SGF Atlanta’s own Dr. Desireé McCarthy-Keith joined NPR’s morning radio news program, “The Takeaway,” to discuss Michelle Obama’s new memoir and her recent admissions of struggling with infertility.
Listen to the full interview here:
Host: “Michelle Obama has a new memoir and in it, she opens up about a subject most people wouldn’t expect a former First Lady to talk about: infertility.”
“I felt lost and alone and I felt like I failed because I didn’t know how common miscarriages were because we don’t talk about them. We sit in our own pain thinking that somehow we’re broken.” That’s Obama from this weekend with ABC’s Robin Roberts. Obama continues, “The biological clock is real because egg production is limited, and I realized that as I was 34 and 35, we had to do IVF. I think it’s the worst thing that we do to each other as women … not share the truth about our bodies and how they work and how they don’t work.”
“Obama speaking openly about her miscarriage and her fertility treatment resonated with millions of American women across the country. If we want to talk about the truth, well the truth is 10 percent of women in the United States, ages 15 to 44, have difficulty getting pregnant or staying pregnant according to the CDC. And for women of color, the numbers are even higher. Married black women are nearly twice as likely to have infertility problems as married white women. So, what’s behind this fertility gap and why aren’t we talking about it more? Dr. Desireé McCarthy-Keith is a board-certified reproductive endocrinologist with Shady Grove Fertility in Georgia.”
Dr. McCarthy-Keith: “Well, we know that black women have a higher incidence of uterine fibroids and by the time a black woman is 50 years old, about 80 percent of us will be diagnosed with fibroids and, depending on the size and location of the fibroid that can definitely impact a woman’s fertility. It can increase her risk of miscarriage and pregnancy complications so that’s one factor that we have.
There’s also a higher incidence of obesity and being overweight in the African-American community and for black women, when you look at the statistics on obesity in our community, they are truly alarming. The most recent statistics show that about 55 percent of black women are obese in this country, and if you combine that with obese and overweight, it’s almost two-thirds of us and that is just a striking number of women who are in that category. Again, overweight and obesity can increase the risk for chronic diseases and can also lower a woman’s fertility and increase her risk of pregnancy complications. When we look at studies of women who go through fertility treatments, we see that African-American women are more likely to wait longer or have longer durations of infertility before they even seek evaluation, and so by the time they come in for treatment, often they are older, which is also a factor that can lower their chance of success once they get to the fertility treatments.”
Host: “Then let’s talk about what’s happening in the doctor’s office because this was something that came up a few years ago when I looked at this issue. There are some cultural differences that happen among women of color. As a woman of color, I know speaking about infertility can be culturally difficult sometimes, culturally challenging. What happens when I go to the doctor’s office? Are doctors more likely or less likely to talk about women of color’s infertility options?”
Dr. McCarthy-Keith: “Well, this really begins when we look at when we first started doing fertility treatments in this country 30+ years ago, the initial campaigns for infertility awareness and treatment did not reflect women of color. The campaigns and the ads usually contained middle-class white women, and so we weren’t even included in the conversation when the treatments were being promoted or presented. And so, if you did not see yourself in those advertisements, you didn’t feel like those treatments were for you. You didn’t feel like they were targeted to you or catered to you.
I’ve seen several articles where women going through fertility treatments comment that when they’re in a fertility office, sometimes they don’t see other women of color in the office, so again, they feel isolated or if they see pictures of success stories and babies in some of these fertility offices, they don’t always see brown babies on the walls. They feel like maybe women of color don’t do these treatments or maybe we’re just not successful and that’s why we don’t see ourselves reflected in these images that we see in the office.”
Host: “I also recall talking to other reproductive endocrinologists and realizing that we also don’t see each other reflected as reproductive endocrinologists or as reproductive specialists, right? I’m assuming the number of black and brown reproductive endocrinologists in the United States is quite low.”
Dr. McCarthy-Keith: “Right. We are also underrepresented in that area. You know, it’s interesting. There was a survey study that was published several years ago where physicians were actually polled and were given different scenarios of different women – a middle-class woman, women of different incomes, lower income women, a woman of color, and the physicians were asked which of these women do you think is more likely to have infertility. The majority of the physicians—and these were internal medicine and OB/GYNs, and family practice physicians—chose the middle-class white woman as the one who is most likely to have infertility, even though we know that the women of color are more likely to be the ones. So, it starts with how physicians and providers perceive infertility in our patients. That can be reflected in our referral patterns, how we counsel patients, and how quickly we would refer them. If we think that women of color are less likely to be infertile, then we may tell her to try longer before she sees a specialist; whereas if we think that middle-class white women are more likely to have infertility, we may tell them sooner to go ahead and see a fertility specialist.”
Host: “Let’s talk a little bit about the cultural elements here because I think that has a lot to do with this sort of over the surface. What might be some of the cultural limitations for women of color ourselves and talking about this issue? Should we be thinking about it differently? Should we be less ashamed? I mean, what was your reaction, for example, to seeing former First Lady Michelle Obama talk about her own struggles? I wonder if culturally that’s opening a door for us. We’ve also seen Gabrielle Union, the actress, talking about these issues, so it seems like more black and brown women are having this conversation.”
Dr. McCarthy-Keith: “Absolutely. For Michelle Obama to speak about that in her book was so refreshing and empowering for all of us. When she made those statements and started promoting that last week, I received so many texts and calls from people who said, ‘Did you know that Michelle Obama did IVF? And we think it’s so great and so cool that she’s talking about it.’ We have traditionally in our community not discussed these types of things. Even though we’ve had infertility in our community, the same as others, we have not discussed that, which leads to a feeling of isolation, of shame, and just loneliness for the women who are going through it. Going back to the perceptions and the stereotypes of women and fertility in our country, while the campaigns for infertility focused on women who didn’t look like us, we were often stereotyped to be hyper-fertile, to have multiple children, and to need birth control more than we would need fertility services.
Many women in the community have internalized those stereotypes, so that if she does have trouble getting pregnant, she feels like black women can have babies. It must just be me. There’s something wrong with me. I feel broken. Then, they become even more ashamed and more closed about their journey. So, I think that when we have prominent people like Michelle Obama and Gabrielle Union, who can speak on that, it gives a face and a voice to it and it takes some of that stigma and that shame away. When we see women who are highly successful, accomplished, and who share that, it really just equalizes and shows us that infertility does not discriminate based on age, ethnicity, status, anything. It can affect us all. It’s really refreshing to have this conversation that’s kind of brought to the forefront now.”