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Seiger KW, McNamara B, Berrahou IK. Gynecologic Care for Sexual and Gender Minority Patients. Obstet Gynecol Clin North Am 2024; 51:17-41. [PMID: 38267126 DOI: 10.1016/j.ogc.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Sexual and gender minority (SGM) people, including lesbian, gay, bisexual, transgender, and queer individuals, are a diverse population with a wide spectrum of gynecologic needs. Institutionalized cisheteronormativity, stigmatization, lack of provider training, and fear of discrimination contribute to health disparities in this patient population. In this article, we review key topics in the gynecologic care of SGM patients and provide strategies to enable gynecologists to provide SGM people with equitable and inclusive full spectrum reproductive health care.
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Affiliation(s)
- Kyra W Seiger
- Yale University School of Medicine, 367 Cedar Street, New Haven, CT 06510, USA
| | - Blair McNamara
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Iman K Berrahou
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, Suite 302 FMB, New Haven, CT 06520-806, USA.
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2
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Chen E, Hollowell A, Truong T, Bentley-Edwards K, Myers E, Erkanli A, Holt L, Swartz JJ. Contraceptive Access and Use Among Undergraduate and Graduate Students During COVID-19: Online Survey Study. JMIR Form Res 2023; 7:e38491. [PMID: 36827491 PMCID: PMC10018798 DOI: 10.2196/38491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to widespread college campus closures in the months of March to June 2020, endangering students' access to on-campus health resources, including reproductive health services. OBJECTIVE To assess contraceptive access and use among undergraduate and graduate students in North Carolina during the COVID-19 pandemic. METHODS We conducted a cross-sectional web-based survey of undergraduate and graduate students enrolled at degree-granting institutions in North Carolina. Participants were recruited using targeted Instagram advertisements. The survey queried several aspects of participants' sexual behavior, including sex drive, level of sexual experience, number of sexual partners, digital sexual experience, dating patterns, and types of contraception used. Participants were asked to compare many of these behaviors before and after the pandemic. The survey also assessed several sociodemographic factors that we hypothesized would be associated with contraceptive use based on prior data, including educational background, sexual orientation and gender minority status (ie, lesbian, gay, bisexual, transgender, queer), health insurance status, race, ethnicity, degree of sensation seeking, religiosity, and desire to become pregnant. RESULTS Over 10 days, 2035 Instagram users began our survey, of whom 1002 met eligibility criteria. Of these 1002 eligible participants, 934 completed the survey, for a 93% completion rate. Our respondents were mostly female (665/934, 71%), cisgender (877/934, 94%), heterosexual (592/934, 64%), white (695/934 75%), not Hispanic (835/934, 89%), and enrolled at a 4-year college (618/934, 66%). Over 95% (895/934) of respondents reported that they maintained access to their preferred contraception during the COVID-19 pandemic. In a multivariable analysis, participants who were enrolled in a 4-year college or graduate program were less likely to lose contraceptive access when compared to participants enrolled in a 2-year college (risk ratio [RR] 0.34, 95% CI 0.16-0.71); in addition, when compared to cisgender participants, nonbinary and transgender participants were more likely to lose contraceptive access (RR 2.43, 95% CI 1.01-5.87). Respondents reported that they were more interested in using telehealth to access contraception during the pandemic. The contraceptive methods most commonly used by our participants were, in order, condoms (331/934, 35.4%), oral contraception (303/934, 32.4%), and long-acting reversible contraception (LARC; 221/934, 23.7%). The rate of LARC use among our participants was higher than the national average for this age group (14%). Emergency contraception was uncommonly used (25/934, 2.7%). CONCLUSIONS Undergraduate and graduate students in North Carolina overwhelmingly reported that they maintained access to their preferred contraceptive methods during the COVID-19 pandemic and through changing patterns of health care access, including telehealth. Gender nonbinary and transgender students and 2-year college students may have been at greater risk of losing access to contraception during the first year of the COVID-19 pandemic.
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Affiliation(s)
- Emily Chen
- Duke University School of Medicine, Durham, NC, United States
| | - Adam Hollowell
- Samuel Dubois Cook Center on Social Equity, Duke University, Durham, NC, United States
| | - Tracy Truong
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, United States
| | - Keisha Bentley-Edwards
- Department of General Internal Medicine, Duke University Medical Center, Durham, NC, United States
| | - Evan Myers
- Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC, United States
| | - Alaattin Erkanli
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, United States
| | - Lauren Holt
- School of Nursing, Duke University School of Nursing, Durham, NC, United States
| | - Jonas J Swartz
- Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC, United States
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Burke KL, Potter JE. Meeting Preferences for Specific Contraceptive Methods: An Overdue Indicator. Stud Fam Plann 2023; 54:281-300. [PMID: 36705876 DOI: 10.1111/sifp.12218] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Fertility surveys have rarely asked people who are using contraception about the contraceptive method they would like to be using, implicitly assuming that those who are contracepting are using the method they want. In this commentary, we review evidence from a small but growing body of work that oftentimes indicates this assumption is untrue. Discordant contraceptive preferences and use are relatively common, and unsatisfied preferences are associated with higher rates of method discontinuation and subsequent pregnancy. We argue that there is opportunity to center autonomy and illuminate the need for and quality of services by building on this research and investing in the development of survey items that assess which method people would like to use, as well as their reasons for nonpreferred use. The widespread adoption of questions regarding method preferences could bring indicators of reproductive health services into closer alignment with the needs of the people they serve.
