Well-Being Prevention & Cures

Decreased fertility associated with poor neighborhood socioeconomic status

“Members of marginalized racial and ethnic minority groups are more likely to reside in socioeconomically disadvantaged neighborhoods owing to structural racism enacted through residential segregation.”
Oklahoma City
The Associated Press/ Tony Gutierrez

Story at a glance


  • Higher levels of stress have been linked to lower fertility rates and poor pregnancy outcomes.

  • Factors such as unemployment or poor housing quality can exacerbate stress levels, potentially affecting infertility rates.

  • To better understand this link, researchers assessed the association between area deprivation indices and fertility rates throughout the country. 

A multitude of factors can affect fertility, including levels of pollution exposure and chronic conditions like diabetes. In the United States, as many as 15 percent of couples are unable to conceive after a year.

Now, new research published in JAMA Network Open points to the impact of neighborhood socioeconomic status on fecundability, or the probability of conception during a menstrual cycle.

After assessing data collected between 2013 and 2019, investigators found probability of conception decreased from 21 percent to 23 percent per menstrual cycle in the most disadvantaged neighborhoods compared with the least. 

For study participants who had annual incomes of less than $50,000, associations between neighborhood status and fertility were slightly stronger, authors wrote. 

Previous research has indicated factors like low educational attainment, unemployment status, low household income and poor housing quality can all impact fertility, as they might lead to higher rates of perceived stress and cortisol levels. In neighborhoods with poor socioeconomic status, one or all of these contributors may be present. 


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Furthermore, “members of marginalized racial and ethnic minority groups are more likely to reside in socioeconomically disadvantaged neighborhoods owing to structural racism enacted through residential segregation, systematic disinvestment in neighborhood infrastructure, and associated disparate exposure to environmental toxicants,” authors wrote.

In the study, researchers used the area deprivation index (ADI) to measure neighborhood status on a country and state-by-state level. A total of 6,356 women between the ages 21 and 45 were included, all of whom were attempting conception without fertility treatment. 

After more than 27,000 menstrual cycles recorded in follow-up, 3,725 pregnancies were reported.

“Associations between ADI and fecundability were similar when neighborhood disadvantage was measured relative to the nation or the state, which lends support for the hypothesis that local context may be particularly influential in fertility,” authors wrote.

However, findings may not be generalizable to wider populations of lower socioeconomic status, and more research is needed to determine whether policies and programs addressing these inequities reduce infertility in local communities.