LGB-parent families: the current state of the research and directions for the future

The importance of perinatal non-birthing parents' mental health and involvement for family health

Perinatal mental health research typically focuses on the birthing parent's experiences and their influence on birth/child outcomes, while not considering non-birthing parents in similar depth. Non-birthing parents are also at increased risk for mental illness during the perinatal period, and non-birthing parents' health and involvement affect the health of birthing people, fetuses, and newborns, necessitating greater understanding of non-birthing parents' contributions to family functioning. This review examines perinatal mental health disorders in non-birthing parents, their relationship quality with the birthing parent, and how the non-birthing parent's mental health and involvement affects the health outcomes of the birthing parent and the child. Recommendations are provided for healthcare professionals who work with perinatal patients and their families to engage non-birthing parents, learn about non-birthing parent health, and facilitate connections to care. By doing so, professionals working with perinatal patients can optimize health outcomes for their patients and the family as a whole.

Family outcome disparities between sexual minority and heterosexual families: a systematic review and meta-analysis

BACKGROUND

The number of children in sexual minority parent families has increased. This systematic review aims to synthesise the evidence of disparities in family outcomes between sexual minority and heterosexual families and to identify specific social risk factors of poor family outcomes.

METHODS

We systematically searched PubMed, the Web of Science, Embase, the Cochrane Library and APA PsycNet for original studies that compared family outcomes between sexual minority and heterosexual families. Two reviewers independently selected studies and assessed the risk of bias of included studies. Narrative synthesis and meta-analysis were conducted to synthesise evidence.

RESULTS

Thirty-four articles were included. The narrative synthesis results revealed several significant findings for children's gender role behaviour and gender identity/sexual orientation outcomes. Overall, 16 of 34 studies were included in the meta-analyses. The quantitative synthesis results suggested that sexual minority families may perform better in children's psychological adjustment and parent-child relationship than heterosexual families (standardised mean difference (SMD) -0.13, 95% CI -0.20 to -0.05; SMD 0.13, 95% CI 0.06 to 0.20), but not couple relationship satisfaction (SMD 0.26, 95% CI -0.13 to 0.64), parental mental health (SMD 0.00, 95% CI -0.16 to 0.16), parenting stress (SMD 0.01, 95% CI -0.20 to 0.22) or family functioning (SMD 0.18, 95% CI -0.11 to 0.46).

CONCLUSION

Most of the family outcomes are similar between sexual minority and heterosexual families, and sexual minority families have even better outcomes in some domains. Relevant social risk factors of poor family outcomes included stigma and discrimination, poor social support and marital status, etc. The next step is to integrate multiple aspects of support and multilevel interventions to reduce the adverse effects on family outcomes with a long-term goal of influencing policy and law making for better services to individuals, families, communities and schools.

LGBTQ+ Persons' Experiences of Parenthood in the Context of Maternal and Child Health Care: A Meta-ethnography

This study aims to integrate and synthesize knowledge of lesbian, gay, bisexual, transgender and queer (LGBTQ+) persons' experiences of parenthood in the context of maternal and child health care. For nurses to provide optimal care for LGBTQ+ parents, we need to derive knowledge from their perspectives. An interpretive meta-synthesis approach, meta-ethnography, was chosen for this study. A lines-of-argument synthesis based on four themes was developed: (1) Entering the world of LGBTQ+ parenthood; (2) The emotional journey in LGBTQ+ parenthood; (3) Struggling with the system as a LGBTQ+ parent and (4) A need to expand the knowledge horizon of LGBTQ+ parenthood. The overarching metaphor, "To be recognised as parents, unique and good enough, like everybody else," reflects how recognition and inclusion may support LGBTQ+ persons in their parenthood and broaden the understanding of parenthood. Knowledge of the LGBTQ+ family needs to be given greater attention in maternity and child health care settings, and in education and health policies.

Correlates of Taiwanese Gay and Bisexual Men's Family-Building Preferences: A Mediation Analysis

This study investigated the role of filial piety, internalized homophobia, and desire for genetic relatedness with one's child in gay and bisexual men's family-building choice. A sample of 1,023 Taiwanese gay and bisexual men with a desire to have a child was recruited to complete an online survey that included the Contemporary Filial Piety Scale, the Chinese Internalized Homophobia Scale, and questions about desire for genetic relatedness with a child and acceptance of adoption and surrogacy. Mediation models, with desire for genetic relatedness as a mediator, were tested. The results show that those who chose surrogacy-only were older and had higher socio-economic status than those who selected adoption-only and both options. Filial piety and internalized homophobia were positively associated with the acceptance of surrogacy-only over adoption-only and both options. Desire for genetic relatedness mediated these relationships. This finding elucidates how sociocultural factors shape family-building preferences among gay and bisexual men.

