AMPLIFYING PERSPECTIVES: BLACK CONTENT CREATORS AND FERTILITY SUPPLEMENT DISCOURSE ON SOCIAL MEDIA

BACKGROUND Social media platforms such as TikTok and Instagram have emerged as influential spaces for fertility education and supplement promotion. While the reach and engagement of these platforms are growing, there is limited research on the representation and role of Black creators in this discourse, particularly in communities disproportionately affected by infertility and systemic barriers to care. OBJECTIVE To explore the visibility, content quality, and audience engagement of Black content creators in the online fertility supplement space, specifically analyzing the medical accuracy of information shared, the inclusion of health risks, and its alignment with evidence-based reproductive health guidelines. METHODS A content analysis was performed on the top 100 TikTok videos utilizing the hashtag #fertilitysupplements. Creators were stratified by creator self-identification or visual cues suggestive of racial identity into Black (n = 19) and Non-Black (n = 75) cohorts, completely excluding ambiguous or missing data profiles (n = 6). Audience reach was evaluated via raw engagement metrics (likes, comments, shares). Medical accuracy was measured using a binary scoring system evaluating whether a supplement’s stated clinical mechanisms aligned with established American Society for Reproductive Medicine (ASRM) and ACOG clinical guidelines. Videos were also coded for the explicit inclusion of health risks or side effects. Demographic and engagement differences were analyzed using non-parametric Mann-Whitney U tests. To ensure statistical robustness, a secondary sensitivity analysis was executed by omitting an extreme viral outlier video (889,000 likes) from the Black creator cohort. RESULTS Only 19% (n = 19) of top-performing posts were created by Black content creators, compared to a 75% Non-Black cohort composed of White (56%), Asian (12%), and Latina (5%) creators. Commonly recommended supplements across the entire dataset included CoQ10, maca root, and inositol. Primary clean-case analysis revealed no significant differences in audience reach or engagement between Black (n=19) and Non-Black (n=75) creators. The secondary sensitivity analysis (excluding the 889,000 viral like outlier; Black n=18) confirmed that the lack of variance was highly robust, with median metrics remaining statistically indistinguishable across likes (5,348 vs. 6,023; p=0.710), comments (108.5 vs. 178; p=0.485), and shares (281.5 vs. 436; p=0.435). Qualitatively, Black creators were significantly more likely to incorporate culturally relevant health narratives addressing fertility concerns disproportionately affecting their communities, such as uterine fibroids and vitamin D deficiency. Across the entire dataset, medical accuracy was strongly associated with professional credentials rather than race, that is, posts from certified medical providers demonstrated significantly higher accuracy than non-providers. Crucially, the explicit inclusion of health risks or clinical side effects was low across all demographic groups, with fewer than 25% of videos highlighting potential adverse interactions or the necessity of clinical oversight. CONCLUSIONS Black content creators are underrepresented (19%) in the online fertility supplement space despite offering unique, community-specific insights that address glaring health disparities. When evaluating audience reach, content engagement is statistically equitable across racial demographics, a finding that remains after adjusting for outlier, indicating that platform algorithms distribute, and viewers interact with, Black and Non-Black patient-creators at comparable rates. However, a pervasive deficit exists across all non-provider content creators regarding the baseline medical accuracy of supplement recommendations and the transparent disclosure of health risks. To improve reproductive health literacy and ensure patient safety, public health initiatives must actively support and elevate the contributions of credentialed Black creators who bring essential cultural context and clinical trust online. Furthermore, targeted educational efforts, should encourage non-provider content creators to cross-reference evidence-based guidelines and emphasize clinical risks. Ultimately, digital health consumers must be reminded to also actively seek out verifiable, evidence-based citations rather than relying on unvetted social media supplement advocacy.