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Affiliation(s)
- Kristen Lagasse Burke
- Population Research Center and Department of Sociology, University of Texas at Austin, Austin, TX, 78712, USA
| | - Joseph E Potter
- Population Research Center and Department of Sociology, University of Texas at Austin, Austin, TX, 78712, USA
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4
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Eilers MA. What a (Young) Woman Wants: Concurrent Effects of Desire to Avoid Pregnancy and Desire for Sex on Sexual Intercourse and Contraceptive Use. Demography 2022; 59:2271-2293. [PMID: 36331338 DOI: 10.1215/00703370-10295826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Of all pregnancies among young women in the United States, more than 60% are undesired, yet explanations for this phenomenon remain elusive. While research has investigated how pregnancy desires and intentions shape pregnancy-related behavior, only recently have scholars noted that desire for sex influences these same behaviors. Many young women simultaneously experience strong desires for sex alongside a strong desire to avoid pregnancy, but few studies have considered the extent to which young women adapt their reproductive behaviors in response to these potentially competing desires. Using novel weekly panel data, this analysis assesses how desires for sex may moderate the effect of the desire to avoid pregnancy on a young woman's sexual behavior and contraceptive use. Findings suggest that when a woman strongly wants to avoid pregnancy, she is less likely to have sex and more likely to use hormonal or coital contraceptives. As her desire for sex increases, however, she is instead more likely to have sex and use hormonal contraceptives. If she does not use hormonal methods, she is less likely to use coital contraceptives when she has intercourse. These findings highlight the importance of recognizing the desire for sex as a behavioral modifier for avoiding undesired pregnancy in the transition to adulthood.
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Affiliation(s)
- Michelle A Eilers
- Department of Sociology, The University of Texas at Austin, Austin, TX, USA
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Blumenstock SM, Barber JS. Sexual Intercourse Frequency During Pregnancy: Weekly Surveys Among 237 Young Women From A Random Population-Based Sample. J Sex Med 2022; 19:1524-1535. [PMID: 35953427 PMCID: PMC9529844 DOI: 10.1016/j.jsxm.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Significant differences in sexual frequency during pregnancy have been documented in cross-sectional and once-per-trimester longitudinal studies, with the highest sexual frequency in the first trimester and the lowest in the third trimester. However, changes in sexual frequency may be more complex than these comparisons suggest; patterns of sexual frequency have not been assessed using frequent (e.g., weekly) assessments throughout a woman's pregnancy. AIM To assess changes in the frequency of sexual intercourse across all weeks of pregnancy. METHODS We used data from 237 women (54% White; 43% Black) who reported a pregnancy during the Relationship Dynamics and Social Life (RDSL) study. RDSL was based on a random population-based sample of 992 women in the United States, aged 18 or 19, who completed a baseline interview and brief weekly follow-up surveys for 2.5 years. We used generalized multilevel modeling to fit and compare linear, quadratic, and piecewise (via b-splines) models. OUTCOME Weekly probability of sexual intercourse. RESULTS Sexual intercourse frequency clearly declined across pregnancy, yet the pattern followed the course of common pregnancy symptomology (i.e., nausea, fatigue) more closely than trimester cutoffs. The best fitting model demonstrated that the probability of sexual intercourse declined sharply (∼18% each week) between conception and 11 weeks, subsequently increased by ∼3% each week between weeks 11 and 21, and then declined steadily (∼6% each week) through the end of pregnancy. CLINICAL TRANSLATION Documenting more precise patterns of change in sexual frequency during pregnancy provides important information to many who wish to maintain sexual intimacy while pregnant, or to those who would otherwise find the sexual disruptions particularly challenging. STRENGTHS & LIMITATIONS This study is the first to document changes in sexual intercourse frequency throughout all weeks of pregnancy as they naturally occurred among a representative sample of young women. The focus on sexual intercourse limits the findings to only one aspect of human sexuality. The narrow age range of the sample precludes generalization to all pregnant women. CONCLUSION Changes in sexual frequency are more complex than the general declines suggested by other studies; within-trimester patterns reveal the shortcomings in understanding sexual behavior changes when aggregated by trimester, such as severely underestimating the degree of fluctuation in the first trimester. Pregnancy symptomology may be most favorable to intercourse towards the end of the first and beginning of second trimesters, and least favorable near the end of the pregnancy. Shari M. Blumenstock, Jennifer S. Barber. Sexual Intercourse Frequency During Pregnancy: Weekly Surveys Among 237 Young Women From A Random Population-Based Sample. J Sex Med 2022;19:1524-1535.
