On February 18, 2025, President Donald J. Trump signed Executive Order 14216, Expanding Access to In Vitro Fertilization, to address financial and systemic barriers that limit access to fertility treatments. Published in the Federal Register on February 24, 2025, the order directs federal agencies, particularly the Department of Health and Human Services (HHS), to enhance the availability, affordability, and accessibility of in vitro fertilization (IVF) services nationwide. This order is a significant step towards addressing the racial disparities that have historically limited access to IVF in communities of color, by reducing financial and regulatory hurdles and promoting culturally responsive patient outreach strategies.
Reducing Financial and Regulatory Barriers
The executive order prioritizes reducing financial and regulatory hurdles that prevent individuals from seeking IVF treatment. High costs and limited insurance coverage remain among the most significant obstacles, with a single cycle of IVF costing between $12,000 and $25,000, often requiring multiple attempts for success. By expanding insurance coverage, financial assistance programs, and regulatory reforms, the administration aims to make fertility treatments more accessible. However, generational racial inequities in employment, wealth distribution, and healthcare access have systematically excluded Black, Hispanic, and Indigenous individuals from equitable fertility care, resulting in disproportionately high rates of uninsurance and underinsurance. Without policies that directly address racial gaps in healthcare coverage, these reforms may continue to benefit wealthier, predominantly White individuals while leaving historically marginalized communities behind.
Racial Disparities in IVF Access
Despite experiencing infertility at similar or higher rates than White women, Black, Hispanic, and Indigenous individuals systematically face barriers to accessing fertility treatments. Several factors contribute to these disparities, including medical racism, implicit bias, and lower referral rates for fertility treatments. Studies show that healthcare providers are less likely to refer Black and Hispanic women for fertility care and often dismiss or downplay their concerns about infertility. These delays in diagnosis and treatment reduce their chances of successful conception and exacerbate reproductive health inequities.
The history of reproductive control over communities of color, including forced sterilization programs and discriminatory healthcare practices, has fostered deep mistrust in the medical system. This legacy, combined with the fact that reproductive healthcare has historically centered on White patients, means that Black and Hispanic individuals often lack access to culturally responsive fertility care. The urgency of achieving racial equity in fertility care is clear. It requires systemic changes, including anti-racist medical training, dismantling provider biases, and designing culturally responsive patient outreach strategies to ensure that communities of color receive equitable access to fertility treatment.
Even when Black and Hispanic women overcome financial and systemic barriers, they face lower IVF success rates compared to White women. Research indicates that Black women have higher rates of miscarriage, pregnancy complications, and lower live birth rates per IVF cycle. Some of these disparities are linked to underlying health conditions—such as higher rates of uterine fibroids, obesity, and hypertension—which are more prevalent in communities of color due to generational health inequities and environmental stressors. However, another significant factor is that reproductive medicine has historically centered on White patients, with research, clinical trials, and treatment protocols failing to address the unique reproductive health needs of Black, Hispanic, and Indigenous populations. The exclusion of these groups from fertility research has reinforced racialized disparities in IVF outcomes. The need for research initiatives that investigate racial disparities in fertility treatment outcomes and develop personalized treatment approaches that address the specific needs of diverse patient populations is clear.
Public Awareness and Education
The executive order emphasizes public awareness campaigns to educate individuals about IVF treatment options, financial assistance, and medical advancements. However, these campaigns must be tailored to diverse communities and address the unique concerns of individuals of color. Many communities of color lack accessible information about fertility treatments, and existing public outreach often does not cater to their specific needs or languages. Ensuring that awareness efforts reach marginalized groups will require funding multilingual, community-driven fertility education initiatives that center the voices and experiences of Black, Hispanic, and Indigenous individuals.
Support for Military Families and Veterans
Another executive order component involves expanding IVF access for military families and veterans. This group often faces unique reproductive health challenges due to deployments, combat-related injuries, and medical conditions. While this provision could provide critical support, it is also important to acknowledge racial disparities within the military healthcare system. Black service members and veterans have historically faced more significant barriers in accessing quality medical care, making it necessary to mandate that military healthcare policies proactively eliminate racial disparities in fertility access by expanding IVF coverage, streamlining approvals for service members of color, and ensuring equitable access to military-funded reproductive services.
Recommendations for Addressing Racial Justice Issues in IVF Access
To ensure that this executive order leads to racially equitable improvements in IVF access, the following recommendations should be considered:
- Pass Federal Legislation Mandating Comprehensive Fertility Care Coverage
- Private insurance and Medicaid are required to cover IVF, explicitly eliminating racial and income-based restrictions.
- Establish federal oversight to ensure states enforce these mandates equitably, with penalties for noncompliance.
- Improve Medical Training and Address Bias in Fertility Care
- Require implicit bias training for OB-GYNs, fertility specialists, and reproductive healthcare providers.
- Increase racial diversity among fertility specialists by providing scholarships and incentives for medical students of color.
- Fund Research on Racial Disparities in Infertility and IVF Outcomes
- Mandate the inclusion of Black, Hispanic, and Indigenous participants in clinical trials to ensure fertility treatments are evidence-based for all racial and ethnic groups.
- Allocate federal research funding to study racial disparities in infertility diagnoses, treatment success rates, and pregnancy outcomes.
- Strengthen Community Outreach and Education
- Fund and implement multilingual, community-driven fertility education initiatives that center the voices and experiences of Black, Hispanic, and Indigenous individuals.
- Partner with trusted community organizations, churches, and advocacy groups to provide accurate and accessible information about reproductive health.
- Enhance Access for Military and Veteran Families of Color
- Require military healthcare programs to track racial disparities in fertility treatment access and eliminate policies that disproportionately exclude Black and Latinx service members.
- Ensure that military healthcare policies on IVF access explicitly address racial disparities and expand fertility coverage for service members of color.
Conclusion
Expanding access to IVF is not only a healthcare issue but a reproductive justice imperative. Accurate equity in fertility care requires dismantling systemic barriers, holding institutions accountable for racialized disparities, and ensuring all individuals—regardless of race, income, or background—have an equal right to build their families. Only through intentional, systemic change can the promise of expanded IVF access truly reach all individuals, ensuring that fertility care is a right, not a privilege.
