Equality, Eggs, and Nest Eggs

You never thought this would happen. As a teenager it was drilled into your head that having sex without using birth control would surely result in a pregnancy. Now you are an adult, you want to have a baby, and it is not happening.

So what do you do? You probably talk with a doctor and maybe she suggests some infertility treatments. One of the cheaper interventions is Artificial Insemination: injecting sperm into the uterus during ovulation. This costs on average $865, although the price can vary considerably. Other interventions like In Vitro Fertilization (embryos are created from sperm and egg and then inserted into the uterus) cost an average of $8,158, with additional expenses up to $5,000 for the medication used to increase egg production prior to each treatment. Because there is no guarantee of pregnancy, these procedures may need to be repeated many times before it occurs, if it occurs at all. With yearly college tuition costing $9,000 - $30,000 it is possible to spend more trying to create your child than to educate your child.

Insurance lightens this burden for some but not everyone has health insurance or insurance policies that cover infertility treatments. As of 2016 only 15 states in the U.S. require that infertility treatments are covered by private insurance; and even in those states there are exceptions based on a woman's place of employment and the specific insurance plans offered through that workplace. In some states insurance companies' definitions of infertility (failure to conceive after a year of unprotected heterosexual sexual intercourse) also unfairly deny lesbian women coverage.

Blanchfield and Patterson (2015) raised further concerns about access to infertility help and insurance coverage. They evaluated data from thousands of women who participated in the 2002, then in the 2006-2013 waves of the National Survey of Family Growth (NSFG) to determine if racial minority women (non-White) and sexual minority women (lesbian women and women who report sexual attractions that are not exclusively heterosexual) have the same access to "fertility assistance" and insurance coverage as women in related majority groups.

From 2002 to the most recent wave in 2013, about twice as many White women compared to racial minority women reported getting medical assistance for pregnancy. Heterosexual women were also more likely to receive this help compared to sexual minority women. However, regardless of race or sexual orientation, women who received help reported getting the same forms of assistance, including advice, testing, fertility drugs, and Artificial Insemination.

Private health insurance coverage varied by race and sexual orientation with White heterosexual women being most likely to have this financial help. In 2002, this comparative lack of insurance and related lower income failed to explain racial and sexual minority women's lower rate of medical assistance for pregnancy: even when these women could pay for these services they were less likely to receive them. However, from 2006-2013, lack of insurance coverage was enough to completely explain the persistent lower level of medical assistance for sexual minority women's infertility. In other words, if sexual minority women can pay for the treatments they are now just as likely to receive them as heterosexual women. On the other hand, even from 2006-2013 lower income and lack of insurance could only account for part of the persistent lower level of medical assistance for racial minority women's infertility. This means that even when non-White women have the means to pay they do not always get these interventions.

This is particularly disturbing as White, Black, and Hispanic women have approximately the same rate of infertility (11%) and these groups represented more than 90% of the women surveyed in the NSFG. Thus with equal means to pay, these groups should have reported equal experience with medical assistance. Blanchfield and Patterson (2015) offer three possible explanations for this racial discrepancy. First, racial minority women may not have the "social support" that White women have when they are faced with infertility: if your friends and family don't suggest talking to a doctor then you are less likely to do so. Second, for Black women in particular, our nation's history of abusing Black citizens for medical testing (see for example: U.S. Military in WWII; the Tuskegee Study; Henrietta Lacks) may make them more cautious about involving the medical community in their personal lives. Finally, although it is unethical and illegal, stereotypes and prejudices about racial minority fertility may bias doctors away from discussing infertility with women from these groups.

This is something that we must try to change. Along with the emotional and financial devastation that often accompanies infertility, a woman should not have to fear or be denied the chance to talk with her doctor about this condition.


FURTHER READING:

You can access the Blanchfield and Patterson (2015) article online or through your local college library. 

Resolve: The National Infertility Association offers facts and information about support groups for individuals and couples coping with infertility.

The Broken Brown Egg is a blog about Black women and infertility; it also includes links to useful resources.

How to make an introvert smile

On social media I have seen a lot of posts about introverts and extraverts (or extroverts): things they want us to know; their everyday struggles; things we can do for them. These traits have been around for a long time and comprise one of the Big Five aspects of personality. In short, introverts get energized by alone time whereas extraverts are energized by time with others. This difference is demonstrated by our meme featuring Introvert Cat:

This meme implies that introverts would prefer to eat alone rather than go out to eat with people they like. It also implies that introverts enjoy solitude more than socializing. However, past research suggests that both introverts and extraverts get more enjoyment from socializing than they do from being alone. If everyone has more fun acting extraverted, why might Introvert Cat shy away from such an opportunity?