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Affiliation(s)
| | - Jennifer S Barber
- Kinsey Institute, Indiana University, Bloomington, IN, United States; Department of Sociology, Indiana University, Bloomington, IN, United States
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Baaske A, Brotto LA, Galea LAM, Albert AY, Smith L, Kaida A, Booth A, Gordon S, Sadarangani M, Racey CS, Gottschlich A, Ogilvie GS. Barriers to Accessing Contraception and Cervical and Breast Cancer Screening During the COVID-19 Pandemic. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1076-1083. [PMID: 35738558 PMCID: PMC9212845 DOI: 10.1016/j.jogc.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 12/02/2022]
Abstract
Objective This study sought to examine how access to contraception and cervical and breast cancer screening in British Columbia, Canada, has been affected by the COVID-19 pandemic. Methods From August 2020 to March 2021, 3691 female residents of British Columbia (age 25–69 y) participated in this study. We used generalized estimating equations to analyze the proportion of females accessing contraception and the proportion having difficulty accessing contraception across the different phases of pandemic control measures, and logistic regression to analyze attendance at cervical and breast cancer screening. We added sociodemographic and biological variables individually into the models. Self-reported barriers to accessing contraception and attending screening were summarized. Results During phases with the highest pandemic controls, self-reported access to contraception was lower (OR 0.94; 95% CI 0.90–0.98; P = 0.005) and difficulty with access was higher (OR 2.74; 95% CI 1.54–4.88; P = 0.001). A higher proportion of adults aged 25–34 years reported difficulty accessing contraception than those aged 35–39 years (P < 0.0001), and participants identifying as Indigenous had higher odds of access difficulties (OR 5.56; 95% CI 2.44–12.50; P < 0.001). Of those who required screening during the COVID-19 pandemic, 62% and 54.5% did not attend at least one of their cervical or breast screening appointments, respectively. Those with a history of breast cancer had significantly higher odds of self-reporting having attended their mammogram appointment compared with those without a history of breast cancer (OR 5.62; 95% CI 2.69–13.72; P < 0.001). The most common barriers to screening were difficulty getting an appointment and appointments being considered non-urgent. Conclusions The COVID-19 pandemic has uniquely affected access to contraception and cancer screening participation for various subgroups. Self-reported data present potential avenues for mitigating barriers.
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Affiliation(s)
| | - Lori A Brotto
- Women's Health Research Institute, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC.
| | - Liisa A M Galea
- Women's Health Research Institute, Vancouver, BC; Department of Psychology, University of British Columbia, Vancouver, BC
| | - Arianne Y Albert
- Women's Health Research Institute, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - Laurie Smith
- Women's Health Research Institute, Vancouver, BC; Cancer Control Research, BC, Cancer, Vancouver, BC
| | - Angela Kaida
- Women's Health Research Institute, Vancouver, BC; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - Amy Booth
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | | | - Manish Sadarangani
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC
| | - C Sarai Racey
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - Anna Gottschlich
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - Gina S Ogilvie
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
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Tabaac AR, Sutter ME, Haneuse S, Agénor M, Bryn Austin S, Guss CE, Charlton BM. The interaction of sexual orientation and provider-patient communication on sexual and reproductive health in a sample of U.S. women of diverse sexual orientations. PATIENT EDUCATION AND COUNSELING 2022; 105:466-473. [PMID: 34023174 PMCID: PMC8594287 DOI: 10.1016/j.pec.2021.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Our goal was to examine associations among provider-patient communication, past-year contraceptive use and lifetime sexually transmitted infection. METHODS Data were analyzed cross-sectionally from 22,554 women in the Growing Up Today Study and Nurses' Health Study 3 between the follow-up period of 1996-2020. We used multivariable Poisson regression models adjusted for race/ethnicity, age in years, study cohort, and region of residence to obtain risk ratio (RR) associations and 95% confidence intervals (CI). RESULTS Provider-patient communication was associated with higher likelihood of using all methods of past-year contraceptive use (RRs ranging from 1.11 to 1.63) and lifetime STI diagnosis (RRs ranging from 1.18 to 1.96). Completely heterosexual women with no same-sex partners (referent) were 13% more likely than lesbians and 4% less likely than other groups to report a provider ever discussed their SRH. Significant interactions emerged between sexual minority status and provider-patient communication. Sexual minority women whose providers discussed their SRH were less likely to report contraceptive non-use in the past year (p < .0001). CONCLUSION Provider-patient communication may benefit sexual minority women's contraceptive practices and engagement with STI testing. PRACTICE IMPLICATIONS Differences in provider-patient SRH discussion by sexual orientation indicate lesbian women are not receiving the same attention in clinical encounters.
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Affiliation(s)
- Ariella R Tabaac
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Megan E Sutter
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY, USA.
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Madina Agénor
- Department of Community Health, Tufts University, Medford, MA, USA; Department of Obstetrics/Gynecology, Tufts University School of Medicine, Boston, MA, USA.
