things that you should know about your body so that when you are ready, or when you know even more, so when you're not ready, you know what to do. And so those are some pretty significant shortcomings. And so, we do see some differences in screening tests, like for pap smears and mammograms, and even uptake of the human papilloma virus, which has been probably one of the most significant public health events of my lifetime was seeing, you know, the change in cervical cancer rates from having people vaccinated against HPV. But despite having, you know, this incredible response, there's still a little bit of a lag in terms of uptake for African American women, and then children. And so that's, that's a really important thing. I think that goes back to a lot of mistrust of the healthcare system, particularly of new and emerging vaccinations, medications, you know, real trust that is based in history in this country that's based in the present in this country, in terms of, you know, human subjects, not being fully informed or fully aware of what is being put into their bodies or treatment being denied them. And so I think, you know, there's still a lot of work to be done in these areas. Lots of providers and physicians, myself and others do a lot of lab campaigning, but also making sure that there's equal representation of the races in these studies, so that we can understand if there are differences that we can say with confidence that it's safe. And in something that's important to us,

25:15  
that is such a good point about needing to diversify our research. So that we can assure people that what we the outcomes that we that we are showing, if you're testing it on, all women are all men are all white women are all Asian women, or whatever that we can, we need diversity in our research. You know, and also, this is an as an aside, but we also it feels to me need diversity in, in both in the medical profession, be the doctors and nurses. Because for all the reasons you've mentioned, there could definitely be a greater comfort level, if the provider, be they a doctor or a nurse is a provider of your race.

26:02  
Absolutely. And there have been studies that have actually shown that racial concordance between providers and patients enhances the health care in terms of measurable outcomes. And so whether or not that's because of issues of compliance, or because they received the message in a way that they can, or they hear the message in a way that they can receive it, or that, you know, there's just more comfort there. Sure, but it actually does make a difference. And so that's, you know, something that we've used in multiple different proposals to help increase the diversity of medicine as a whole. I think it's definitely a worthwhile topic. It's not something that is taken lightly at all, there's a lot of work in this area, recruitment of professionals into medical schools and nursing and dental schools, pharmacy is one thing, but there is also a huge gap in how to help these students succeed in areas where not a lot of people look like them. They need mentorship, they need scholarships, they need opportunities to increase their research, they have to be in environments that are supportive and unbiased and don't stigmatize them. And that is just comes from normal structure, the racial hierarchical structure of the medical system. And so there's, you know, there's so much more to it. Recruitment is a big part of it, but retention and kind of continuing the pipeline from, you know, elementary school, high school education into college into professional schools is important as well.

27:42  
And you're right, it goes all the way back to really well, certainly, probably even middle school, just the emphasis on on what courses you take, and the encouragement you receive, to take the the harder sciences and the harder maths, which are what are needed to get you into be able to succeed on the undergraduate level. And in these courses, which is the prerequisite to getting into nursing school, medical school, or any of the other medical professional schools. What about it's been in the news quite a bit the what is that? What's the current research show on maternal mortality in the differences by race?

28:23  
Yeah, maternal mortality is something that, you know, some people may have heard of more recently, in the past few years. It is a measure of, you know, public health and safety really, because, you know, pregnant and recently as part of women are some of the most kind of medically vulnerable. And so we use maternal mortality really as a measure of how strong and how good is your healthcare system. And unfortunately, the US as a whole is failing, not just specific groups, but overall, but the issue is that certain groups such as African American women have hugely different rates of maternal mortality. Maternal Mortality is defined as death of a pregnant woman, either during pregnancy, or I believe, for up to 42 days after and we're actually trying to expand that into the year after, because there are so many different physiologic changes that happen during pregnancy and during that near postpartum period, that can predispose you to poor health outcomes. And so when we think about the maternal mortality rate, you know, it can be up to three times higher for African American women overall. But if you look in certain groups, in certain places, even a place like New York City, it can be much higher than that. Hispanic women also have higher maternal mortality rates. But then Indigenous women Native American Indian gymnasts, women in this country also have significantly higher maternal mortality rates. And this is all directly reflective of how well these women are cared for in their lives during pregnancy and postpartum period. But then also within the healthcare system, who's listening to them, who takes care of them, who is making sure that they have everything that they need, who is making sure that they have adequate support and follow up at the end of the day, at the end of you know, pregnancy. And in that postpartum transitional period, as any birthing person will tell you, your needs do not stop when the baby is born. And so those are some really important things. You know, there are some issues that occurred during pregnancy that increase the risk for certain groups violence being one of them, both domestic violence, and community violence is a significant cause of maternal mortality. And that's something that is not often talked about. But other things, too, you know, cardiovascular and hypertensive disorders, is another significant area. This can be anything from getting high blood pressure during pregnancy that can lead to organ failure or organ compromise, cardiac failure, renal failure. And in the form of things like preeclampsia or eclampsia, it could also mean entering a pregnancy with one of these chronic medical comorbidities like high blood pressure, or diabetes, which can make your whole pregnancy kind of more high risk and more delicate. And those things have to be appreciated. Also, you know, we have to educate the public of what it means to enter pregnancy with that kind of a disadvantage, innocence. And then as we talked about in the postpartum period is particularly of women who've had these issues. How what are we doing to enhance their level of care? Or are we just subjecting them to the standard routine care, even if they did not have a standard routine pregnancy? And so these things are, you know, overall, really important in order to really address the maternal mortality crisis, essentially, in our country?

