Work led by The Institute's Ugochinyere Vivian Ukah suggests that everyday and lifetime experiences of discrimination may diminish the chances of conception, highlighting the potential role of social stressors in reproductive health
SOURCE: Research Institute of the McGill University Health Centre (The Institute)
August 13, 2025
A new study co-authored by researchers at the Research Institute of the McGill University Health Centre (The Institute), Boston University and other top-tier U.S. institutions, reveals a significant association between experiences of discrimination and lower fertility in women, raising critical questions about the role of social stressors in shaping reproductive health and outcomes. Published in JAMA Network Open, the study found that women who reported frequent experiences of everyday and lifetime discrimination had reduced fecundability—the probability of conceiving during a menstrual cycle.
The findings are based on data from 6,578 women in North America enrolled in the Pregnancy Study Online (PRESTO), a web-based prospective preconception cohort study run by researchers from the Department of Epidemiology at the Boston University School of Public Health (BUSPH) that tracks lifestyle and health factors associated with fertility and pregnancy outcomes. Participants in the study self-reported experiences of discrimination in everyday life and across key life domains such as employment, medical care and interactions with police. The researchers, including senior epidemiologist Lauren A. Wise, ScD, principal investigator of PRESTO, used statistical models to estimate how these experiences influenced fertility outcomes. With additional co-authors from Boston Medical Center, the Yale University School of Public Health and the Harvard T.H. Chan School of Public Health, the study represents a robust international effort to better understand the social determinants of reproductive health.
A missing piece in fertility research
While previous research has linked discrimination to adverse birth outcomes—such as preterm birth and low birth weight—this is the first large-scale study to examine whether discrimination may impact a woman's ability to conceive.
"This study is important because racial and ethnic disparities in fertility have long been observed, but we lacked understanding of whether discrimination itself could be contributing," explains lead author, Ugochinyere Vivian Ukah, MPH, PhD, a Junior Scientist with the Child Health and Human Development Program at The Institute. "We found that discrimination experiences—whether attributed to race, gender, or other causes—were associated with decreased fecundability in women, regardless of racial or ethnic background."
Interestingly, the study found that women who faced discrimination—whether White or from racial and ethnic minority groups—were less likely to conceive. However, association differed with the types of discrimination: lower fecundability was strongly observed among racial and ethnic minority participants who experienced discrimination at work and when receiving medical care, and among White participants who felt harassed. These patterns suggest that both structural barriers (like bias in workplaces and healthcare) and everyday interpersonal mistreatment can combine to negatively affect women's reproductive health.
Implications for public health and reproductive care
The research raises critical questions about the role of social stressors in shaping reproductive health and outcomes. "For women trying to conceive, particularly those from historically marginalized communities, discrimination may add an invisible burden to an already challenging journey," says Prof. Ukah, also a member of The Institute's Centre for Outcomes Research and Evaluation. "These findings highlight a previously underappreciated factor in fertility disparities."
What's next?
Looking ahead, the researchers call for additional studies to explore the underlying mechanisms linking discrimination to fertility, including biological stress responses, access to reproductive care and psychosocial impacts. They also underscore the importance of designing inclusive and supportive healthcare environments that recognize and address discrimination as a barrier to reproductive health.
About the study
"Fecundability in Association With Everyday and Lifetime Discrimination" by Ugochinyere Vivian Ukah, PhD; Sharonda M. Lovett, PhD; Renée Boynton-Jarrett, MD, ScD et al., was published in JAMA Network Open.
doi: 10.1001/jamanetworkopen.2025.20597
The study was funded by the National Institutes of Health (NIH).
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