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Carly E Guss
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Brittany M Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Kanazawa S, Larere A. Infertility and same-sex attraction in women. Int J Gynaecol Obstet 2021; 158:528-543. [PMID: 34796501 DOI: 10.1002/ijgo.14035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/17/2021] [Indexed: 11/07/2022]
Abstract
A polygyny hypothesis of female sexual fluidity proposes that women may have been evolutionarily selected to be sexually fluid, in order to have occasional sex with their cowives in polygynous marriage to reduce tension and conflict inherent in such marriage, while at the same time reproducing children with their husbands. Among others, the hypothesis predicts that women who are biologically (but not surgically) infertile would experience greater same-sex attraction. Biological infertility stems from natural, evolutionarily familiar causes such as menopause, whereas surgical infertility stems from artificial, evolutionarily novel causes such as tubal ligation or hysterectomy. Consistent with the prediction, the analyses of the National Survey of Family Growth data showed that biological infertility, but not surgical infertility, was significantly associated with same-sex self-identified labels, behavior and sexual attraction in women. Biological infertility nearly doubled the odds of women having engaged in same-sex behavior and the number of same-sex partners in the last 12 months and nearly tripled the number of same-sex partners in life. In sharp contrast, biological infertility was not associated (and surgical infertility was significantly negatively associated) with same-sex attraction in men.
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Affiliation(s)
- Satoshi Kanazawa
- Department of Management, London School of Economics and Political Science, London, UK
| | - Adrien Larere
- Department of Management, London School of Economics and Political Science, London, UK
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Carpenter CS, Gonzales G, McKay T, Sansone D. Effects of the Affordable Care Act Dependent Coverage Mandate on Health Insurance Coverage for Individuals in Same-Sex Couples. Demography 2021; 58:1897-1929. [PMID: 34477825 DOI: 10.1215/00703370-9429469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A large body of research documents that the 2010 dependent coverage mandate of the U.S. Affordable Care Act was responsible for significantly increasing health insurance coverage among young adults. No prior research has examined whether sexual minority young adults also benefitted from the dependent coverage mandate despite previous studies showing lower health insurance coverage among sexual minorities. Our estimates from the American Community Survey, using difference-in-differences and event study models, show that men in same-sex couples aged 21-25 experienced a significantly greater increase in the likelihood of having any health insurance after 2010 than older, 27- to 31-year-old men in same-sex couples. This increase is concentrated among employer-sponsored insurance, and it is robust to permutations of periods and age groups. Effects for women in same-sex couples and men in different-sex couples are smaller than the associated effects for men in same-sex couples. These findings confirm the broad effects of expanded dependent coverage and suggest that eliminating the federal dependent mandate could reduce health insurance coverage among young adult sexual minorities in same-sex couples.
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Affiliation(s)
- Christopher S Carpenter
- Department of Economics, Vanderbilt University, Nashville, TN, USA; National Bureau of Economic Research, Cambridge, MA, USA; IZA, Bonn, Germany
| | - Gilbert Gonzales
- Department of Medicine, Health, & Society and Program for Public Policy Studies, Vanderbilt University, Nashville, TN, USA
| | - Tara McKay
- Department of Medicine, Health, & Society, Vanderbilt University, Nashville, TN, USA
| | - Dario Sansone
- Business School, Department of Economics, University of Exeter; IZA, Bonn, Germany
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Weitzman A, Barber JS, Heinze J, Zimmerman M. How Nearby Homicides Affect Young Women's Pregnancy Desires: Evidence From a Quasi-Experiment. Demography 2021; 58:927-950. [PMID: 33861339 PMCID: PMC8406045 DOI: 10.1215/00703370-9160045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Leveraging spatiotemporal variation in homicides that occurred during a 2.5-year weekly panel survey of 387 women ages 18-22 in Flint, Michigan, we investigate how young women's desires to become pregnant and to avoid pregnancy evolve in response to local homicides during the transition to adulthood. To address the endogeneity of exposure, we explore how the same woman's pregnancy desires (1) differed, on average, across weeks before and after the first homicide occurred within a quarter mile of her home; (2) evolved in the aftermath of this initial homicide exposure; and (3) changed in response to additional nearby homicides. One-fifth (22%) of women were exposed to a nearby homicide at least once during the study, and one-third of these women were exposed multiple times. Overall, the effects of nearby homicides were gradual: although average desires to become pregnant and to avoid pregnancy differed after initial exposure, these differences emerged approximately three to five months post-exposure. Repeated exposure to nearby homicides had nonlinear effects on how much women wanted to become pregnant and how much they wanted to avoid pregnancy. Together, our analyses provide a new explanation for why some young women-especially those who are socially disadvantaged-desire pregnancy at an early age.
