PROJECT SUMMARY
Infertility is an important public health problem that affects up to 15% of reproductive-aged couples in the
United States. Black women experience infertility at approximately two times the rate of white women, yet are
less likely to seek medical care and have poorer fertility treatment outcomes. Despite this disparity,
epidemiologic research on infertility has largely been conducted among economically privileged white couples
seeking treatment at fertility clinics. Studies of fertility that enroll women during preconception or early
pregnancy have likewise had limited success in recruiting Black women. Thus, there has been virtually no
study of causes of infertility in Black women. Racial residential segregation and racialized patterns of
neighborhood investment and disinvestment have resulted in inequitable burdens of spatially-distributed
environmental exposures on communities of color. In the present proposal, we examine several exposures of
high relevance to Black women, with a focus on environmental and neighborhood-level exposures. We will use
data from the Black Women’s Health Study (BWHS), the largest study in existence focusing on the health of
Black women. BWHS recruited 59,000 Black women from the United States in 1995 and have followed them
biennially for over 25 years. Outcome information was collected retrospectively in 2011, when women reported
information on time-to-pregnancy (TTP) for each of their planned pregnancies that ended in a live birth,
whether they had ever tried to conceive for >12 months without success, and if so, what cause was identified.
We will use these data to examine the association of TTP, infertility, and cause-specific infertility, with 1)
historical redlining, a 1930s government sponsored policy in which neighborhoods were classified by
investment risk based largely on the presence of Black residents, 2) residential racial and economic
segregation and neighborhood socioeconomic status, and 3) residential environmental exposures (including air
pollution, green space, and environmental noise). Finally, we will explore how redlining grades are associated
with patterns of neighborhood disadvantage and environmental pollution and how mixtures of social and
environmental exposures are related to fertility. Exposures will be derived from linkage between BWHS
participant addresses (collected biennially from 1995-2011) with geospatial data sets. The proposed study is
likely to have a large and sustained impact on the fields of reproductive epidemiology, environmental health,
and health disparities. The centering of Black women in infertility research advances health equity, combats
racist stereotypes that propagate the idea that infertility is a non-issue for Black women, and allows for the
identification of opportunities for intervention to reduce and eliminate infertility disparities. This will be the first
study to focus on causes of infertility in Black women, and is highly relevant for understanding how the
environment shapes human reproduction.
