Reducing barriers to care for patients who practise consensual nonmonogamy

Abstract

L inked research by Arseneau and colleagues highlights diffi culties faced by individuals in consensually nonmonoga mous relationships when they access health care. 1 Consen sual nonmonogamy encompasses a wide variety of relationships that include "the practice of, belief in, or willingness to engage in multiple [intimate], romantic and/or sexual relationships with the informed consent of everyone involved." 2 Both interest and engagement in consensual nonmonogamy seem to be increas ing. 3 At the same time, training of health care providers to work effectively with this population has not kept up with these trends. Although existing research is limited, several qualitative studies have documented the concerns of patients in consensually non monogamous relationships regarding their health care experi ences: concerns that may affect their willingness to access health care and concerns about the quality of their care when they do. 1,4 These individuals face great stigma and are often patholo gized based on inaccurate assumptions. 5 However, several studies have failed to find differences in relationship satisfaction and other indices of relationship functioning between monoga mous and consensually nonmonogamous relationships. 2,5 Furthermore, rates of sexually transmitted infections (STIs) are comparable across consensually nonmonogamous and monoga mous populations. 6 Despite this, the majority of individuals who practise consensual nonmonogamy have experienced discrimina tion, 7 a phenomenon associated with higher levels of psycho logical distress and poorer health outcomes. 8 Health care provid ers have an opportunity to mitigate this stress by providing inclusive environments and sensitive health care.In a recent qualitative study of patients in consensually non monogamous relationships, participants reported that their health care experiences were undermined by provider assump tions that patients were monogamous and provider ignorance regarding other relationship structures. 4 These patients subse quently felt pressure to educate their providers and furthermore experienced unnecessary barriers to obtaining regular, custom ized STI screenings and individualized advice regarding risk reduction strategies. Several participants who had disclosed that they practised consensual nonmonogamy reported experiencing both implicit and explicit judgment from their provider. Similar concerns were shared by the participants in the linked qualita tive study of the birth care experiences of Canadian polyamorous individuals, who reported that the failure to acknowledge and accommodate their multiple intimate partners, both in terms of physical space and on forms, negatively affected their birthing experiences. 1 Some chose home births as a means of avoiding anticipated hospital restrictions (both physical and administra tive) that would have prevented full participation of all their part ners in the birth.Given the limited research among patients who practise con sensual nonmonogamy, research with other sexual minorities may furt...

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“…2a Studies have documented concerns of polyfamilies regarding their health care experiences, all of which have been found to shape not only their willingness to access health care and the trust they have in medical providers but also the quality of services they receive. 3a This highlights the importance of engagement and rapport building with polyfamilies. While there are limited data on interventions specifically targeting trust in medical settings, many evidence-based therapeutic interventions (e.g., motivational interviewing) use the provider's expression of genuine interest and curiosity as a core component of communication to enhance the therapeutic relationship.…”