Nursing staff must act to stop Black and ethnic minority women “falling through the cracks” of fertility care, a specialist nurse in the field has said.
Yemi Adegbile, lead fertility nurse at IVF specialist centre Create Fertility, told the Royal College of Nursing’s Fertility Nursing Forum today that the profession could help stamp out racial inequalities.
“Fertility [nursing] is no exception: we must make sure we incorporate culturally competent care”
Ms Adegbile said that support for infertility, which affects around one in seven heterosexual couples in the UK, was something BME people often missed out on due to inaccessibility and cultural differences.
“When you have a [BME] couple who are married, they have the expectation that they will have children in the next few months, because it’s an expectation in their culture,” she said.
“And when this doesn’t happen, there is a lot of stress, from the outside as well; when it isn’t happening soon enough, there is pressure on them, and what happens is some are excluded from social gatherings because they haven’t conceived.”
Ms Adegbile said this social pressure led, often, to self-imposed ostracisation, and, in turn, women “falling through the cracks”, because they would not present at fertility clinics, or take much longer to.
“Black patients start IVF treatment, on average, almost two years later [aged 36.4] than the average person,” said Ms Adegbile, who pointed that this is problematic in some NHS areas where IVF is only funded up to the age of 35.
One forum member described fertility care in the UK as a “postcode lottery” for the BME community.
Ms Adegbile continued: “It takes them longer to present [at a fertility clinic] in the first place, and maybe they have medical issues, like endometriosis. Black patients have higher incidences of certain conditions – and they’re not necessarily diagnosed correctly.
“So by the time they do present, their outcomes are worse and the number of live births are lower,” she said.
And by the point at which they did attend a clinic, Ms Adegbile said nursing staff were not always equipped for culturally sensitive care.
As a result, she called on nurses working in the field to become more educated on culturally-specific care.
“We need to acknowledge, sometimes, that they [patients] don’t understand what’s being said,” she said.
“[We] might assume they do, and so they are told to go and try some more, and by the time they have come back, more time has passed, leading to a delayed diagnosis.
“We need to understand cultures better, we live in a diverse society and fertility is no exception: we must make sure we incorporate culturally competent care.”
She pointed to several developments that she had seen in fertility clinics where this was being addressed.
For example, tracking and ensuring that people for whom English was not their first language were able to engage with digital materials and instructions.
“We need to improve patient trust,” she continued. “A nurse going the extra mile to make a patient trust them can mean they come back quicker.”
Ms Adegbile also called for better provision for interpreters in fertility clinics and said that, sometimes, nurses spoke about sensitive and highly clinical matters via a young relative.
“We must also give them time to pray,” she suggested, for some patients. “We must understand their culture, as it’s part of who we are and what they do.”
In response to a question from a forum member, Ms Adegbile said outreach was also crucial for improving access for BME women seeking fertility care.
“It’s all about raising awareness,” she said. “I speak at churches, talk to pastors, and explain to [their religious community] that they’re not cursed because they can’t conceive – and where to seek help.
“[Nurses] need to help debunk all of that, while also respecting that they have those beliefs,” added.
If this was not done, Ms Adegbile said, many women would simply “wait their turn or sit in silence”.