Racial Disparity in Healthcare Experience among Patients Seeking Fertility Care during the Covid-19 Pandemic

Objective: Recent data have shown that there are racial disparities in access and outcomes of assisted reproductive technology treatment in the USA (1), however, the effect of the pandemic on this racial disparity has not been studied. Thus, the primary aim of this study was to identify how the pandemic has affected patient decision-making regarding fertility planning and treatment among black versus non-black women. Material(s) and Method(s): Following IRB approval, a link to a survey was sent to the emails of all patients presenting to a university-affiliated fertility clinic between January 2021 and December 2021. The patients were asked to fill out a questionnaire regarding fertility plans prior and during the pandemic. Data collected included demographics about age, race, ethnicity, employment, vaccination, fertility treatments prior to the pandemic and changes in treatments during the pandemic. Data are presented as percentages and chi-square test was performed for statistical analysis. Result(s): A total of 223 patients (mean age 41 +/- 1.6) filled out the questionnaire. When all participants were asked about fertility treatment plans before the pandemic, 58% were pursuing IVF, 7% wanted oocyte freezing, 4% wanted IUI, and 31% were doing fertility work-up. The majority (69%) reported that the pandemic did not change their plans and the minority reported either postponing or canceling their treatments with financial instability being the most commonly reported reason (22%). Fewer black women were vaccinated compared to non-black women (35% vs. 52%;p=0.03). When asked whether the pandemic was well-handled by major healthcare systems, black women were less likely to think that it met expectations compared to non-black women (35% vs. 54%;p=0.02). Additionally, black women were less likely to be uncomfortable visiting the office in person during the pandemic compared to non-black women (2% vs. 15%;p=0.02). Interestingly, there was no difference between black and non-black women when asked whether they think that the vaccine could affect fertility or pregnancy outcomes or whether taking the vaccine stopped them from pursuing fertility treatments (p>0.05). Conclusion(s): Among women undergoing fertility treatments during the pandemic, black race was associated with less likelihood of being vaccinated, less likelihood of being satisfied with major healthcare systems handling the pandemic, and more comfort in visiting physically the fertility clinic. Impact Statement: There is a clear need to understand the underlying reasons why the pandemic contributes to racial disparity in fertility treatments. Support: No Financial Support was required for this study. REFERENCES:: Makhijani et al. Black race associated with lower live birth rate in frozen-thawed blastocyst transfer cycles: an analysis of 7,002 Society for Assisted Reproductive Technology frozen-thawed blastocyst transfer cycles. Fertil Steril. 2022;117:360-367. Copyright © 2022

Why was the ECB's reaction to Covid-19 crisis faster than after the 2008 financial crash?

At the time of the financial crises of 2008 and 2010–11 the ECB reacted with an extremely cautious gradualism. This behaviour is attributable to the slower learning process that characterizes a central bank of a monetary union composed of countries with fiscal sovereignty compared to other central banks. In sharp contrast to the previous crises, the ECB reacted promptly to the COVID-19 crisis. This change in behaviour is explained here by the learning process about the effects on monetary policy transmission of the increased financial fragmentation of the eurozone over the last decade. © 2021