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A Demographic and Sociological Analysis of Assisted Reproductive Technologies in the United States

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A Demographic and Sociological Analysis of Assisted Reproductive Technologies in the United States A DEMOGRAPHIC AND SOCIOLOGICAL ANALYSIS OF ASSISTED REPRODUCTIVE TECHNOLOGIES IN THE UNITED STATES Katherine I. Tierney A dissertation submitted to the faculty at the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Sociology in the College of Arts and Sciences. Chapel Hill 2020 Approved by: Kathleen Mullen Harris Yong Cai Lisa Pearce John Thorp Julia McQuilla © 2020 Katherine I. Tierney ALL RIGHTS RESERVED ii ABSTRACT Katherine I. Tierney: A Demographic and Sociological Analysis of Assisted Reproductive Technologies in the United States (Under the direction of Kathleen Mullan Harris) Use of assisted reproductive technologies (ART) has increased rapidly in the United States and other countries amid continued fertility postponement and record low fertility rates. ARTs can enable people to overcome biological barriers to having children and may be the only option to have biological children for some. Given the current U.S. social and demographic context of increasing investments in education and career development by women and the associated postponement of marriage and first births as well as the increasing acceptance of same-sex and single-parent headed households, demand for and use of ART is likely to continue to increase. In the U.S., however, use and outcomes of ARTs are strongly patterned by race and socioeconomic status. The goal of this dissertation is to provide a demographic and sociological analysis of the racial inequalities observed in ART. Chapter 1 uses demographic projections and shows that ART will continue to play a small and racially and socioeconomically patterned role in total fertility if current trends continue. Chapter 2 uses two nationally representative data sources and finds inconsistent evidence of weathering and weathering-related health indicators among women of color seeking infertility treatments, suggesting the need for improved data as well as the consideration of other causes of inequality. Chapter 3 investigates claims that “sociocultural differences” drive racial disparities in utilization of ART. Given the limited information about the substance of these differences, Chapter 3 uses qualitative interviews with 16 Black or African American women and 15 White women in graduate programs. The results demonstrate similarities as well as nuanced differences in sources of knowledge about ART and perceptions (or schemas) of ART between Black and White women in the sample. These iii results cast doubt on previous suggestions that exposure to knowledge about ART, perceptions of ART, or openness to use of ART may drive lower treatment seeking or treatment receipt among Black women. The dissertation ends with a discussion of avenues for future research. iv ACKNOWLEDGEMENTS I wish to thank my committee members and my dissertation chair for their help and feedback throughout this process. I am also deeply grateful to my partner, friends, and family who have supported and encouraged me in this and all my other endeavors. In addition, I would like to acknowledge the generous funding from the National Science Foundation, which has enabled me to focus on my research throughout graduate school, and the publicly available national data, which this dissertation uses. This material is based upon work supported by the National Science Foundation Graduate Research Fellowship under Grant No. DGE-1650116. Any opinion, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the National Science Foundation. This paper uses data from the National Center for Health Statistics. Any opinion, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of NCHS, which is responsible only for the initial data. v TABLE OF CONTENTS LIST OF TABLES ....................................................................................................................................... ix LIST OF FIGURES ..................................................................................................................................... xi DISSERTATION INTRODUCTION .......................................................................................................... xi 1.1 Background of ART ......................................................................................................................... xiii 1.2 Trends in ART ................................................................................................................................. xiv 1.3 Inequality and ART in the United States .......................................................................................... xv 1.4 Overview of Dissertation Chapters ................................................................................................... xv 1.5 Scope and Overarching Contribution of Dissertation ...................................................................... xvi CHAPTER 1: IMPACTS OF ASSISTED REPRODUCTIVE TECHNOLOGY ON TOTAL FERTILITY IN THE UNITED STATES: ESTIMATES, PROJECTIONS, AND INEQUALITIES ......................................................................................................................................... 18 1.1 Introduction ....................................................................................................................................... 18 1.2 Background ....................................................................................................................................... 18 1.3 Theoretical Framework ..................................................................................................................... 20 1.4 Research Questions ........................................................................................................................... 22 1.5 Data ................................................................................................................................................... 23 1.6 Measures ........................................................................................................................................... 23 1.7 Analytic Methods .............................................................................................................................. 24 1.8 Results ............................................................................................................................................... 30 1.9 Discussion ......................................................................................................................................... 35 1.10 Conclusion ...................................................................................................................................... 38 1.11 Tables and Figures .......................................................................................................................... 40 vi CHAPTER 2: EXPLORING THE ROLE OF WEATHERING AMONG WOMEN OF COLOR SEEKING INFERTILITY TREATMENTS ................................................................................ 58 2.1 Introduction ....................................................................................................................................... 58 2.2 Background ....................................................................................................................................... 59 2.3 Theoretical Framework ..................................................................................................................... 61 2.4 Research Question & Hypotheses ..................................................................................................... 63 2.5 Data ................................................................................................................................................... 64 2.6 Measures ........................................................................................................................................... 65 2.7 Analytic Methods .............................................................................................................................. 68 2.8 Results ............................................................................................................................................... 72 2.9 Discussion ......................................................................................................................................... 76 2.10 Conclusion ...................................................................................................................................... 79 2.11 Tables and Figures .......................................................................................................................... 80 CHAPTER 3: “IT’S VERY IN THE ZEITGEISTS”: KNOWLEDGE AND SCHEMAS OF ART AMONG BLACK AND WHITE WOMEN PURSUING GRADUATE EDUCATION ........................................................................................................................................... 101 3.1 Introduction ..................................................................................................................................... 101 3.2 Background ..................................................................................................................................... 102 3.3 Sensitizing Theoretical Framework ...............................................................................................
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