Journal of Immigrant and Minority Health

, Volume 17, Issue 4, pp 1033–1040 | Cite as

A Comparison of Immigrant and Canadian-Born Patients Seeking Fertility Treatment

  • Phyllis Zelkowitz
  • Leonora King
  • Rob Whitley
  • Togas Tulandi
  • Carolyn Ells
  • Nancy Feeley
  • Ian Gold
  • Zeev Rosberger
  • Peter Chan
  • Sharon Bond
  • Neal Mahutte
  • Sophia Ouhilal
  • Hananel Holzer
Original Paper

Abstract

The present study examined whether public funding for in vitro fertilization (IVF) in Quebec, Canada was associated with differential access among Canadian-born infertility patients and those born outside of Canada. Anonymous demographic questionnaires were completed at 3 time points: 2 weeks before the implementation of public funding, 2 weeks after, and 8 months later. Almost half the patients were not born in Canada and of these, 35 % were recent immigrants to Canada. While patients born outside Canada were generally better educated than Canadian-born patients, they were more likely to be unemployed and have lower incomes. Following public funding, there was an overall increase in patients with lower incomes and lower levels of education. Canadian-born patients were more likely than immigrant patients to consult for secondary infertility. Patients born outside Canada tended to be older and nulliparous, suggesting that they may have delayed treatment seeking due to financial and other barriers. The results indicate that public funding reduces health disparities in access to IVF.

Keywords

Infertility Access to treatment Assisted reproductive technology In-vitro fertilization Public funding Immigrants 

