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Critical Issues in Reproductive Health pp 103–126Cite as

Using New Data and Improved Study Designs to Examine Infertility-Service Seeking and Adverse Maternal and Perinatal Outcomes in the South-Central United States

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Part of the book series: The Springer Series on Demographic Methods and Population Analysis ((PSDE,volume 33))

Abstract

The inability to produce a biological child can profoundly disturb mental and social wellbeing, although it does not in itself threaten physical health. Infertility is also a problem of global proportions, affecting about 4–14 % of couples worldwide (Nachtigall 2006), with estimates of couples experiencing involuntary childlessness for a least 1 year ranging from 10 to 30 %. After a long period of neglect, infertility is finally receiving increased public and research attention. Infertility treatments can assist those desperate to become parents, but they have also fallen under scrutiny for their potential adverse maternal and infant outcomes. In this chapter, we use a new data source and novel comparison group to consider the use of such services and their salient outcomes. Our application is to Texas, the second most populous and extensive state in the U.S., and which has some of its most glaring reproductive health disparities.

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Notes

  1. 1.

    The U.S. standard certificate of live birth, first introduced in 1900, is the model for state birth certificates and provides reasonably accurate information for maternal demographic characteristics. It is revised every 10–15 years to improve data quality and the collection of comparable and relevant birth data (Kulczycki 2008).

  2. 2.

    The U.S. Census Bureau collects and tabulates race and ethnicity data following the U.S. Office of Management and Budget’s (OMB) standards, the most recent issued in 1997. These identify five race groups: white, black or African-American, American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander. The Census Bureau also utilized a sixth category (‘some other race’). Hispanic-origin information is also collected to give data on ethnicity by two categories: “Hispanic or Latino” and “Not Hispanic or Latino.”

  3. 3.

    U.S. teen pregnancy and birth rates declined by more than one-third over 1990–2008, but in 2008, their public costs (federal, state, and local) still amounted to $10.9 billion and in Texas, teen childbearing (with over 80 % of such births unintended) cost taxpayers at least $1,193 million, substantially more than for any other state (National Campaign to Prevent Teen and Unplanned Pregnancy 2011). Among other factors, the negative consequences for the children of teen mothers include increased costs for health care, child welfare and foster care, lost tax revenue due to decreased earnings and spending.

  4. 4.

    Planned Parenthood uses private contributions and patient fees to provide abortions, but not federal or state funds as this is not permitted under U.S. law. The sharply curtailed funding has led to the closure of numerous clinics in the state.

  5. 5.

    Medicaid is a joint federal-state program that finances health care for poor women. Under U.S. law, those who depend on Medicaid have to be able to access healthcare from clinics that accept Medicaid. The Medicaid-supported Women’s Health Program generates $9 in federal funding for every $1 dollar spent by Texas. This match makes it a very good investment for the state and provides a safety net that is often the only health care many low-income women receive. In 2011, a lower court overruled the measure to bar Planned Parenthood (the program’s largest provider, serving nearly half the women in the program with their primary health and family planning) and abortion affiliates from continuing as members of the Women’s Health Program. This move was then appealed by the powerful Republican governor, whose presidential candidacy and coveting of social conservatives led his party to push more firmly against spending money on contraception and further limit access to reproductive health services.

  6. 6.

    Pre-eclampsia can be a dangerous pregnancy complication in which hypertension is diagnosed during the pregnancy along with significant amounts of protein in the urine (proteinuria). There is no known cure for this set of symptoms, whose most visible sign is elevated blood pressure (above normal for age, gender, and physiologic condition) but which may also involve more generalized damaged to the kidneys and liver. It is more common among women who are pregnant for the first time and in women with a multiple gestation (twins or multiple birth), and it may occur in the immediate post-partum period when it can be more dangerous. Some women develop pregnancy-induced hypertension (high blood pressure without proteinuria), which also requires careful monitoring of mother and fetus. Eclampsia can occur after the onset of pre-eclampsia and is an acute and life-threatening complication of pregnancy. This form of hypertension includes seizures or coma.

  7. 7.

    In keeping with prior literature (Nuojoa-Huttunen et al. 1999), non-vertex presentation is considered here as a maternal outcome, although it can also be viewed as a predictor for other adverse infant outcomes. In this dataset, the most significant predictors of non-vertex presentation were twin and triplet or higher order births, type of infertility treatment, preterm birth, and low birthweight.

  8. 8.

    The Apgar score, the very first test given to a newborn, is a systematic measure used for evaluating the physical condition of the infant at specific intervals following birth. Apgar scores range from 0 to 10, with scores 3 and below generally regarded as critically low and requiring immediate medical care (ACOG/AAP 2006). However, the Apgar score has its limitations and is neither a good indicator of long-term complications, nor of the etiology of a problem.

  9. 9.

    The Special Supplemental Nutrition Program for Women, Infants and Children (abbreviated as WIC) is a Federal grant program whose target population are those at low-income and nutritionally at risk (for more information, see http://www.fns.usda.gov/wic/aboutwic/wicataglance.htm). To be eligible for WIC and for Medicaid during the time period evaluated, households had to have an income that was at or less than 185 % of the federal poverty level (i.e. an eligible family of four could earn up to $37,000 in 2006); and needed to have had a child younger than age 5 years, or a woman who was pregnant, breastfeeding, or up to 6 months postpartum (Texas Department of State Health Services 2012). Those with private health insurance can still apply for WIC and U.S. citizenship is not a requirement for eligibility.

  10. 10.

    Results for plurality are calculated incidence rates, whereas other demographic characteristics and co-morbidities are prevalence rates because they were computed with cross-sectional data.

  11. 11.

    This was evident when gestational age was studied as a continuous variable, although the preterm birth difference was not shown to be significantly different among the two infertility treatment groups when it was looked at as a categorical variable.

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Acknowledgments

The authors would like to thank the Texas Department of State Health Services for granting access to data used in this study.

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Authors and Affiliations

  1. Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA

    Suzanne Dhall DrPH & Andrzej Kulczycki Ph.D. (Associate Professor)

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  1. Suzanne Dhall DrPH
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Correspondence to Suzanne Dhall DrPH .

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  1. Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, USA

    Andrzej Kulczycki

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Dhall, S., Kulczycki, A. (2014). Using New Data and Improved Study Designs to Examine Infertility-Service Seeking and Adverse Maternal and Perinatal Outcomes in the South-Central United States. In: Kulczycki, A. (eds) Critical Issues in Reproductive Health. The Springer Series on Demographic Methods and Population Analysis, vol 33. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6722-5_6

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  • DOI: https://doi.org/10.1007/978-94-007-6722-5_6

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