Katherine M. Johnson

Race-Ethnicity and Medical Services for Infertility: Stratified Reproduction in a Population-based Sample of U.S. Women

Evidence of group differences in reproductive control and access to reproductive health care suggests the continued existence of “stratified reproduction” in the United States. Women of color are overrepresented among people with infertility but are underrepresented among those who receive medical services. The authors employ path analysis to uncover mechanisms accounting for these differences among black, Hispanic, Asian, and non-Hispanic white women using a probability-based sample of 2,162 U.S. women. Black and Hispanic women are less likely to receive services than other women. The enabling conditions of income, education, and private insurance partially mediate the relationship between race-ethnicity and receipt of services but do not fully account for the association at all levels of service. For black and Hispanic women, social cues, enabling conditions, and predisposing conditions contribute to disparities in receipt of services. Most of the association between race-ethnicity and service receipt is indirect rather than direct.

The hidden infertile: infertile women without pregnancy intent in the United States.

A national probability sample reveals two relatively distinct groups of infertile women: those with intent, who have experienced a period of 12 or more months during which they tried to conceive but did not, and those without intent, who had a period of at least 12 months during which they could have conceived and did not but who do not describe themselves as having tried to become pregnant at that time. Those with intent are more likely to identify as having a fertility problem, to be distressed, and to pursue infertility treatment than those without intent, suggesting that many women do not realize that they meet the medical criteria for infertility and may wait longer to get help, therefore lowering their chances of conception.

Specifying the effects of religion on medical helpseeking: The case of infertility

Several recent studies have examined the connection between religion and medical service utilization. This relationship is complicated because religiosity may be associated with beliefs that either promote or hinder medical helpseeking. The current study uses structural equation modeling to examine the relationship between religion and fertility-related helpseeking using a probability sample of 2183 infertile women in the United States. We found that, although religiosity is not directly associated with helpseeking for infertility, it is indirectly associated through mediating variables that operate in opposing directions. More specifically, religiosity is associated with greater belief in the importance of motherhood, which in turn is associated with increased likelihood of helpseeking. Religiosity is also associated with greater ethical concerns about infertility treatment, which are associated with decreased likelihood of helpseeking. Additionally, the relationships are not linear throughout the helpseeking process. Thus, the influence of religiosity on infertility helpseeking is indirect and complex. These findings support the growing consensus that religiously-based behaviours and beliefs are associated with levels of health service utilization.

Revisiting "her" infertility: medicalized embodiment, self-identification and distress.

Prior research emphasizes womens distress and responsibility for a couples infertility because of gendered, pronatalist norms. Yet some studies suggest that being personally diagnosed and/or undergoing treatment differentially shapes reactions. We focused on differences in womens experiences with diagnosis and treatment, conceptualized as the medicalized embodiment of infertility. Using regression analysis, we examined two psychosocial outcomes (self-identification as infertile and fertility-specific distress) in a sample of 496 heterosexual, U.S. women from the National Survey of Fertility Barriers. Medicalized embodiment was salient to womens reactions, but had different relationships to self-identification versus distress. Although women experienced distress regardless of type of diagnosis, they were generally less likely to self-identify as infertile unless personally diagnosed. As such, we cannot assume that all women universally experience infertility. Future research should also address self-identification and distress as separate as opposed to simultaneous psychosocial outcomes.

Fertility clinic, egg donation agency, and sperm bank policies.

OBJECTIVE To assess the level of openness in U.S. gamete donation policies across fertility clinics, egg donation agencies, and sperm banks. DESIGN Primarily a content analysis of organizational materials (e.g., websites, brochures). SETTING Not applicable. PARTICIPANT(S) A total of 219 fertility clinics, 100 egg donation agencies, and 30 sperm banks. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Use of donor photographs, anonymity between parties, cycle outcome disclosure, and postcycle contact. RESULT(S) Agencies were more likely to provide donor photographs, have proactive policies to inform donors of the cycle outcome, and have nonanonymous options compared with sperm banks and clinics. Sperm banks were more likely to offer institutionalized donor identity-release programs. CONCLUSION(S) Clinics, agencies, and sperm banks have different policies to address the level of openness between donors, recipients, and donor-conceived children. Although agencies generally offer more open arrangements, only a minority of organizations restricted all types of contact and communication between parties.