References

  1. 1.
    Bushnik T, Cook JL, Yuzpe AA, Tough S, Collins J. Estimating the prevalence of infertility in Canada. Hum Reprod. 2012;27(3):738–46.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod. 2007;22(6):1506–12.PubMedCrossRefGoogle Scholar
  3. 3.
    Nachtigall RD. International disparities in access to infertility services. Fertil Steril. 2006;85(4):871–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Chambers GM, Sullivan EA, Ishihara O, Chapman MG, Adamson GD. The economic impact of assisted reproductive technology: a review of selected developed countries. Fertil Steril. 2009;91(6):2281–94.PubMedCrossRefGoogle Scholar
  5. 5.
    Collins JA. An international survey of the health economics of IVF and ICSI. Hum Reprod Update. 2002;8(3):265–77.PubMedCrossRefGoogle Scholar
  6. 6.
    Connolly MP, Hoorens S, Chambers GM. The costs and consequences of assisted reproductive technology: an economic perspective. Hum Reprod Update. 2010;16(6):603–13.PubMedCrossRefGoogle Scholar
  7. 7.
    Jain T. Socioeconomic and racial disparities among infertility patients seeking care. Fertil Steril. 2006;85(4):876–81.PubMedCrossRefGoogle Scholar
  8. 8.
    Wellons MF, Lewis CE, Schwartz SM, Gunderson EP, Schreiner PJ, Sternfeld B, Richman J, Sites CK, Siscovick DS. Racial differences in self-reported infertility and risk factors for infertility in a cohort of black and white women: the CARDIA women’s study. Fertil Steril. 2008;90(5):1640–8.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Missmer SA, Seifer DB, Jain T. Cultural factors contributing to health care disparities among patients with infertility in Midwestern United States. Fertil Steril. 2011;95(6):1943–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Bitler M, Schmidt L. Health disparities and infertility: impacts of state-level insurance mandates. Fertil Steril. 2006;85(4):858–65.PubMedCrossRefGoogle Scholar
  11. 11.
    Chandra A, Stephen EH. Infertility service use among U.S. women: 1995 and 2002. Fertil Steril. 2010;93(3):725–36.PubMedCrossRefGoogle Scholar
  12. 12.
    Feinberg EC, Larsen FW, Wah RM, Alvero RJ, Armstrong AY. Economics may not explain hispanic underutilization of assisted reproductive technology services. Fertil Steril. 2007;88(5):1439–41.PubMedCrossRefGoogle Scholar
  13. 13.
    White L, McQuillan J, Greil AL. Explaining disparities in treatment seeking: the case of infertility. Fertil Steril. 2006;85(4):853–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Atkin K. Making sense of ethnic diversity, difference and disadvantage within the context of multicultural societies. In: Culley L, Hudson N, Van Rooij FB, editors. Marginalized reproduction: ethnicity, infertility and reproductive technologies. London: Earthscan; 2009. p. 48–63.Google Scholar
  15. 15.
    Vanderlinden LK. Treating ethnic others: cultural sensitivity and minority stereotypes at a german fertility clinic. Human Organ. 2011;70(3):253–64.CrossRefGoogle Scholar
  16. 16.
    Huddleston HG, Cedars MI, Sohn SH, Giudice LC, Fujimoto VY. Racial and ethnic disparities in reproductive endocrinology and infertility. Am J Obstet Gynecol. 2010;202(5):413–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Statistics Canada. 2011 National Household Survey: immigration, place of birth, citizenship, ethnic origin, visible minorities, language and religion. 2011 [cited 2013 July 22]; http://www.statcan.gc.ca/daily-quotidien/130508/dq130508b-eng.htm.
  18. 18.
    Statistics Canada. Selected demographic, cultural, educational, labour force and income characteristics (926), First Official Language Spoken (4), Age Groups (8A) and Sex (3) for the Population of Canada, Provinces, Territories, Census Metropolitan Areas and Census Agglomerations, 2006 Census 20% Sample Data. 2006 [cited 2013 April 9]; http://www12.statcan.gc.ca/census-recensement/2006/dp-pd/tbt/Rp-eng.cfm?TABID=1&LANG=E&APATH=3&DETAIL=0&DIM=0&FL=A&FREE=0&GC=0&GK=0&GRP=1&PID=99015&PRID=0&PTYPE=88971,97154&S=0&SHOWALL=0&SUB=0&Temporal=2006&THEME=70&VID=0&VNAMEE=&VNAMEF=.
  19. 19.
    Kim IH, Carrasco C, Muntaner C, McKenzie K, Noh S. Ethnicity and postmigration health trajectory in new immigrants to Canada. Am J Public Health. 2013;103(4):e96–104.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Lebrun LA. Effects of length of stay and language proficiency on health care experiences among immigrants in Canada and the United States. Soc Sci Med. 2012;74(7):1062–72.PubMedCrossRefGoogle Scholar
  21. 21.
    Brabant Z, Raynault MF. Health situation of migrants with precarious status: review of the literature and implications for the Canadian context—Part A. Soc Work Public Health. 2012;27(4):330–44.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Culley LA, Hudson N, Rapport FL, Katbamna S, Johnson MR. British South Asian communities and infertility services. Hum Fertil (Camb). 2006;9(1):37–45.CrossRefGoogle Scholar
  23. 23.
    Vanderlinden LK. German genes and Turkish traits: ethnicity, infertility, and reproductive politics in Germany. Soc Sci Med. 2009;69(2):266–73.PubMedCrossRefGoogle Scholar
  24. 24.
