Context: Sexual minority women (SMW) are less likely to use sexual and reproductive health care services and receive contraceptive counseling than their heterosexual peers. The role of recent sexual partners and the type of information provided when SMW access health services are unclear. Methods: The National Survey of Family Growth 2006-2015 was used to document sexual orientation disparities in the use of sexual and reproductive health services and counseling in clinical settings among 20,703 women. We incorporate data on sexual partners in the past 12 months to investigate whether recent sex with men was associated with health care seeking behavior and reproductive counseling. Results: Eight-seven percent of the sample reported a male partner in the past 12 months, including 83% of bisexual women and 17% of lesbian women. In clinical settings, 48% of women reported birth control counseling at pregnancy or Pap tests, 49% reported a condom consult at an sexually transmitted diseases (STD) screening, and 9% reported emergency contraception counseling at a Pap test. Logistic regression models show that lesbian women were less likely than heterosexual women to have been given a contraceptive prescription or received contraceptive counseling, but were more likely to have received an STD test. In clinical settings, lesbian women were less likely to receive contraceptive counseling at pregnancy tests, and lesbian women without male partners were less likely to have a counseling about condom use at STD-related visits compared with heterosexual women. Conclusions: At least some women and providers adjust health care seeking behaviors and information provided to women based upon recent sexual behavior histories. More work is needed to understand why disparities in reproductive health services and contraceptive use persist among SMW who engage in sex with men.
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.
Reproductive justice is an intersectional social movement, theory, and praxis well aligned with social work’s mission and values. Yet, advancing reproductive justice—the right to have children, to not have children, to parent with safety and dignity, and to sexual and bodily autonomy—has not been a signature area of scholarship and practice for the field. This article argues that it is critical for social work to advance reproductive justice to truly achieve the grand challenge of closing the health gap. The article starts by discussing the history and tenets of reproductive justice and how it overlaps with social work ethics. The authors then highlight some of the ways by which social workers have been disruptors of and complicit in the oppression of individuals, families, and communities with regard to their reproductive rights and outcomes. The article concludes with a call to action and recommendations for social work to foreground reproductive justice in research, practice, and education efforts by centering marginalized voices while reimagining the field’s pursuit of health equity.
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