Black History Month: “It’s time to acknowledge the challenges that remain. Only by addressing them can we ensure that all women have equal access to the care they need and deserve.”

Black History Month is a time of celebration, joy, and learning, an opportunity to honour the richness of Black culture and history. Yet, for me, as a Black female gynaecologist, it is also a time to reflect on the long-standing inequalities that continue to affect the lives of Black women in the UK—especially in healthcare. One disparity that is often overlooked is the limited access to fertility care and the poorer health outcomes experienced by many Black women. Despite the harmful and outdated myth that Black women are "super fertile," infertility remains a harsh reality for far too many.

The challenges faced by Black women

In my clinics, I see firsthand the struggles Black women face when trying to conceive. These challenges present themselves in various ways: the perimenopausal woman coming to terms with the fact that she may not conceive a child of her own; the woman and her partner who are unable to access timely fertility care or have had repeatedly unsuccessful IVF attempts; or the young woman who is fresh out of university, worried about her future fertility and dealing with unexplained heavy menstrual periods. For these women, finding the right advice, treatment, and support is often an uphill battle.

Delays when starting treatment

The HFEA’s Ethnic Diversity in fertility treatment report, which was published in December 2023, brings these issues into sharp focus. The report found that, in 2021, Black patients in heterosexual couples started fertility treatment at the age of 36, compared to the national average of 35 and the report also found that Black patients who were single started treatment two to three years later than single White women. The findings in the most recent publication of the HFEA’s Fertility Trends report draw attention to age being a critical factor in whether IVF treatment is successful or not. Therefore, the delays experienced by Black patients are significant, given that Black women consistently have the lowest IVF birth rates compared to their counterparts.

The donation disparity

Black women who are not able to conceive naturally might consider using donated eggs or sperm as part of their treatment. According to the HFEA’s National Patient Survey 2021, most patients who choose this route believe it is important that the ethnicity of their donor matches their own, however, over the past 30 years there have been less than 150 new sperm donors from a Black background who live in the UK, according to the HFEA Dashboard. Being unable to find a donor whose ethnicity matches their own can complicate Black patients’ fertility journeys. The HFEA’s findings highlight how these disparities compound to create a system where Black women are consistently disadvantaged.

Underlying health conditions

Beyond delayed access to fertility treatment, other factors such as underlying health conditions further exacerbate these barriers. Fibroids and endometriosis are two conditions that disproportionately affect Black women—both of which have an impact on fertility and IVF success rates. However, there is a worrying lack of awareness and research about how these conditions specifically affect Black women. Many women go undiagnosed or receive suboptimal care, further delaying fertility treatment and decreasing the chances of success.

Calling for action

The call for action, which the HFEA have agreed to alongside the British Fertility Society, Fertility Network UK and the Royal College of Obstetricians and Gynaecologists, emphasises the urgent need for a more nuanced and inclusive approach to fertility care for Black women.

Updated clinical policies must acknowledge the unique barriers Black women face, such as delayed access to treatment, and address these in a way that improves outcomes. Additionally, better data collection on ethnicity in fertility care is essential for targeted research and policy reform. Importantly, Black women must be involved in these conversations to ensure that their voices and experiences shape the future of fertility care.

Challenging the longstanding disparities

Black History Month is a time to celebrate Black culture and achievements, but it is also an opportunity to confront the disparities that continue to exist. As a clinician, I am committed to raising awareness of these issues, advocating for better care, and working toward a future where Black women no longer face disproportionate barriers in their fertility journeys. Improving health outcomes for Black women, particularly in the realm of fertility, is a crucial step toward addressing broader healthcare inequalities. Only by addressing these disparities can we ensure that all women, regardless of their ethnicity, have equal access to the care they need and deserve.

Dr Christine Ekechi

Dr Christine Ekechi is an early pregnancy and gynaecology specialist based in London with an additional interest in the gender and racial inequalities continually present within the health system. She is a vocal advocate for a life course approach to women's health to which she has spoken extensively in national and international media, academically and politically.

She was the Co-Chair of the Race Equality Taskforce at the Royal College of Obstetricians & Gynaecologists, the first of its kind within any medical college and sits as a Member of the Maternity Working Group for the NHS Race and Health Observatory.

She is Trustee for the gynaecology cancer charity, The Eve Appeal and is their Medical Ambassador. She is equally focussed on maternity safety and serves on the Multi-Professional Advisory Panel for Baby Lifeline – a UK charity focused on the supportive care of pregnant women and newborn babies.

Dr Ekechi holds a Masters in Reproductive Health Research from the London School of Hygiene and Tropical Medicine, and her previous public health experience includes working with the UN, UNICEF, and national governments in the UK, Nigeria, Senegal, Malawi and Kenya. Using this extensive experience, she is particularly interested in the social drivers that underpin inequity in individual health outcomes, health knowledge and education, and healthcare delivery.

Dr Christine Ekechi is the Founder and Director of Early Pregnancy Plus, an innovative holistic early pregnancy care service in central London.