    Van Rooij FB, Van Balen F, Hermanns JMA. Emotional distress and infertility: Turkish migrant couples compared to Dutch couples and couples in Western Turkey. J Psychosom Obstet Gynaecol. 2007;28(2):87–95.PubMedCrossRefGoogle Scholar
  25. 25.
    Becker G, Castrillo M, Jackson R, Nachtigall RD. Infertility among low-income Latinos. Fertil Steril. 2006;85(4):882–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Inhorn MC. Right to assisted reproductive technology: overcoming infertility in low-resource countries. Int J Gynaecol Obstet. 2009;106(2):172–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Dyer SJ. The value of children in African countries—insights from studies on infertility. J Psychosom Obstet Gynaecol. 2007;28(2):69–77.PubMedCrossRefGoogle Scholar
  28. 28.
    Inhorn M, Birenbaum-Carmeli D. Assisted reproductive technologies and culture change. Annu Rev Anthropol. 2008;37:177–96.CrossRefGoogle Scholar
  29. 29.
    Adamson GD. Global cultural and socioeconomic factors that influence access to assisted reproductive technologies. Women’s Health. 2009;5:351.PubMedCrossRefGoogle Scholar
  30. 30.
    McCarthy-Keith DM, Schisterman EF, Robinson RD, O’Leary K, Lucidi RS, Armstrong AY. Will decreasing assisted reproduction technology costs improve utilization and outcomes among minority women? Fertil Steril. 2010;94(7):2587–9.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Wellons MF, Fujimoto VY, Baker VL, Barrington DS, Broomfield D, Catherino WH, Richard-Davis G, Ryan M, Thornton K, Armstrong AY. Race matters: a systematic review of racial/ethnic disparity in Society for assisted reproductive technology reported outcomes. Fertil Steril. 2012;98(2):406–9.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Vayena E, Rowe PJ, Griffin PD. Medical, ethical & social aspects of assisted reproduction, in Current practices & controversies in assisted reproduction: report of a WHO meeting. 2001, World Health Organization: Geneva, Switzerland.Google Scholar
  33. 33.
    Tulandi T, King L, Zelkowitz P. Public funding of and access to IVF. N Engl J Med. 2013;368(20):1948–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Human Resources and Skills Development Canada. Indicators of well-being in Canada. 2009 [cited 2012 25 May]; http://www4.hrsdc.gc.ca/.3ndic.1t.4r@-eng.jsp?iid=21.
  35. 35.
    Inhorn MC, Fakih MH. Arab Americans, African Americans, and infertility: barriers to reproduction and medical care. Fertil Steril. 2006;85(4):844–52.PubMedCrossRefGoogle Scholar
  36. 36.
    Mac Dougall K, Beyene Y, Nachtigall RD. Age shock: misperceptions of the impact of age on fertility before and after IVF in women who conceived after age 40. Hum Reprod. 2013;28(2):350–6.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Atkin K, Chattoo S, Crawshaw M. Clinical encounters and culturally competent practice: the challenges of providing cancer and infertility care. Policy Polit. 2013:1–16.Google Scholar
  38. 38.
    Daniluk JC, Koert E, Cheung A. Childless women’s knowledge of fertility and assisted human reproduction: identifying the gaps. Fertil Steril. 2012;97(2):420–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Feinberg EC, Larsen FW, Catherino WH, Zhang J, Armstrong AY. Comparison of assisted reproductive technology utilization and outcomes between Caucasian and African American patients in an equal-access-to-care setting. Fertil Steril. 2006;85(4):888–94.PubMedCrossRefGoogle Scholar
  40. 40.
    Culley L, Hudson N, Van Rooij F. Marginalized reproduction: ethnicity, infertility and reproductive technologies. London: Earthscan; 2009.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Phyllis Zelkowitz
    • 1
  • Leonora King
    • 1
  • Rob Whitley
    • 2
  • Togas Tulandi
    • 3
  • Carolyn Ells
    • 4
  • Nancy Feeley
    • 5
  • Ian Gold
    • 6
  • Zeev Rosberger
    • 7
  • Peter Chan
    • 8
  • Sharon Bond
    • 9
  • Neal Mahutte
    • 10
  • Sophia Ouhilal
    • 10
  • Hananel Holzer
    • 11
  1. 1.Department of Psychiatry, Jewish General Hospital, The Lady Davis Institute for Medical ResearchMcGill UniversityMontrealCanada
  2. 2.Douglas Mental Health InstituteMcGill UniversityMontrealCanada
  3. 3.Department of Obstetrics and Gynecology, Jewish General HospitalMcGill UniversityMontrealCanada
  4. 4.Department of Medicine and Biomedical Ethics Unit, The Lady Davis Institute for Medical ResearchMcGill UniversityMontrealCanada
  5. 5.Centre for Nursing Research, Jewish General Hospital, The Lady Davis Institute for Medical ResearchIngram School of Nursing, McGill UniversityMontrealCanada
  6. 6.Departments of Philosophy and PsychiatryMcGill UniversityMontrealCanada
  7. 7.Department of Psychiatry, Jewish General Hospital, The Lady Davis Institute for Medical ResearchMcGill UniversityMontrealCanada
  8. 8.Division of UrologyMcGill University Health CentreMontrealCanada
  9. 9.Department of Psychiatry, Jewish General Hospital, School of Social WorkMcGill UniversityMontrealCanada
  10. 10.Montreal Fertility CentreMontrealCanada
  11. 11.MUHC Reproductive CentreMcGill UniversityMontrealCanada

Personalised recommendations