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Polling Spotlight: Understanding the Experiences of LGBTQ+ Birthing People

Carla S. Alvarado, PhD, MPH
Diane M. Cassidy, MLIS
Kendal Orgera, MPH, MPP
Sarah Piepenbrink
June 27, 2022

From March 29 to April 3, 2022, the AAMC Center for Health Justice conducted a poll of a nationally representative sample of people in the United States who had given birth in the last 5 years. The poll asked questions regarding their pregnancy, birth, and postpartum experiences. The highlights of the poll were presented in a data brief published in May 2022, From Pregnancy to Policy: Experiences of Birthing People in the U.S.  

About 13% of the sample identified with the LGBTQ+ community (including lesbian, gay, bisexual, transgender, queer, asexual, and other). In this polling spotlight, we highlight findings that significantly differed from responses of the cisgender, heterosexual population. We’re sharing this snapshot as part of our efforts to examine the perspectives of marginalized communities as we seek to build an inclusive health justice movement.  

When asked to describe the overall childbirth experience, more LGBTQ+ individuals (31%) reported having a less than “good” experience (fair, poor, or very poor) than their cisgender, heterosexual counterparts (18%).*  

LGBTQ+ birthing people reported worse birthing experiences than straight birthing people.
Figure 1

More than half (51%) of LGBTQ+ birthing people reported that the quality of their experience with pregnancy, birth, and postpartum care was impacted by bias or discrimination, compared to 35% of cisgender, heterosexual people, and 37% of all birthing people.  

A larger share of LGBTQ+ birthing people felt their care was impacted by any bias or discrimination.
Figure 2

More LGBTQ+ birthing people reported complications with physical health, mental health, returning to work, and/or lactation/breastfeeding following childbirth compared with cisgender, heterosexual people.  

LGBTQ+ birthing people were more likely to report complications following childbirth than straight people.
Figure 3

More LGBTQ+ birthing people (56%) reported using telemedicine/telehealth for services related to pregnancy, birth, and postpartum health compared to cisgender, heterosexual people (41%). Prior to the COVID-19 pandemic, LGBTQ+ birthing people were significantly more likely to use telehealth services compared to cisgender, heterosexual birthing people; however, during the pandemic, these difference were not significant. 

LGBTQ+ birthing people were more likely to use telehealth for their care than straight people.
Figure 4

Research has shown that the LGBTQ+ people experience perinatal care inequities ranging from limited access to care to adverse health outcomes.1,2  

The LGBTQ+ community faces stressors like stigma and discrimination that impact their health and the health of their families. Adverse health outcomes including miscarriage, stillbirth, preterm births, and infants with low birth weight3 are higher for LGBTQ+ birthing people. Physical and mental health are inextricably linked to one another, and LGBTQ+ people shoulder higher burdens of mental distress, anxiety, and depression.1,2 

The drivers of these disparities range widely, from lack of access to culturally competent health care services to structural and interpersonal discrimination.4,5,6 Notably, the challenges individuals faced in the perinatal period are extensions of the negative and harmful experiences faced when accessing reproductive health care services.7 Moreover, the access to affirming mental health care for the LGBTQ+ community — especially during the perinatal period — is paramount for righting these inequities. 

Solutions to these remediable issues must be system-wide, including the formal education and training of providers, and must incorporate organizations of all types demonstrating trustworthiness to the individuals in this community. Trustworthiness also means having knowledgeable, competent health care professionals delivering care, which happens by ensuring that the educational curricula as well as the research and evidence base8 upon which the curricula are developed are sound, responsive, and inclusive of the voices and perspectives of those from the community. Similarly, the social environments of health care organizations and institutions and their policies must be respectful and affirming, in order to serve the multiplicity of marginalized populations including the LGBTQ+ community.9,10 Due to the COVID-19 pandemic, telemedicine and telehealth have been thrust to the forefront of health care access and have proved to be a viable, reliable, acceptable, and welcomed mode of access, including for pregnant people, even those who are at higher risk of complications.11  

Access the full data table


*Our previous research brief, From Pregnancy to Policy, used a different definition for LGBTQ+ than does this analysis. In this analysis, we added transgender to this category , whereas previously it was listed as solely a gender. As a result, any differences between this spotlight and the previous brief are likely due to this change.

Sources
1Gonzales G, Quinones N, Attanasio L. Health and Access to Care among Reproductive-Age Women by Sexual Orientation and Pregnancy Status. Women's Health Issues. 2019;29(1):8-16. doi:10.1016/j.whi.2018.10.006
2Kirubarajan A, Barker LC, Leung S, et al. LGBTQ2S+ childbearing individuals and perinatal mental health: A systematic review. BJOG. 2022;n/a(n/a)doi:https://doi.org/10.1111/1471-0528.17103
3Everett BG, Kominiarek MA, Mollborn S, Adkins DE, Hughes TL. Sexual Orientation Disparities in Pregnancy and Infant Outcomes. Matern Child Health J. 2019;23(1):72-81. doi:10.1007/s10995-018-2595-x
4Wingo E, Ingraham N, Roberts SCM. Reproductive Health Care Priorities and Barriers to Effective Care for LGBTQ People Assigned Female at Birth: A Qualitative Study. Women's Health Issues. 2018/07/01/ 2018;28(4):350-357. doi:https://doi.org/10.1016/j.whi.2018.03.002
5Mirza S, Rooney C. Discrimination prevents LGBTQ people from accessing health care. Washington, DC: Center for American Progress. 2018.
6Sabin JA, Riskind RG, Nosek BA. Health Care Providers' Implicit and Explicit Attitudes Toward Lesbian Women and Gay Men. Am J Public Health. 2015;105(9):1831-1841. doi:10.2105/AJPH.2015.302631
7Carpenter E. “The Health System Just Wasn't Built for Us”: Queer Cisgender Women and Gender Expansive Individuals' Strategies for Navigating Reproductive Health Care. Women's Health Issues. 2021/09/01/ 2021;31(5):478-484. doi:https://doi.org/10.1016/j.whi.2021.06.004
8McCracken M, DeHaan G, Obedin-Maliver J. Perinatal considerations for care of transgender and nonbinary people: a narrative review. Current Opinion in Obstetrics and Gynecology. // 2022;34(2):62-68. doi:10.1097/GCO.0000000000000771
9Sbragia JD, Vottero B. Experiences of transgender men in seeking gynecological and reproductive health care: a qualitative systematic review. JBI Evidence Synthesis. 2020;18(9)
10Gomez AM, Hooker N, Olip-Booth R, Woerner P, Ratliff GA. “It's Being Compassionate, Not Making Assumptions”: Transmasculine and Nonbinary Young Adults' Experiences of “Women's” Health Care Settings. Women's Health Issues. 2021/07/01/ 2021;31(4):324-331. doi:https://doi.org/10.1016/j.whi.2021.02.008
11Aziz A, Zork N, Aubey JJ, et al. Telehealth for High-Risk Pregnancies in the Setting of the COVID-19 Pandemic. Am J Perinatol. Jun 2020;37(8):800-808. doi:10.1055/s-0040-1712121

Young parent holds their baby with happy grandparent

From Pregnancy to Policy: Experiences of Birthing People in the United States

A nationally representative poll of 1200 people who gave birth in the last five years shows a diversity of pregnancy, birth, and postpartum experiences. Read the research brief.