What Education Cannot Equalize: Segregated Social Networks and Media in Stratified Reproduction

ABSTRACT

In the United States, age at first birth is increasing and fertility rates are declining. In the absence of policy solutions that enable people to have the children they desire, individuals who have postponed childbearing may seek biomedical solutions in the form of fertility treatments. However, fertility care is marked by racial and socioeconomic inequalities in the United States. How and why such inequalities persist remains unclear, especially for populations with socioeconomic advantages. Using an intersectional and comparative approach, this article explores how access to health information related to in-vitro fertilization (IVF) among Black and White women in United States graduate programs may contribute to the observed inequalities in fertility care. Through qualitative analyses of semi-structured interviews, the results demonstrate social class can act as an equalizer of exposure to and knowledge about IVF. However, social network segregation and media portrayals of infertility construct social contexts that create implicit, structural barriers to Black women’s use of fertility treatments while encouraging use among White women. The findings provide new insights into the social structures that create stratified reproduction and demonstrate how resources garnered by social class cannot entirely ameliorate the effects of structural and systemic racism on health information.

KEYWORDS:

• Health information
• infertility
• racial health disparities
• racism
• stratified reproduction

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Ethics Statement

The procedures for collecting these data were approved by the Institutional Review Board at the University of North Carolina at Chapel Hill (Study #: 19–0087). The analyses of these data for this paper were approved by the Institutional Review Board at Western Michigan University (Project #: 21-04-26).

Data Statement

The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research, supporting data is not available.

Notes

¹ In these demographic calculations there is little attention to the difference between sex and gender. The use of “woman” here is not intended to be exclusionary of people with other gender identities who can become pregnant, but is, instead, a reflection of common definitions used in the field of demography.

² A total fertility rate of 2.1 is considered “replacement-level” in many high-income contexts as, in this scenario, a woman has a child to replace both herself and her partner with the 0.1 accounting for infant mortality. By contrast, total fertility rates below 1.5 are considered low and rates around or below 1.3 are considered “lowest-low” (Kohler, Billari, and Antonio Ortega 2002; Lesthaeghe and Willems 1999).

³ Infertility is medically defined as the inability to become pregnant after 12 months of regular, unprotected sexual intercourse (Practice Committee of the American Society for Reproductive Medicine 2013),

⁴ Following prior work, we use the term disparities interchangeably with inequalities (Braveman 2006).

⁵ Importantly, health literacy as an individual trait is not consistent with the fundamental cause theory framework. Instead, it can be seen as a part of SES and habitus (Clouston and Link 2021).

⁶ It is possible that participants interpreted the question about success rates more broadly. That is, it is possible participants may have interpreted the question as the overall success rate of using IVF. The SART tool estimate the probability of live birth after two cycles for this scenario at 38 percent and for three cycles 49 percent.

⁷ Additionally, the observed differences may be linked to the concentration of Black women in health-related fields in this sample. While this may influence the findings, this concentration reflects general trends in higher education (NCES 2022; NSB and NSF 2022).

⁸ Importantly, awareness is only one potential mechanism that could contribute to treatment-seeking inequalities. Social class could contribute to utilization disparities in numerous other ways, including insurance coverage and financial affordability.

⁹ The present study draws upon the work of Sewell (1992) in understanding “structure” as “mutually sustaining cultural schemas and sets of resources that empower and constrain social action and tend to be reproduced by that action” (p. 27). Thus, the patterned differences in social networks (and marital status and choice of graduate field of study) are conceptualized as the result of this social structure.

Additional information

Funding

This material is based upon work supported by the National Science Foundation Graduate Research Fellowship under Grant No. DGE-1650116. Any opinion, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the National Science Foundation. The author is thankful for the pilot project funds received from the Department of Sociology at the University of North Carolina at Chapel Hill to support the collection of these data.

Notes on contributors

Katherine I. Tierney

Katherine I. Tierney is an assistant professor in the Department of Sociology at Western Michigan University. Her research interests are in health, fertility, family, and social demography. Using quantitative and qualitative methodologies, Tierney’s research aims to uncover the social mechanisms and structural causes of inequalities in fertility to support the development of policies and interventions for improving equity and well-being. Tierney’s current projects focus on inequalities in access, use, and outcomes of reproductive health technologies.