A recent Oregon State University study found that people who live in socioeconomically deprived areas are about 20% less likely to get pregnant during any menstrual cycle than people who live in more affluent areas.
The study measured “fertility,” which is the monthly chance of getting pregnant, among couples trying to conceive without using fertility treatments.
The researchers compared neighborhoods based on their “index of area deprivation,” which shows the socioeconomic resources in a neighborhood. They found that even among the relatively affluent, highly educated study population, people living in poorer neighborhoods had lower fertility rates than people living in better-off neighborhoods.
“The world of fertility research is starting to look at factors related to the anthropogenic environment. There are dozens of studies examining how your neighborhood environment is associated with adverse birth outcomes, but the period before conception is very understudied from a structural perspective,” said lead author Mary Willis, a doctoral student in OSU’s College of Public Health and Human Sciences. It turns out there can be things that affect your health even before you conceive.’
Public health research in the past decade has emphasized the importance of social determinants of health and the idea that zip code is the greatest predictor of overall life expectancy, based on factors such as income, access to health care, employment rate, education level, and access to safe water .
“But the concept that your neighborhood affects your fertility hasn’t been studied in depth,” Willis said. “Also, the world of infertility research is very much focused on individual factors, so when I started this research as an environmental epidemiologist, I thought we had to look at this as a structural problem.”
The study used data from Boston University’s ongoing Pregnancy Study Online (PRESTO) study. Researchers analyzed a cohort of 6,356 people between the ages of 21 and 45 who were trying to conceive without fertility treatment, based on data collected from 2013 to 2019.
Study participants completed online surveys every eight weeks for 12 months, answering questions about their menstrual cycle and pregnancy status. During the study time period, 3,725 pregnancies were documented.
The researchers compared participants on different deprivation index ratings at the national and state levels, which used socio-economic indicators including educational attainment, housing, employment and poverty.
They found that participants in the most impoverished areas, based on national rankings, had a 19-21% lower birth rate compared to participants in the least impoverished areas. Based on the ranking within the state, the most impoverished areas experienced a 23-25% drop in productivity compared to the least impoverished areas.
Most people in the cohort were white, had a four-year college degree, and earned more than $50,000 a year.
“The fact that we see the same results at the national and state level really shows that neighborhood deprivation can affect reproductive health, including fertility,” Willis said.
Approaching fertility research from a structural perspective could help reduce or prevent infertility in general, she said, especially because infertility treatment is expensive and usually only available to families with significant resources.
The study concludes that investing in poor neighborhoods to address socioeconomic disparities can have positive fertility benefits.
Co-authors were Olivia Horta of John Jay College of Criminal Justice; Collette Ncube, Amelia Wesselink, Renee Boynton-Jarrett, Elizabeth Hatch, and Lauren Wise of Boston University; Lan ?oàn of New York University; and Kipruta Kirwa of Tufts University.