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Affiliation(s)
- Abigail Weitzman
- Department of Sociology and Population Research Center, University of Texas Austin, Austin, TX, USA
| | - Jennifer S Barber
- Department of Sociology and Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Justin Heinze
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Marc Zimmerman
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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The social context of retrospective-prospective changes in pregnancy desire during the transition to adulthood: The role of fathers and intimate relationships. DEMOGRAPHIC RESEARCH 2021. [DOI: 10.4054/demres.2021.44.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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12
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Barber JS, Guzzo KB, Budnick J, Kusunoki Y, Hayford SR, Miller W. Black-White Differences in Pregnancy Desire During the Transition to Adulthood. Demography 2021; 58:603-630. [PMID: 33834223 PMCID: PMC8167887 DOI: 10.1215/00703370-8993840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article explores race differences in the desire to avoid pregnancy or become pregnant using survey data from a random sample of 914 young women (ages 18-22) living in a Michigan county and semi-structured interviews with a subsample of 60 of the women. In the survey data, desire for pregnancy, indifference, and ambivalence are very rare but are more prevalent among Black women than White women. In the semi-structured interviews, although few women described fatalistic beliefs or lack of planning for future pregnancies, Black and White women did so equally often. Women more often described fatalistic beliefs and lack of planning when retrospectively describing their past than when prospectively describing their future. Using the survey data to compare prospective desires for a future pregnancy with women's recollections of those desires after they conceived, more Black women shifted positive than shifted negative, and Black women were more likely to shift positive than White women-that is, Black women do not differentially retrospectively overreport prospectively desired pregnancies as having been undesired before conception. Young women's consistent (over repeated interviews) prospective expression of strong desire to avoid pregnancy and correspondingly weak desire for pregnancy, along with the similarity of Black and White women's pregnancy plans, lead us to conclude that a "planning paradigm"-in which young women are encouraged and supported in implementing their pregnancy desires-is probably appropriate for the vast majority of young women and, most importantly, is similarly appropriate for Black and White young women.
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Affiliation(s)
- Jennifer S Barber
- Department of Sociology and Kinsey Institute, Indiana University, Bloomington, IN, USA
| | | | - Jamie Budnick
- Population Studies Center and Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Yasamin Kusunoki
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Sarah R Hayford
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Warren Miller
- Transnational Family Research Institute, Aptos, CA, USA
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Kusunoki Y, Barber JS. The Dynamics of Intimate Relationships and Contraceptive Use During Early Emerging Adulthood. Demography 2020; 57:2003-2034. [PMID: 32901407 PMCID: PMC8112453 DOI: 10.1007/s13524-020-00916-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We investigate the immediate social context of contraceptive behaviors: specifically, the intimate relationship. We use the Relationship Dynamics and Social Life (RDSL) study (2008-2012), based on a random sample of 1,003 women ages 18-19 residing in a Michigan county. Women were interviewed weekly for 2.5 years, resulting in an age range of 18-22. We test three sets of hypotheses about change over time within a relationship, using relationship-level within-between models, which compare a couple's contraceptive behaviors across different times in the relationship. First, we find that a couple is less likely to use contraception when the relationship is more intimate and/or committed and that a couple becomes less likely to use contraception over time, regardless of intimacy and commitment. Second, we find that a couple using contraception becomes increasingly likely to choose hormonal over coital methods, but this change occurs as a relationship endures and is unrelated to intimacy and/or commitment. Third, we find that a condom-using couple's consistency does not decline when there is conflict; rather, consistency of condom use declines over time regardless of the relationship's characteristics. We also demonstrate that conflict and power imbalance increase reliance on hormonal methods among those using contraception; conflict decreases consistency among withdrawal (but not condom) users; and nonmonogamy increases reliance on condoms and decreases withdrawal consistency. The strong and consistent link between duration and contraceptive behaviors-regardless of intimacy, commitment, conflict, or power imbalance-suggests that the continual vigilance required for long-term contraceptive use is difficult during early emerging adulthood.
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Affiliation(s)
- Yasamin Kusunoki
- School of Nursing, Department of Systems, Populations and Leadership, and Population Studies Center and Survey Research Center at the Institute for Social Research, University of Michigan, 400 North Ingalls Street, Room 4156, Ann Arbor, MI, 48109-4582, USA.
| | - Jennifer S Barber
- Department of Sociology and Kinsey Institute, Indiana University, Bloomington, IN, 47405-7103, USA
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Abstract
Decades of research have attempted to understand the paradox of stubbornly high unintended pregnancy rates despite widespread use of contraception. Much of this research has focused on socioeconomic disparities in rates of unintended pregnancy, finding that economically disadvantaged women tend to use less effective contraceptive methods and use them less consistently. Building on this research, this study examines how material hardship is associated with less consistent contraceptive use among women who do not desire to become pregnant. Using the Relationship Dynamics and Social Life (RDSL) Study, a weekly longitudinal survey, I find lower levels of contraceptive use and less consistent use of contraception among women experiencing material hardship, relative to those without hardship experiences. I also investigate the extent to which this association is explained by access barriers and lower contraceptive efficacy among women experiencing hardship. Using structural equation modeling, I find that these mediators significantly explain the relationship between hardship and risky contraceptive behaviors, suggesting that hardship creates mental and resource constraints that impede successful implementation of contraception. However, net of these mediators, material hardship remains associated with riskier contraceptive behaviors among young women, calling for further research on how hardship exposes women to greater risk of unintended pregnancies.