Making families: Organizational boundary work in US egg and sperm donation

Egg and sperm donation can create distinct issues for designating family boundaries. These issues come to the forefront as relations between donors, recipients, and donor-conceived children have been shifting from anonymous to more open arrangements in the US and other western countries. In this study, I address US organizational practices and family boundary construction. Fertility clinics, egg donation agencies, and sperm banks are central providers of US gamete donation services. Given the disruptive potential of gamete donation, how do they manage relationships between parties? Through a content analysis of materials from twenty fertility clinics, twenty egg donation agencies, and thirty-one sperm banks, I address three major strategies of organizational boundary work: 1) creating identity categories, 2) managing information, and 3) managing interaction. I ultimately argue that even as many organizations offer opportunities for connections between parties, they exercise social control over donation arrangements through bounded relationships.

Are prior pregnancy outcomes relevant for models of fertility-specific distress or infertility helpseeking?

Women with prior pregnancy but no live birth are inconsistently termed as either ‘primary infertile’ or ‘secondary infertile’ in psychosocial studies of infertile women. The goal of this study was to discover whether infertile women who had experienced pregnancies but no live births were more similar in attitudes and behaviour to infertile women who had not experienced pregnancies or to those who had live births. We used the National Survey of Fertility Barriers (NSFB), which contains self-reported data from a probability-based sample of US women aged between 25 and 45, to accomplish our goal. In this cross-sectional analysis, infertile women who had not experienced pregnancies were compared on the basis of fertility-specific distress (FSD) and medical help-seeking for infertility to women who had had pregnancies with live births and women with pregnancies but no live births. Women were interviewed by telephone in their homes. Data of 1,027 women who had had an infertility episode within the past 10 years were analysed using multiple regression and logistic regression. Infertile women who had never been pregnant experience higher levels of FSD and were more likely to seek treatment than infertile women who had been pregnant, regardless of the outcome of the pregnancy.

Women’s Attitudes Toward Biomedical Technology for Infertility The Case for Technological Salience

Research has consistently revealed gender differences in attitudes toward science and technology. One explanation is that women are more personally affected by particular technologies (e.g., biomedical interventions), so they consider them differently. However, not all women universally experience biomedical technologies. We use the concept of technological salience to address how differences in subjective implications of a technology might explain differences in women’s attitudes toward biotechnology. In a sample of U.S. women from the National Survey of Fertility Barriers, we examine how women with and without a biomedical barrier to fertility evaluate biotechnology for infertility, which, we argue, reflects differences in technological salience. For women with a biomedical barrier, various experiences, beliefs, and values impacted their attitudes; yet, most of these did not affect attitudes if women had not experienced a fertility barrier. Results suggest that technological salience contextualizes women’s attitudes toward these biotechnologies and may also have broader implications for other biotechnologies.

Amount, Source, and Quality of Support as Predictors of Women's Birth Evaluations

BACKGROUND This paper examines the separate effects of the perceived amount, source, and quality of support during labor and delivery on womens positive and negative evaluations of their birth experiences. METHODS Data come from the Listening to Mothers I and II (LTM) surveys (n = 2,765). Womens perception of support was regressed separately onto indices of positive and negative words that women associated with their labor and delivery. RESULTS The total number of support sources, type of support person, and quality of support all impacted womens birth evaluations across different regression models, controlling for demographics, birth interventions, and other birth characteristics. Support overall had a greater effect on increasing womens positive evaluations, but was not as protective against negative evaluations. Support from medical and birth professionals (doctors, nurses, doulas) had the greatest effect on womens positive evaluations. Good partner support was complexly related: it was associated with less positive evaluations but also appeared to have a protective effect against negative birth evaluations. DISCUSSION Support in childbirth is a complex concept with multiple dimensions that matter for womens birth evaluations. Support from nursing staff, doctors, and doulas is important for enabling positive evaluations while support from partners is more complexly related to womens evaluations. Research on support for laboring women should more extensively address the division of labor between different sources of support.

Decline in ethical concerns about reproductive technologies among a representative sample of US women

Public awareness and utilization of assisted reproductive technology has been increasing, but little is known about changes in ethical concerns over time. The National Survey of Fertility Barriers, a national, probability-based sample of US women, asked 2031 women the same set of questions about ethical concerns regarding six reproductive technologies on two separate occasions approximately 3 years apart. At Wave 1 (2004–2007), women had more concerns about treatments entailing the involvement of a third party than about treatments that did not. Ethical concerns declined between Wave 1 and Wave 2, but they declined faster for treatments entailing the involvement of a third party. Ethical concerns declined faster for women with greater levels of concern at Wave 1. Initial ethical concerns were higher, and there was less of a decline in ethical concerns for women with higher initial levels of religiosity.