One suggestion is highlighted in research done by Zelenski, Whelan, Nealis, Besner, Santoro, and Wynn (2013). In a preliminary study they asked introverts and extraverts to imagine themselves in different scenarios: some scenarios would require them to act introverted whereas the other scenarios would require them to act extraverted. For each scenario 97 undergraduate participants, who had been classified as introverted or as extraverted, rated themselves on a list of positive and negative adjectives based on how they thought they would feel: this was a measure of their affective forecasting. The results demonstrated that when introverts imagined themselves acting extraverted, they were more likely than extraverts to predict negative emotions and feeling self-conscious, and less likely than extraverts to predict positive emotions and enjoyment. However, these results cannot tell us what either group's emotional experiences would be in a real-world situation that calls for them to act one way or the other.

To get closer to that answer, Zelenski et al. conducted four follow-up experiments from which the results were combined. Thus 495 undergraduate students, who had been classified as introverted or extraverted, were randomly assigned to act either introverted or extraverted while interacting with others in a laboratory setting. In each experiment the participants were given instructions on how they should act, then asked to imagine how they will feel once the interaction begins - again, they rated themselves on adjectives to measure their affective forecasting. Next, they interacted with others in one of four ways: taking part in a group discussion with other participants; being interviewed by a confederate; planning a day's activities or building with blocks while partnered with a confederate; putting together a timed puzzle with other participants. At the end of each experiment, the participants rated how they had actually felt during the activity.

The measures of affective forecasting demonstrated that introverts were especially likely to have low predictions of positive emotions when preparing to act extraverted. In addition, introverts were especially likely to have high predictions of negative emotions and self-consciousness when preparing to act extraverted. However, there was little difference between introverts and extraverts on their predictions of how "pleasant" the experience of acting extraverted would be.

Measures of the participants' ratings of their actual experiences demonstrate that all participants who had been assigned to act extraverted experienced more positive emotion and less negative emotion than the participants who had been assigned to act introverted. Additionally, the level of positive emotions was higher and the level of negative emotion was lower than they had predicted beforehand. As well, all participants overestimated how self-conscious they would feel; this was especially true for the participants who were preparing to act extraverted. So we see that both introverts and extroverts had a more positive experience than they thought they would have and that this effect was most pronounced when their behavior was extraverted.

Zelenski et al. compared participants' predictions with their reports of the experience to estimate how accurate introverts and extraverts are in predicting their emotional experiences. They found that introverts were comparatively less accurate: introverts were more likely to overestimate negative emotional reactions and that this was especially true when introverts were planning on acting extraverted. Likewise, introverts were more likely than extraverts to inaccurately over-estimate their degree of self-consciousness when asked to act in an extraverted way.

These findings may have some limitations, as one's experience in a laboratory may be different than in real life. For example, in real life you are not instructed to act introverted or extraverted, although one could argue that acting extraverted may be rewarded in American culture. Another limitation that was not addressed by the authors is that 70% of the participant were women. Past research suggests that women are less likely than men to be introverted, so it is not clear if the introverted and extraverted participants were equally represented by male and female students. If they were, one could ask if the introverted females were somehow different than average females - a question that could influence how well the results would generalize to the population at large.

Nevertheless, Zelenski et al. conclude that part of what may drive Introvert Cat to decline a dinner invitation could be an error in his affective forecasting: he would have enjoyed himself more than he realized. If introverts underestimate the enjoyment and over-estimate the pain of social situations, they may mistakenly say, "no" to experiences that would increase their happiness. On the other hand, this is not to imply that all introverts should try to be extraverts! On the contrary, the authors write:

Despite our speculations about acting extraverted..., we feel compelled to explicitly state that we do not view introverts as inferior or in need of psychological change. (Many of us have pronounced introverted tendencies of our own!) Some introverts might desire the potential happiness boost that an acting extraverted exercise might provide. We believe that studying the potential of such a tool and providing accurate information about its effects may ultimately produce hedonic benefits for some, but we have no interest in forcing it on anyone" (p. 1105)."

Further Reading:

The Zelenski et al. (2013) article can be accessed through your local college library.

Find out if you are an introvert or an extravert by taking this Psychology Today quiz. If you end up scoring in the middle, you may be an ambivert - find out about yourself in this Wall Street Journal article.

