The Cost of Motherhood: Physical, Emotional, Financial, and Social Demands of Diagnosed Infertility and Treatment

Background and Purpose: Infertility affects an estimated 6.7 million women in the United States. It is a widespread issue affecting women across all ethnic backgrounds, yet, women of color (WOC) are more likely to experience infertility compared to White women. Limited research exists that examines the emotional challenges and physical costs that affect women, in general, and WOC, in particular. Infertility has multitudinal impacts on not only women’s physical health, but also on their mental health, economics, intimate partnerships, and personhood. Using a multidimensional approach, this study seeks to shed light on these overlooked relational, economic, racial, and emotional aspects for WOC affected by infertility.

Methods: Thirty-six in-depth, semi-structured interviews were conducted with WOC (ages 25 to 50) who were diagnosed with primary or secondary infertility. The sample is predominately Black or African American (83 % Black/African American; 13.8% South Asian/Chinese American; 2.7% race undisclosed); married women (75% married; 13% divorced/widowed; 11% single), and educated (100% had a college degrees – Associates degree, JDs, PhD, and MDs). Participants were recruited for the study through social media and snowball sampling. The recruitment flier detailed the inclusion criteria for participants: (a) women of color, (b) 18 years of age and older, (c) fluent in English and (d) tried for 3 months or more to get pregnant without success. A QR code was provided for respondents to complete a brief online survey providing their demographic information and to confirm eligibility. All interviews were conducted via Zoom and interviews were transcribed verbatim using online transcription service.

Findings: Data analysis revealed 4 costs of infertility: 1. financial burden, 2. relational disruption, 3. physical toll, and 4. emotional and psychological strain. Some participants described the financial burden as challenges of paying for treatments, navigating insurance coverage, and making difficult choices when costs became unsustainable. Participants described how their relationships were disrupted because the focus on procreation and failure to conceive ruined the sexual enjoyment ruined the romance and intimacy in the relationship. Participants suggest that a physical toll occurred on their bodies from the bodily demands of medication, injections, and procedures. Some participants also reported feeling emotionally and psychologically strained, as evidenced by anxiety, depression, and identity-related distress that accompanied the infertility journey.

Conclusion and Implications: Findings highlight the costs of infertility that include and go beyond financial costs. It also includes the costs that occur in multiple areas of women and their families lives, such as effort and energy, as well as the capacity of the woman’s body to endure mental, physical, and physiological strain. Implementing a robust and targeted approach to women who experience infertility that include mental health interventions, family supports, and insurance advocacy, social workers may assist women and their families to better understand the journey of infertility and reduce the various costs associated with this experience.