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Affiliation(s)
- Elly Field
- Department of Sociology and Population Studies Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Room 2267, Ann Arbor, MI, 48106-1248, USA.
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15
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Porsch L, Zhang H, Paschen-Wolff M, Grosskopf N, Grov C. Contraceptive Use by Women Across Multiple Components of Sexual Orientation: Findings from the 2011-2017 National Survey of Family Growth. LGBT Health 2020; 7:321-331. [PMID: 32808867 DOI: 10.1089/lgbt.2020.0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: We estimated sexual orientation-related disparities in contraceptive outcomes among women across multiple components of sexual orientation. Methods: Using pooled National Survey of Family Growth data, 2011-2017, we performed multivariable logistic and multinomial regression analyses (adjusted for race/ethnicity, age, education, and income) to estimate the independent associations between multiple components of sexual orientation (sexual identity, behavior, and attraction) and two contraceptive outcomes-any contraceptive use and type of method used at last intercourse with a male partner. Results: Women who reported any attraction to females had increased odds of having used any contraceptive method compared with those only attracted to males (adjusted odds ratio [AOR] 1.22, 95% confidence interval [CI] 1.03-1.44). For the type of contraception outcome, we present age-stratified results due to effect modification. Among 15- to 25-year-olds, bisexual-identified females had higher odds of having used a low efficacy method compared with heterosexual females (AOR 1.49, 95% CI 1.01-2.19). Among 26- to 35-year-olds, women with male and female partners had increased odds of having used a low efficacy method compared with women with male partners only (AOR 3.31, 95% CI 1.46-7.51). Conclusion: Sexual minority women, defined by sexual identity and sexual behavior, may be at increased risk for unintended pregnancy due to increased use of low efficacy contraceptive methods compared with their non sexual minority peers. These outcomes vary by age group.
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Affiliation(s)
- Lauren Porsch
- Department of Community Health and Social Sciences and CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Hongbin Zhang
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Margaret Paschen-Wolff
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, USA
| | - Nicholas Grosskopf
- Department of Community Health and Social Sciences and CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Christian Grov
- Department of Community Health and Social Sciences and CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
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16
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Weitzman A, Kusunoki Y. The Prevalence, Frequency and Social Ecology of Sexual Concurrency Among Young Adult Women. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:129-138. [PMID: 32666672 PMCID: PMC8380409 DOI: 10.1363/psrh.12149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/13/2020] [Accepted: 04/17/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT Sexual concurrency among women is associated with increased risks of STD transmission, unintended pregnancy and sexual health disparities. Understanding the prevalence of concurrency-overlapping sexual partnerships-is imperative to reducing these disparities. METHODS Weekly, population-representative panel data from 757 women aged 18-22, collected from 2008 to 2012 in Michigan, were drawn from the Relationship Dynamics and Social Life study. Univariate analyses assessed the prevalence of two forms of sexual concurrency. Multivariate logistic regression models investigated associations between women's social-ecological characteristics and concurrency. RESULTS Twenty percent of women had vaginal intercourse with two partners in one week; 14% had intercourse with a second partner during an ongoing relationship. In both cases, the majority of individuals had intercourse with the second partner in one to three weeks in total. The likelihood of both types of concurrency was elevated among women who believed they should have sex with men after seeing them for a while (log-odds, 0.27 and 0.23, respectively) and among those who were Black (0.58 and 1.02, respectively); the likelihood was reduced among women who were more willing to refuse unwanted sex (-0.10 and -0.13, respectively) and who were in exclusive, cohabiting, or married or engaged relationships (-1.82 to -2.64). Having intercourse with multiple partners in one week was also associated with receiving sex education from parents, the degree that parents and friends approved of sex, and having had early intercourse without contraception. CONCLUSIONS Sexual concurrency among young women is prevalent but intermittent, and interventions that address individuals' social-ecological contexts are needed to reduce negative health outcomes.
