Family Planning for Sexual Minority Women

Abstract

The family planning needs of sexual minority women (SMW) are an understudied but growing area of research. SMW have family planning needs, both similar to and distinct from their exclusively heterosexual peers. Specifically, SMW experience unintended pregnancies at higher rates than their exclusively heterosexual peers, but factors that increase this risk are not well understood. Contraception use is not uncommon among SMW, but lesbian women are less likely to use contraception than bisexual or exclusively heterosexual women. High rates of unintended pregnancy suggest contraception is underused among SMW. Contraception counseling guidelines specific to SMW do not yet exist, but greater adoption of current best practices is likely to meet the needs of SMW. SMW may have unique needs for their planned pregnancies as well, for which obstetrics and gynecology (Ob/Gyn) providers should provide care and referrals. In general, understandings of the distinct family planning needs for SMW are limited and further research is needed, with particular attention to issues of over-lapping health disparities related to status as a SMW and other factors such as race/ethnicity that may add additional layers of stigma and discrimination. Clinical resources are needed to help Ob/Gyns make their practice more welcoming to the needs of SMW.

Disparities in accessing infertility care in the United States: results from the National Health and Nutrition Examination Survey, 2013–16

“…Racial and ethnic disparities in the use of infertility services and the outcomes of infertility treatments have been observed in prior studies (6)(7)(8)(9). However, additional sociodemographic characteristics may influence an individual's ability or likelihood to seek infertility care, such as educational status, marital status, household income, citizenship, insurance coverage, and accessibility to medical facilities (10)(11)(12). Prior studies have attempted to evaluate these characteristics, but primarily within specific study populations or geographic regions, limiting the generalizability of their findings (13,14).…”

Lesbian Pregnancy: Care and Considerations

“…Also, depending on sexual practices, consideration may need to be given to postpartum contraceptive plans. As described by Stoffel et al in this issue 39 and in a recent article by Everett et al, 40 sexual minority women have unexpectedly high rates of unintended pregnancy. As in the general population, postpartum depression screening should be a central priority of postpartum care for lesbian patients, as this group has been reported to have higher Edinburgh Postnatal Depression Scale scores than heterosexual women.…”

“…41 Postpartum depression has been reported not only in the birth mother but also in the co-mother. 39 Factors found to be associated with postpartum depression in either mother include lack of support from families of origin, stress in negotiating parenting roles, and legal system barriers to establishing parental rights. 42…”

Sexual Dysfunction in Lesbian Women: A Systematic Review of the Literature

“…Identification of these problems relies on a provider's ability to ask directive questions about a woman's sexual orientation and sexual practices without assumption that lesbians do not participate in certain sexual activities, including having sex with men as reviewed by Stoffel et al in this issue. 35 We also identified lesbians suffer from dysfunction related to sexual desire and arousal, though they may do so with less frequency than heterosexual women. The reason for this remains unclear, though it may be related to relationship factors.…”