1. Write a brief paragraph discussing what social determinants are most relevant to your area of research and why. Consider both structural stratifiers (e.g. income, education, etc) and intermediary determinants such as material and psychosocial circumstances, as described in the WHO reading. Explain why you chose the factors (might use Braveman article from last week to provide justification. The association could be reported in published research or it could be your hypothesized relationship. Consider whether how these factors might function over the lifecourse and/or intergenerationally.
As a Reproductive Endocrinology and Infertility Fellow, my eventual research goals are to examine and reduce health disparities in infertility. Disparities in infertility prevention and treatment are vast spanning both the individual and across society. In terms of the structural stratifiers, previous research has shown limitations in the evaluation of infertility or fertility treatment based on socioeconomic and ethnic barriers. Individuals with a college education, higher income, and often Caucasian are more likely to be referred to an infertility specialist and have a greater likelihood of obtaining treatment. Besides from access to care, we see individuals from disadvantaged backgrounds more likely engage in behaviors that are detrimental to their own natural fertility leading them to increased risk for tubal factor disease and have a higher prevalence of untreated comorbidities such as diabetes and hypertension. Furthermore, limited education of infertility within some populations can manifest as late entry into care at which point a more aggressive and often unattainable treatment may be recommended. I think about this intergenerationally as infertility is viewed as a disease with reproduction considered a human right. For those who desire to conceive, limitations of infertility evaluations/treatments to those who are the economic elite limits social justice for these disadvantaged groups. Lastly, limitations in diversity among those able to afford these services consequently limits the research potential to improve outcomes among specific population. It is well known that African American women, even after adjustment for education and intrauterine fibroids along with other potential confounders, still have worse IVF outcomes then Caucasian women. Similar trends can be seen among Asian women as well. By limiting those with access to treatment, researchers have focused little on subtleties in evaluations/treatments that may have ethnic implications.
2. Write a brief paragraph describing the extent to which an socioecological framework incorporating issues related to social determinants has been applied to your area of research. Are there opportunities for improving our understanding of or approach to disparities in your area with a greater emphasis on a socioecological framework?
Fortunately, expansion of access to fertility care and investigation of health disparities is a recent initiative of the American Society for Reproductive Medicine. While it is challenging to apply the socioecological framework to this area of research given the inherent financial limitations currently associated with this field, my goals will be to investigate how changes in legislation/policy affects the likelihood for evaluation and acquisition of treatment particularly among diverse populations.
As a Reproductive Endocrinology and Infertility Fellow, my eventual research goals are to examine and reduce health disparities in infertility. Disparities in infertility prevention and treatment are vast spanning both the individual and across society. In terms of the structural stratifiers, previous research has shown limitations in the evaluation of infertility or fertility treatment based on socioeconomic and ethnic barriers. Individuals with a college education, higher income, and often Caucasian are more likely to be referred to an infertility specialist and have a greater likelihood of obtaining treatment. Besides from access to care, we see individuals from disadvantaged backgrounds more likely engage in behaviors that are detrimental to their own natural fertility leading them to increased risk for tubal factor disease and have a higher prevalence of untreated comorbidities such as diabetes and hypertension. Furthermore, limited education of infertility within some populations can manifest as late entry into care at which point a more aggressive and often unattainable treatment may be recommended. I think about this intergenerationally as infertility is viewed as a disease with reproduction considered a human right. For those who desire to conceive, limitations of infertility evaluations/treatments to those who are the economic elite limits social justice for these disadvantaged groups. Lastly, limitations in diversity among those able to afford these services consequently limits the research potential to improve outcomes among specific population. It is well known that African American women, even after adjustment for education and intrauterine fibroids along with other potential confounders, still have worse IVF outcomes then Caucasian women. Similar trends can be seen among Asian women as well. By limiting those with access to treatment, researchers have focused little on subtleties in evaluations/treatments that may have ethnic implications.
2. Write a brief paragraph describing the extent to which an socioecological framework incorporating issues related to social determinants has been applied to your area of research. Are there opportunities for improving our understanding of or approach to disparities in your area with a greater emphasis on a socioecological framework?
Fortunately, expansion of access to fertility care and investigation of health disparities is a recent initiative of the American Society for Reproductive Medicine. While it is challenging to apply the socioecological framework to this area of research given the inherent financial limitations currently associated with this field, my goals will be to investigate how changes in legislation/policy affects the likelihood for evaluation and acquisition of treatment particularly among diverse populations.