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17
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Bosse JD. Sexual and Gender Identity Development in Young Adults and Implications for Healthcare. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00215-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Barber JS, Miller W, Kusunoki Y, Hayford SR, Guzzo KB. Intimate Relationship Dynamics and Changing Desire for Pregnancy Among Young Women. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:143-152. [PMID: 31518052 PMCID: PMC7100877 DOI: 10.1363/psrh.12119] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 05/07/2019] [Accepted: 05/14/2019] [Indexed: 05/26/2023]
Abstract
CONTEXT Although substantial research has focused on unintended pregnancy among young women, less is known about the circumstances under which pregnancy is desired. Whether a young woman's pregnancy desire changes across her different relationships, or over time within a relationship, has not been directly assessed. METHODS Data on intimate relationships and pregnancy desire were assessed weekly for 895 women aged 18-22 who participated in the Relationship Dynamics and Social Life study in a county in Michigan (2008-2012). Within-between logistic regression models were used to examine within-cluster and between-cluster differences-comparisons of a woman's pregnancy desire within a relationship over time as well as across a woman's different relationships. RESULTS Young women were more likely to desire pregnancy if they were in any relationship more intimate and committed than a casual relationship (odds ratios, 1.6-9.2); the odds of desiring pregnancy were also higher in long-term relationships rather than in short-term ones (2.1). In general, pregnancy desire increased over time as a relationship endured and became more serious. The odds of desiring pregnancy were lower among women with less educated, rather than equally educated, partners (0.7), while the odds were higher in nonmonogamous or violent relationships than in monogamous or nonviolent relationships (1.6 and 1.9, respectively). CONCLUSIONS Young women's pregnancy desire changes depending on their intimate relationship context, across the range of relationships they experience during the transition to adulthood.
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Affiliation(s)
- Jennifer S. Barber
- Corresponding author, Department of Sociology, University of Michigan, 500 S. State Street, Ann Arbor, MI 48109-1382, 734-647-6324 ph,
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19
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Shen S, Kusunoki Y. Intimate Partner Violence and Psychological Distress Among Emerging Adult Women: A Bidirectional Relationship. J Womens Health (Larchmt) 2019; 28:1060-1067. [PMID: 31166827 PMCID: PMC6709941 DOI: 10.1089/jwh.2018.7405] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Intimate partner violence (IPV) and psychological distress (PD) are major public health concerns among emerging adult women. Emerging adulthood presents a complex set of new experiences and challenges that pose a risk to normative development. In particular, an increased prevalence of IPV and PD during this time period may lead to long-term health consequences. Methods: Data from the Relationship Dynamics and Social Life study, a longitudinal study of a racially and socioeconomically diverse population-representative random sample of 726 partnered women, aged 18-19, residing in a Michigan county, and followed for 2.5 years, were used to investigate the relationship between IPV and PD. Logistic regression models predicted each measure of PD (depression, stress, loneliness, self-esteem) as a function of past IPV (none, psychological violence only, any physical violence), and multinomial logistic regression models predicted subsequent weekly IPV as a function of each measure of PD. Results: PD and IPV were prevalent among emerging adult women. Past psychological IPV was associated with experiencing all four distress measures. Past physical IPV was also associated with depression, stress, and loneliness, but not self-esteem. Women with each PD were more likely to subsequently experience psychological violence, and women who reported stress were more likely to subsequently experience any physical violence. Conclusions: The IPV-PD relationship is bidirectional. Women who experienced past IPV were more likely to report PD. Conversely, women who experienced PD were at a greater risk of subsequent IPV.
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Affiliation(s)
- Sharon Shen
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yasamin Kusunoki
- Department of Systems, Populations and Leadership, School of Nursing, Survey Research Center, Institute for Social Research Population Studies Center, University of Michigan, Ann Arbor, Michigan
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20
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Greene MZ, Carpenter E, Hendrick CE, Haider S, Everett BG, Higgins JA. Sexual Minority Women's Experiences With Sexual Identity Disclosure in Contraceptive Care. Obstet Gynecol 2019; 133:1012-1023. [PMID: 30969215 PMCID: PMC6483879 DOI: 10.1097/aog.0000000000003222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To describe a group of young sexual minority women's experiences with and preferences for sexual identity disclosure in the context of contraceptive care. METHODS In Chicago, Illinois, Salt Lake City, Utah, and Madison, Wisconsin, investigators conducted five focus groups (n=22) and 11 interviews with women aged 20-30 years who identified as something other than heterosexual. Focus groups explored social norms regarding contraceptive care; interviews documented individual experiences with contraceptive care. Using a qualitative descriptive approach and combined deductive and inductive content analysis, investigators coded transcripts for themes related to disclosing sexual orientation to contraceptive providers. RESULTS Participants described the process of sexual identity disclosure in contraceptive care in three stages: 1) listening for whether, when, and how health care providers asked about sexual orientation, 2) deciding whether or not to disclose sexual identity to providers, and 3) evaluating responses from providers after disclosure. Participants wanted providers to: avoid assumptions and ask about both sexual identity and sexual behaviors, signal their openness and competence around the health of sexual minority women during contraceptive encounters, and focus discussions on the individual patient's priorities and needs for contraceptive care. CONCLUSION Decisions made by sexual minority women about sexual identity disclosure in contraceptive contexts are influenced by previous and current interactions with health care providers. Contraceptive providers should ask all patients about sexual identity and sexual behavior, avoid assumptions about use of and need for contraception, and acknowledge the prevalence of marginalization, discrimination, and stigma experienced by sexual minority women and their communities in health care contexts.
