Compromised reproductive health associated with socioeconomically disadvantaged neighborhoods

A recent study published in JAMA Network Open found that women living in socioeconomically disadvantaged neighborhoods in the United States (US) had modestly lower odds of conceiving without infertility treatment.

Study: Association between neighborhood disadvantage and fertility among US women planning pregnancy. Image credit: Chinnapong/Shutterstock


Infertility imposes a huge economic burden in the United States, and its prevalence among couples of reproductive age is 10-15%.

Fertility is a measure that describes the likelihood of a couple conceiving during a menstrual cycle. Modifiable risk factors thought to influence fertility are lifestyle and behavioral changes. Recently, structural, political and environmental factors have also been observed to influence this fertility rate.

The socioeconomic neighborhood environment encompasses aspects such as access to education, household income, employment and housing quality. Emerging evidence suggests that a disadvantaged socioeconomic environment can influence a community’s reproductive health outcomes. Confounding factors that link neighborhood socioeconomic disadvantage to fertility include stress, allostatic load, and cortisol levels.


This was a prospective cohort study conducted on American couples trying to conceive spontaneously, which aimed to establish the relationship between living in a disadvantaged position and fertility. A national and state level classification of disadvantaged neighborhood status was considered.

For six (consecutive) years, through 2019, women of reproductive age from the contiguous US completed a questionnaire—inquiring about their sociodemographic and lifestyle characteristics, medical and drug history, and reproductive health.

Overall, 6,356 participants had 3,725 pregnancies occurring during the study period and from 27,427 menstrual cycles in the 48 US states.

The majority of participants were white, non-Hispanic, nulliparous individuals with at least 16 years of education. In addition, the average annual household income of most participants is higher than that of the general population.

Nationally, participants from disadvantaged neighborhoods were noted to be younger and have lower levels of education and lower household income. In addition, smoking was more common in this group, and they were less likely to identify as non-Hispanic whites.

State-level characteristics were consistent; however, the differences seemed more remarkable. The Spearman correlation between national and intra-state indices of deprivation (ADI), which assesses relative disadvantage in a neighborhood or community, was 0.76. ADI is associated with population health outcomes.

There was an inverse correlation between ADI and fertility in participants living in a region with ADI > 60. The fertility rate (FR) showed a linear inverse relationship with ADI, while fertility represented a 19% and 21% reduction in the comparison between most disadvantaged neighborhoods and, respectively most disadvantaged neighborhoods.

Furthermore, state-level ranking shows an inverse relationship between ADI and fertility among participants living in neighborhoods with ADI > 5. On the other hand, when the most disadvantaged neighborhoods are compared to the least disadvantaged neighborhoods, FR represents a 25% and 23% reduction of the respective fertility.

Subgroup analysis focused primarily on state-level ADI rankings, which showed an inverse association of ADI with fertility in participants with annual household income <$50,000.

Furthermore, participants attempting pregnancy during < three menstrual cycles (at baseline) showed similar results, although nonspecific. Furthermore, female parity did not appear to alter the results, whereas childbearing participants showed less precise inverse associations.

Furthermore, the results were less impressive when adjustments were made for race, ethnicity, and educational attainment. The overall results look even weaker after confounding for household income.


The findings highlighted the association of socioeconomically disadvantaged neighborhood environments with compromised reproductive health. Strategies aimed at reducing the socioeconomic divide can help improve reproductive health and birth rates in these communities.

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