Is Western culture biased against introverts? In this TED talk, writer and lawyer, Susan Cain, argues that introverts have overlooked positive qualities that should be valued.

Saying "I love you"...

For this post I have to revert to preschool scatological humor for just a moment...

so if a brief, funny reference to poop is offensive...

read no further.

I have often thought that diarrhea is really the perfect excuse if you want to leave a boring situation.  If anyone tries to stop your departure, whispering, "I have diarrhea," will be the instant get-out-of-jail-free card because everybody has been there and -- for goodness sake -- nobody wants you to stick around in that state.  

With this shared human experience we introduce this week's meme:

When I searched this meme on the Internet I found a curious thing:  like this version starring Optimistic O'Connell, the other versions display a male making this statement.  Ignore the diarrhea part for now - what interested me was that this is a meme of about a confession of love.  And some versions -- like this one -- convey that this confession is being expressed to a female.

Past research suggests that, in heterosexual dating relationships, men tend to tell their partners, "I love you," earlier women do.  A pair of studies by Ackerman, Griskevicis, and Li (2011) confirm that trend, and demonstrate that this reality is the opposite of our stereotype.  Sixty-four percent of college students (who were stopped on a street corner and offered, "candy and juice drinks" (p. 1082) for their insights - I guess that is all it takes...) actually believed that the reverse was true:  that women say "I love you" first.

Ackerman et al. (2011)  includes other laboratory studies about how people feel when their partners just can't hold it in and blurt out "I love you."  Not surprisingly:  they like it.  But does the timing matter and what do we interpret that "I love you" to mean?  Because the authors come from an Evolutionary Psychology point of view, they were particularly interested in the variable of sex.

The authors' final studies determined that men are happiest when their female partners say "I love you," before the relationship has become sexual; women are happiest when that confession of love occurs after sex has been initiated.  This gender difference meshed well with the participants' reported interpretations of "I love you" at different points in the relationship:  men interpreted women's pre-sex "I love you" to mean, "I will probably have sex with you in the future;" while women interpreted a pre-sex "I love you" to mean, "I am trying to convince you to have sex with me."  If instead men's first "I love you" occurs after sex is introduced into the relationship, women interpret that same phrase to mean, "I will stick around for you."

Ackerman et al. invoke Evolutionary theory to interpret these findings.  The basic idea, put forth by researchers such as Buss, is that men have evolved to look for baby-makers - so they would like it if they get the signal that sexual reproduction might be possible.  Women have evolved to look for a mate who will stick around when they are pregnant and nursing babies - so they would like it if they get the signal that a guy is in it for the long-haul and not just looking for one night of reproduction of the fittest.

Evolutionary theory is one way to look at gender differences.  An alternative point of view, Social Role Theory, comes from Eagly and Wood (1999).  They suggest that today's gender stereotypes may have their roots in the long history of men having more power than women.  This inequality came from some biological differences (men are stronger and faster; solely women contend with pregnancy and breast feeding) that gave way to common roles that men and women took on in society.  Seeing thousands of years with more men in leadership positions we still leap to conclusions that all men are better leaders than all women; seeing thousands of years with more women than men caring for children we still leap to conclusions that all women are more nurturing than all men.

So it may be that evolutionary reproductive urges are guiding the timing and interpretation of "I love you."  It could also be that Social Role Theory is guiding these behaviors.  In that case, men's history of greater power and our stereotype of them as being leaders allow them to take more risks in relationships by saying "I love you" first and not being scared off if women say it before sex has occurred.  Likewise, women's history of less power and our stereotype of them as caregivers might encourage them to hold back that "I love you" until they have evidence (like sex) that their partners will be glad to hear this.

At this point we cannot say which perspective is right.  But what you can know for certain is this:  if somebody tells you "I love you," and you don't feel the same way...just tell them you have diarrhea and they will get out of your way.

Further Reading:

A post on a related topic from the Science of Relationships blog:  "Who Falls in Love First"?  This study is also explained using Evolutionary theory; can you imagine how Social Role Theory might interpret the same findings? 

Click here for home remedies for diarrhea and for a broken heart.

You can find a version of this article on Joshua Ackerman's website and obtain the published article through your local university library:  Ackerman, J.M, Griskevicius, V., Li, N.P. (2011) Let's get serious: Communicating commitment in romantic relationships. Journal of Personality and Social Psychology, 100(6),1079-1094.