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Affiliation(s)
- Madelyne Z Greene
- Schools of Medicine and Public Health and Social Work and the Department of Gender and Women's Studies, University of Wisconsin-Madison, Madison, Wisconsin; the University of Chicago School of Medicine, Chicago, Illinois; and the Department of Sociology, University of Utah, Salt Lake City, Utah
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21
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Contraceptive Use Effectiveness and Pregnancy Prevention Information Preferences Among Heterosexual and Sexual Minority College Women. Womens Health Issues 2018; 28:342-349. [DOI: 10.1016/j.whi.2018.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/08/2018] [Accepted: 03/13/2018] [Indexed: 11/20/2022]
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Klein DA, Berry-Bibee EN, Keglovitz Baker K, Malcolm NM, Rollison JM, Frederiksen BN. Providing quality family planning services to LGBTQIA individuals: a systematic review. Contraception 2018; 97:378-391. [PMID: 29309754 DOI: 10.1016/j.contraception.2017.12.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/20/2017] [Accepted: 12/27/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Lesbian, gay, bisexual, transgender, queer/questioning, intersex and asexual (LGBTQIA) individuals have unique sexual and reproductive health needs; however, facilitators and barriers to optimal care are largely understudied. The objective of this study was to synthesize findings from a systematic review of the literature regarding the provision of quality family planning services to LGBTQIA clients to inform clinical and research strategies. STUDY DESIGN Sixteen electronic bibliographic databases (e.g., PubMed, PSYCinfo) were searched to identify articles published from January 1985 to April 2016 relevant to the analytic framework. RESULTS The search parameters identified 7193 abstracts; 19 descriptive studies met inclusion criteria. No studies assessed the impact of an intervention serving LGBTQIA clients on client experience, behavior or health outcomes. Two included studies focused on the perspectives of health care providers towards LGBTQIA clients. Of the 17 studies that documented client perspectives, 12 elucidated factors facilitating a client's ability to enter into care, and 13 examined client experience during care. Facilitators to care included access to a welcoming environment, clinicians knowledgeable about LGBTQIA needs and medical confidentiality. CONCLUSIONS This systematic review found a paucity of evidence on provision of quality family planning services to LGBTQIA clients. However, multiple contextual facilitators and barriers to family planning service provision were identified. Further research is needed to assess interventions designed to assist LGBTQIA clients in clinical settings, and to gain a better understanding of effective education for providers, needs of specific subgroups (e.g., asexual individuals) and the role of the client's partner during receipt of care.
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Affiliation(s)
- David A Klein
- Departments of Family Medicine and Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD; Departments of Family Medicine and Pediatrics, Fort Belvoir Community Hospital, Fort Belvoir, VA.
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23
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Hartnett CS, Lindley L, Walsemann KM, Negraia DV. Sexual Orientation Concordance And (Un)Happiness About Births. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2017; 49:213-221. [PMID: 29120532 DOI: 10.1363/psrh.12043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/16/2017] [Accepted: 05/18/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT A woman's happiness about a pregnancy and birth has implications for her child's health and her own well-being. Sexual orientation and, particularly, the extent of concordance across its dimensions (sexual identity, behavior and attraction) may be related to happiness about these events, but research on this relationship has been lacking. METHODS Data on 5,744 pregnancies ending in births among women aged 15-44 in three waves of the National Survey of Family Growth (2006-2015) were examined. Weighted linear regression models examined the relationship between sexual orientation concordance and women's happiness about a birth. Analyses also explored whether birth intention and male partnership characteristics mediated the relationship, and whether it varied by intention status. RESULTS Women who identified as heterosexual but reported same-sex attraction or behavior (categorized as "heterosexual-identified discordant") were less happy about their births than were women who were exclusively heterosexual (or "heterosexual-identified concordant"). The difference was more than half a point on a scale of 0-10 (coefficient, -0.7). This association was partially explained by the fact that births were less likely to be intended, and that relationships with male partners were less favorable for births, among discordant than among concordant women. Moreover, the happiness gap between concordant and discordant women was larger when births were unwanted (predicted score, 4.9 vs. 4.1) than when they were intended (9.3 vs. 9.1). CONCLUSIONS To help ensure optimal reproductive health care for all women, research should explore whether providers take into account all dimensions of individuals' sexual orientation.
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Affiliation(s)
| | - Lisa Lindley
- associate professor, Department of Global and Community Health, George Mason University, Fairfax, VA
| | - Katrina M Walsemann
- associate professor, Department of Health Promotion, Education, and Behavior
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Stoffel C, Carpenter E, Everett B, Higgins J, Haider S. Family Planning for Sexual Minority Women. Semin Reprod Med 2017; 35:460-468. [PMID: 29073685 DOI: 10.1055/s-0037-1604456] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractThe 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 overlapping 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.
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Affiliation(s)
- Cynthia Stoffel
- Department of Academic Internal Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Emma Carpenter
- Madison School of Social Work, University of Wisconsin, Madison, Wisconsin
| | - Bethany Everett
- Department of Sociology, University of Utah, Salt Lake City, Utah
| | - Jenny Higgins
- Department of Gender and Women's Studies, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sadia Haider
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
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