Sexual Minority Women and Contraceptive Use: Complex Pathways Between Sexual Orientation and Health Outcomes

Abstract

Compared with their heterosexual peers, sexual minority women (SMW; e.g., queer, bisexual, lesbian, pansexual) have an elevated risk for unintended pregnancy. A team of social science and clinical researchers qualitatively documented the multilevel pathways leading to this disparity, particularly the contexts of contraceptive use. From August 2017 to April 2018, we conducted focus groups and interviews with young adult cisgender SMW in 3 cities: Chicago, Illinois; Madison, Wisconsin; and Salt Lake City, Utah. Most participants reported experience with both penile–vaginal intercourse and contraception. However, they faced several queer-specific barriers to preventing unwanted pregnancy, including a comparative lack of self-concept as contraceptive users, fear of stigma from both queer and health care communities, use of less-effective methods because of infrequent penile–vaginal intercourse and a sense that longer-acting methods were “overkill,” and previous experiences of discrimination such as homophobia and gender-based violence. However, participants also reported ways that contraception could align with queer identity, including both taking advantage of noncontraceptive benefits and framing contraception as sex- and queer-positive. These facilitators can inform future efforts to help SMW better meet their pregnancy prevention needs.

Contraceptive Use by Women Across Multiple Components of Sexual Orientation: Findings from the 2011–2017 National Survey of Family Growth

“…18,19 Bisexual women may face stereotyping related to the idea that they are promiscuous or that their identity is not valid, and this stereotyping may compound their experiences of stigma. [20][21][22] Prior research has demonstrated that diverse groups of SMW face fear of stigmatization from health care providers 23 and that bisexual women may face unique burdens in health care settings, such as invisibility and misunderstanding from health care providers. 24 It should be highlighted that most low efficacy methods of birth control are available over the counter or do not require any interaction with a health care provider.…”

Racial/Ethnic Differences in Unwanted Births: Moderation by Sexual Orientation

“…SMW's risks for unintended pregnancy may be further heightened by decreased use of contraception and lower provision of contraceptive counseling (Charlton et al, ; Everett, Higgins, Haider, & Carpenter, ). SMW may perceive that they do not need regular contraception if sexual intercourse with men is a relatively rare event and may be reluctant to seek contraception because of the stigma against contraceptive use within some queer communities (Higgins et al, ). SMW are also more likely to experience childhood and adulthood sexual abuse and victimization (Everett, ; Friedman et al, ; Katz‐Wise & Hyde, ; Xu et al, ), both of which have been linked to sexual risk‐taking behaviors and unintended pregnancy (Boyer & Fine, ; Dietz et al, ; Magnusson & Trost, ).…”

“…Race/ethnicity may also interact with sexual orientation to shape contraceptive use. For example, qualitative research based on a White‐majority sample of SMW identified several unique barriers to preventing unintended pregnancy (Higgins et al, ), such as fear of antigay stigma from health care providers, fear of anticontraception stigma within the queer community, resistance to identity as a regular contraceptive user, and the perception that one's risk for pregnancy was low if penile–vaginal intercourse was infrequent. Altogether, these factors provided robust disincentives to use contraceptives and regular contraceptive care.…”

Evaluating a Longitudinal Cohort of Clinics Engaging in the Family Planning Elevated Contraceptive Access Program: Study Protocol for a Comparative Interrupted Time Series Analysis

“…For example, a presurvey provided at a Utah contraceptive training conference found that 65% of respondents (n=29) perceived that intrauterine placements were less uncomfortable for recipients if provided during menstruation [ 28 ]. In addition, research on sexual minority women in Utah found that these individuals are less likely to report having had a provider offer contraception or discuss pregnancy intentions or reproductive life planning [ 29 , 30 ].…”