32:12  
What about African American babies? Are they at greater risk for either preterm birth or low birth weight,

32:19  
they are at risk for things like preterm birth, and the low birth weight can happen because they're being born early. And they're also an increased risk for dying before their first birthday, which is an infant mortality, you know, luckily, in the NICU, so there are some differences that show that African American babies can do better. But you know, being born prematurely is not something to take lightly, it can get the child to, you know, a lifetime of issues, sometimes developmental, sometimes physical, you know, certainly there are health issues that are involved. And so that has been a really difficult area of, you know, pinning down what, what exactly can we do to decrease our premature birth rate.

33:10  
And some of the comorbidities you mentioned, are certainly going to contribute to that, especially if they're not well controlled.

33:18  
Absolutely. So on to all of this, we also add the, you know, COVID 19 pandemic, which we know disproportionately affected communities of color, during a time initially, during, you know, the first phase in 2020, where even getting into a doctor's appointment was more difficult, you know, infection was high. This was before we had vaccines. And there were some really significant health consequences for pregnant women, particularly for black pregnant women. And so looking into ways to ameliorate that you have to, you know, reinforce the urgency for vaccination for women during pregnancy and in the postpartum period, and women who are even trying to become pregnant, just as a way to minimize their risk of severe COVID 19 infection during pregnancy on a postpartum time. And so, you know, there's always going to be new challenges. I think there's not one solution. But you know, really a different way of looking at how we care for all women is important. But particularly, you know, there are going to be nuances that are needed in order to enhance care for women of color, and it's something that, you know, we can't take seriously until everybody recognizes it as a priority.

34:41  
What are some of the changes you would like to say that would affect that change that for all women, obviously, but but specifically for women of color?

34:52  
I would love to see that Medicaid coverage for health care be extended to one year Year, instead of six weeks after delivery, it's a very important time in a woman's life and to have, you know, certain forms of Medicaid kind of end right after delivery is inappropriate, because then it leaves them in this kind of health care desert in between children, which is most important, you know, to regain your proper health status. So that's one thing that I think about. I do believe that, you know, providers, and anyone who has interactions with patients in the healthcare setting needs to be aware of their own biases, and we talk about having an anti racism and unconscious bias training, I think it really, you know, we have to fill out OSHA and, you know, blood borne pathogens and HIPAA modules every single year. And this should be an integral part of that as well, not to say that they all can be addressed with a module, it has to really be ingrained in the level of education for the next generation, but also for existing providers. And I think that's going to be a big part of it. And then, you know, I think we need to restructure our public health messages. You know, I think, when we look at, you know, the industries that promote different goods, you know, advertising industry, and all of these different things, they can make anything look great and look attractive, when you struggle, we absolutely struggle with getting people to do what's good for their own health. And so I think we need to start employing some better marketing strategies in health care and public health.

36:35  
Yes, we need to get sent the same people who are selling us Cheetos, too. I speak I speak as a person who loves chickens. Can you give an example? I am imagining that some people are thinking, Well, I don't have any internal racial biases. Can you give an example of some biases that people may hold, but not even be aware that it's a bias?

37:01  
Everybody in America has a racial bias, there's no way that you exist in this country. Without it our country was founded on the division of race, religion of class. And so I think one of the most important things is to recognize that everyone has it, it's like skin. Literally, like it's just, it's there, you know, different? I think one that comes to mind is an idea of worthiness. So who is worthy of parenting? Who, you know, what are the things that you determined to make a person a good parent? Does that mean that they have to have a high level of education, or live in a certain neighborhood? Or have a certain income? What if one of the parents is in another country, or incarcerated, or they're a single parent? You know, these are things that start to tease apart? How do you feel about different groups? You know, in terms of who you think, can if you are shown pictures of three different people who you think can afford health care? Who do you think can afford IVF?

38:15  
I was gonna say, who could afford IVF, that's a fertility treatment. That's absolutely a real one.

38:20  
And that is how you would be able to pick up on your own biases, because should you ever be able to tell just by looking at someone what they can and can't afford, what their level of education is, you know, what kind of life they live? No, you shouldn't, but we have to make these decisions every single day. It's both human nature, but it's also our social construct that in which we live. And so those are the ways that you can begin to recognize the presence of bias in your own life. You're on a street walking home, you see someone coming towards you, do you feel fear? Or do you feel comfort? How is it they don't how they look? What is it about how they look that made you feel that way? Why would some person make you feel comfortable in other places make you feel afraid? What are the differences there? And so those are the the big picture items, but to realize that biases are subtle. We're all conditioned to make kind of very, you know, quick decisions based on limited information. But that becomes a liability when it when we're involving people's health care in their lives.

39:25  
And the subtle biases are the most insidious because the obvious ones are easy for us to identify. I want to thank one of our partners, it is through their support that we are able to provide you this show. That partner is Cooper surgical fertility and genomic solutions. Cooper surgical fertility and genomic solutions are global leaders in IVF and reproductive genetics. Cooper genomics offers PGT a PGT M PTTs AR and er pig endometrial receptivity testing for those pursuing IVF their genetic tests screen and embryos genetic health, to help your care team select the best embryo for transfer and improve your chance of achieving a successful pregnancy. 

42:20  
Thank you so much, Dr. Tia Jackson-Bey for being with us today to talk about racial disparities and reproductive medicine. It's been very good

Transcribed by https://otter.ai