Media influence on awareness and utilization of assisted reproduction technology in Hispanic populations.

14 12 2010

To the Editor:

We read with interest and appreciation the recent article by McCarthy-Keith et al. regarding the utilization and outcomes of assisted reproduction technology among minority women (1). First we would like to commend the authors for acknowledging that there are likely greater reproductive issues in minority groups. We agree that ART costs may be prohibitive for some which can create unequal utilization of these services. When costs are accounted for, the authors report that Hispanics are less inclined to seek out infertility treatments due to language/cultural barriers, lack of continuity with providers, difficulty scheduling visits and procedures, decreased availability and affordability of services (5). We would like to point out that a prominent factor in utilization rates among Hispanics involves a divide of information in our media and social networks.

Hispanics living in the United States receive information from unique sources, usually in Spanish, including print, radio, television, and internet. Many English speaking Hispanics also continue to access these channels which usually do not address, discuss, or feature infertility topics. This drought of information limits Hispanic women first in their recognition of infertility as a disease, second in their search for treatment, and third in the knowledge that coverage may be mandated, where available. Prior studies have evaluated Spanish and English media regarding issues such as HIV transmission or tobacco cessation (3,4). These studies describe the variation in information available, and differences between minority’s perceptions of each media source (6).

The drive to procreate is universal, crossing all ethnic and cultural boundaries. Hispanics place great importance on fertility; Becker et.al. reported that “childless marriages were considered a failure” in Latino populations (2). We hypothesize that states or organizations mandating insurance coverage for assisted reproduction technology would see increased use among Hispanics once proper fertility information is commonly available in Spanish mediums. We appreciate the author’s attention to this subject.

Alice Serou, M.D.
Rudy Quintero, M.D.
C.A.R.E. Fertility
Glendale, California

References
1. McCarthy-Keith DM et al. Will decreasing assisted reproduction technology costs improve utilization and outcomes among minority women? Fertil Steril. 2010 Dec;94(7):2587-9.

2. Becker G et al., Infertility among low-income Latinos. Fertil Steril. 2006 Apr;85(4):882-7.

3. Hu DJ, Keller R, Fleming D. Communicating AIDS information to Hispanics: the importance of language and media preference. Am J Prev Med. 1989 Jul-Aug;5(4):196-200.

4. Gombeski WR Jr, Ramirez AG, Kautz JA, Farge EJ, Moore TJ, Weaver FJ., Communicating health information to urban Mexican Americans: sources of health information. Health Educ Q. 1982 Winter;9(4):293-309.

5. Nachtigall RD et al., The challenge of providing infertility services to a low-income immigrant Latino population. Fertil Steril. 2009 Jul;92(1):116-23.

6. Williams JE, Anstrom KJ, Friedman JY, Schulman KA. Racial/ethnic variation in perceptions of medical information sources in Durham County, North Carolina. N C Med J. 2007 Nov-Dec;68(6):391-8.

Published online in Fertility and Sterility doi:10.1016/j.fertnstert.2010.12.030

The Authors Respond:

We would like to thank Dr. Serou and Dr. Quintero for their interesting and insightful comments. Although many of the statements made about the barriers to ART services are certainly accurate, differences in our study population may explain the results that we reported in our manuscript (1). Because our population was comprised of Department of Defense (DoD) beneficiaries, their access to care was greater than the majority of Hispanic patients. Their access to information is also greater, because at least one member of the couple must be fluent in English to be enrolled in the military. The opportunity to educate patients about infertility as a disease is also enhanced in this environment.

We had anticipated that Hispanic women would access ART services in numbers equal to their representation in the DoD population, as was the case with African American women. As a result of these findings, we have undertaken additional investigations in collaboration with a colleague at the University of Denver, Dr. Ruben Alvero.

Reference
1. McCarthy-Keith DM et al. Will decreasing assisted reproduction technology costs improve utilization and outcomes among minority women? Fertil Steril. 2010 Dec;94(7):2587-9.

Alicia Armstrong , M.D., M.H.S.C.R.a,b
Desiree McCarthy-Keith M.D., M.P.H.a,b
Ruben Alvero, M.D.c

aProgram in Reproductive and Adult Endocrinology
Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Institutes of Health
Bethesda, Maryland

bWalter Reed Army Medical Center
Washington, D.C.

cUniversity of Denver
Denver, Colorado

Published online in Fertility and Sterility doi:10.1016/j.fertnstert.2010.12.031

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