LGBTQ patients face discrimination and erasure when seeking reproductive health care

A queer-identified genderqueer person at their first preventive care visit with a gynecologist was told that “nobody is actually gay.” A provider told a transgender man seeking hormone replacement therapy that there’s “nothing wrong with being a woman” and that his gender identity stems from hatred of women. A pregnant cisgender woman in a same-sex relationship was handed medical paperwork that asks extensive questions about the “father of the baby” and “male partner.”

These kinds of negative experiences are alienating and contribute to reproductive health care being viewed as a “running joke in the LGBTQ community,” according to interviewees in a new ANSIRH study that explores the reproductive health care priorities and experiences of LGBTQ people. Despite increasing interest in better serving the LGBTQ community, there is little research that includes the direct input of LGBTQ-identified people. To address this gap, researchers interviewed female-assigned-at-birth people who identified as lesbian, gay, queer and/or genderqueer or transmasculine about what accessing reproductive health care has been like for them and where improvements should be made in research and practice.

Reproductive health care, where sexual activity and reproductive anatomy are central topics, lends itself to disclosures of gender and sexual identity and behavior. This can lead to greater trust with provider, but can also increase vulnerability to discrimination.

Several barriers to care surfaced in the interviews:

  • Focus on fertility and “women’s care.” Providers often steered conversations toward fertility even when people were seeking help for unrelated health concerns. As one interviewee said, it “kind of sends the message that a woman’s only purpose is to shoot children out of her uterus.” This focus on childbearing can be alienating to LGBTQ people who are not at risk for pregnancy or don’t plan to have children. One queer transgender man described how labeling services “women’s health care” made him feel uncomfortable and anxious as the only man in the waiting room who wasn’t with a woman.
  • Lack of LGBTQ competency and erasure. Interviewees encountered intake forms that were heteronormative and made it difficult to share accurate information about sexual and medical history. Providers were often unprepared to talk about same-sex sexual activity, leaving patients feeling confused, invisible, and lacking accurate health information.
  • Discriminatory comments and care. Many people interviewed encountered homophobic or transphobic remarks in health care, and trans male participants reported being misgendered. Most described providers as being ignorant of trans-related health issues and some refused to refer to gender-affirming care.

These negative experiences affected the desire of LGBTQ people to seek reproductive health care in the future.

The study showed that members of the LGBTQ community had some similar reproductive health care needs as cisgender, heterosexual patients (like pap tests, birth control, STI prevention) and some unique needs (like gender-affirming care, including top surgery and hysterectomies). An important first step in providing that care would be LGBTQ-specific competency and sensitivity training for all reproductive healthcare providers. Interviewees wanted future research to explore topics including discrimination in reproductive health care settings, aspects of LGBTQ pregnancy, impact of hormone replacement therapy on fertility, and sexual health research questions like how LGBTQ people engage in sex and STI prevention.