Childbearing at the margins: A systematic metasynthesis of sexual and gender diverse childbearing experiences

Abstract

Background:The reproductive and perinatal health of sexual and genderdiverse (SGD) individuals is a research priority area for the National Institutes of Health. Over the past decade, this childbearing population has been the focus of several qualitative studies providing the opportunity to evaluate and synthesize the qualitative literature on SGD childbearing experiences in a metasynthesis. Methods:We conducted a literature search of four databases to identify original research published from January 2011 through June 2021. These results were augmented by forward and backward searching strategies. Two authors independently screened studies. All qualitative studies of the childbearing experience were eligible. Data were extracted and inductively coded using conventional content analysis, and studies underwent a quality appraisal by two authors. Results: From 2396 articles, 127 full-text articles were screened, and 25 were included in this synthesis. Three overarching themes were identified: (a) Systematic Invisibility; (b) Creating Personhood Through Parenthood; and (c) Resilient Narratives of Childbearing.Conclusions: Relative to heterosexual and cisgender parents, SGD childbearing parents experience unique structural and interpersonal challenges and employ critically important resilience strategies and coping techniques to manage an overwhelming heterocisnormative experience. These findings provide an important target for health care organizations and professionals to improve SGD perinatal health. In addition, this metasynthesis identified persistent gaps in our understanding of this marginalized childbearing population, which have important implications for reducing health disparities that SGD parents experience.

Systematic Reviews to Inform Practice, January/February 2023

“…As the number of people in the United States who are not heterosexual and/or whose gender identity differs from their sex assigned at birth increases to over 7%, 1 the number of sexually and gender diverse (SGD) people choosing childbearing and parenting will increase. An excellent meta‐synthesis by Soled and colleagues of qualitative studies since 2011 provides valuable information for health care providers as well as larger health‐related endeavors such as insurers, electronic health record companies, and health professional educators 2 …”

Changing language, changes lives: Learning the lexicon of LGBTQ+ health equity

“…Using language that centers heterocisnormativity, that is, the assumption that heterosexual and cisgender people are the norm, is a common microaggression that can perpetuate discrimination in more insidious ways. For example, some insurance companies use language in policies that restrict health care services to a specific gender (e.g., cervical cancer screening restricted to women, excluding transgender men and transmasculine individuals) or restrict assisted reproductive technology to those with an infertility diagnosis—a diagnosis that is impossible for many LGBTQ+ people to receive (Soled, Niles et al, 2022).…”

Family building and pregnancy experiences of cisgender sexual minority women

“…CSMW experience significant barriers to achieving desired pregnancies, including difficulty accessing general sexual and reproductive healthcare, difficulty accessing medically assisted reproduction (eg, intrauterine insemination [IUI], in vitro fertilization [IVF]), and financial barriers. 9 , 10 At the same time, bisexual women are more likely than heterosexual women to experience pregnancy over their lifetime, 11 , 12 including unintended pregnancies. 13 , 14 CSMW's sexual and reproductive healthcare experiences are frequently characterized by discrimination, erasure, and feeling their like identities and experiences are invisible owing to heteronormative assumptions and lack of LGBTQ+ competency.…”