Health and access to care among reproductive-age women by sexual orientation and pregnancy status

Abstract

Background: A large body of research has documented disparities in health and access to care among sexual minority populations, but very little population-based research has focused on the health care needs among pregnant sexual minority women.
Methods: Data for this study came from 3,901 reproductive-age (18–44 years) women who identified as lesbian or bisexual and 63,827 reproductive-age women who identified as heterosexual in the 2014–2016 Behavioral Risk Factor Surveillance System. Logistic regression models were used to compare health care access, health outcomes, and health behaviors by sexual orientation and pregnancy status while controlling for demographic characteristics and socioeconomic status.
Results: Approximately 3% of reproductive-age sexual minority women were pregnant. Pregnant sexual minority women were more likely to have unmet medical care needs owing to cost, frequent mental distress, depression, poor/fair health, activity limitations, chronic conditions, and risky health behaviors compared with pregnant heterosexual women. Nonpregnant sexual minority women were more likely to report barriers to care, activity limitations, chronic conditions, smoking, and binge drinking compared with nonpregnant heterosexual women. Health outcomes were similar between pregnant and nonpregnant sexual minority women, but pregnant sexual minority women were more likely to smoke cigarettes every day compared with other women.
Conclusions: This study adds new population-based research to the limited body of evidence on health and access to care for pregnant sexual minority women who may face stressors, discrimination, and stigma before and during pregnancy. More research and programs should focus on perinatal care that is inclusive of diverse families and sexual orientations.

A large body of research has documented disparities in health and access to medical care for sexual minority populations. Lesbian, gay, bisexual (LGB), and other nonheterosexual people are more likely to report adverse health outcomes owing to minority stress, or the additional stressors associated with being a member of a marginalized minority group. Discriminatory environments and stigma against LGB populations can lead to lower self-esteem, less confidence, and increased rates of mental distress and risky health behaviors, including heavy cigarette smoking and alcohol consumption. Meanwhile, limited access to health insurance and to culturally competent health care providers trained on LGB health issues may create barriers to regular medical care. Indeed, LGB populations are less likely to receive routine medical care, and they continue to experience challenges finding LGB-affirming providers.

Very little research has focused on health and access to care for sexual minority women during pregnancy. Rather, research on pregnancy among sexual minority populations has tended to focus on sexual behaviors and risk of pregnancy. For instance, several studies have compared the lifetime prevalence of pregnancy in sexual minority women relative to heterosexual women; these studies found that sexual minority women were less likely to ever be pregnant compared with heterosexual women. Some research, however, suggests that sexual minority adolescents may be more likely to engage in sexual behaviors and report greater risks of pregnancy compared with heterosexual adolescents. This research was important for correcting misconceptions that sexual minority women cannot or do not wish to become pregnant—beliefs that have stalled progress on research that aims to address the health care needs of pregnant sexual minority women. Our study builds on previous research and begins to fill wide gaps in knowledge on pregnant sexual minority women using data from a large, representative, and multistate health survey to compare access to care, health status, and health behaviors by sexual minority and pregnancy status.