Mothers' Sexual Identity and Children's Health

Sexual minority women face a plethora of structural, socioeconomic, and interpersonal disadvantages and stressors. Research has established negative associations between women's sexual minority identities and both their own health and their infants' birth outcomes. Yet a separate body of scholarship has documented similarities in the development and well-being of children living with same-sex couples relative to those living with similarly situated different-sex couples. This study sought to reconcile these literatures by examining the association between maternal sexual identity and child health at ages 5-18 using a US sample from the full population of children of sexual minority women, including those who identify as mostly heterosexual, bisexual, or lesbian, regardless of partner sex or gender. Analyses using data from the National Longitudinal Study of Adolescent to Adult Health (N=8,978) followed women longitudinally and examined several measures of their children's health, including general health and specific developmental and physical health conditions. Analyses found that children of mostly heterosexual and bisexual women experienced health disadvantages relative to children of heterosexual women, whereas the few children of lesbian women in our sample evidenced a mixture of advantages and disadvantages. These findings underscore that to understand sexual orientation disparities and the intergenerational transmission of health, it is important to incorporate broad measurement of sexual orientation that can capture variation in family forms and in sexual minority identities.

Mental Health of Lesbian, Bisexual, and Other-Identified Parents and Non-Parents from a Population-Based Study

Studies have compared sexual minority mothers (mostly lesbian) to heterosexual mothers on mental health, but little research has compared sexual minority women with and without children. This was the first study to compare sexual minority women who did or did not have children, using a population-based sample with three age cohorts. Unlike prior convenience studies, this study finds parents more likely to be bisexual, in a relationship with a man, and non-urban. Bisexual parents scored higher than lesbian parents on psychological distress and lower on life satisfaction and happiness; they also reported less connection to the lesbian, gay, bisexual, and transgender (LGBT) community. Among lesbians, the oldest non-parents reported more happiness and less psychological distress than the youngest non-parents. Parents with other identities perceived more social support from friends and reported lower levels of internalized homophobia than bisexual parents. The results will help professionals and policymakers understand how parenthood status affects women across sexual identities.

Breastfeeding Initiation and Continuation Among Sexual Minority Women

OBJECTIVES

Identify disparities in breastfeeding initiation and continuation among sexual minority women (SMW) and determine if known risk factors explain any observed disparities.

METHODS

We used data from the 2006 to 2017 National Survey of Family Growth female pregnancy questionnaire. We measured sexual orientation using self-reported sexual identity and histories of same-sex sexual experiences reported by women (heterosexual-WSM [women who only reported sex with men]; heterosexual-WSW [women who reported sex with women]; bisexual, and lesbian. In total, we had 18,696 births that occurred within the last 10 years and used logistic and multinomial regression models to assess sexual orientation disparities in breastfeeding initiation and duration that clustered on women to account for potential multiple births to a woman.

RESULTS

Compared to heterosexual-WSM, infants born to lesbian-identified women had decreased odds of ever being breastfed (OR 0.55, 95% CI 0.30, 0.99) and a decreased relative risk of being breastfed more than 6 months (RRR 0.46, 95% CI 0.22, 0.97). Infants of heterosexual-WSW had an increased odds of ever breastfeeding (OR 1.40, 95% CI 1.12, 1.74) and increased relative risk of breastfeeding more than 6 months (RRR 1.32, 95% CI 1.02, 1.69).

CONCLUSIONS

Our results show that infants born to lesbian-identified women were less likely to be breastfed than those born to their heterosexual counterparts, even after adjusting for several factors associated with breastfeeding behaviors. We found no differences in breastfeeding between bisexual women and heterosexual-WSM. Understanding and addressing the barriers sexual minority women face for breastfeeding is critical for ensuring maternal and child health equity.

Parenthood, Stress, and Well-Being among Cisgender and Transgender Gay and Lesbian Adults

OBJECTIVE

This study examines whether and how parenthood status is associated with two key aspects of health- mental well-being and smoking- among sexual minority adults across three gender identity groups: cisgender gay men, cisgender lesbian women, and transgender gay/lesbian adults.

BACKGROUND

Parents tend to report worse health than non-parents due to elevated stress associated with parenting. However, most existing scholarship de facto examines parental status and health among cisgender heterosexual adults. Little research has employed an intersectional approach to focus on parenthood and health differences within sexual minority adults across varying gender identities.

METHOD

OLS and logistic regression models were used to analyze data from the 2010 Social Justice Sexuality Project (N = 2,803), a survey of racially diverse sexual and gender minority adults residing in all 50 US states and Puerto Rico.

RESULTS

In a sample composed predominantly of people of color, parenthood status is related to both mental well-being and smoking status among gay and lesbian adults, but this relationship is inconsistent across cisgender and transgender groups. OLS regression models show that parenthood is positively related to mental well-being among gay and lesbian transgender people, whereas logistic regression results find that parenthood is associated with higher odds of smoking among cisgender gay men.

CONCLUSION

These findings suggest that among a sample of sexual and gender minorities composed mostly of people of color, parenthood status is connected with the health and well-being of gay and lesbian adults in ways that depend on gender identity.

Finding people like me: contact among young adults who share an open-identity sperm donor

STUDY QUESTION

What interests and experiences do donor-conceived adults have with respect to same-donor peers/siblings, when they share an open-identity sperm donor?

SUMMARY ANSWER

Donor-conceived young adults report considerable interest in, and primarily positive experiences with, their same-donor peers, with some finding ‘people like me’.

WHAT IS KNOWN ALREADY

Through mutual-consent contact registries, director-to-consumer DNA testing and other means, donor-conceived people with anonymous (i.e. closed-identity) sperm donors are gaining identity-related information from, and establishing relationships with, people who share their donor.

STUDY DESIGN, SIZE, DURATION

Semi-structured, in depth telephone and Skype interviews with 47 donor-conceived young adults were carried out over a 31-month period. Inclusion criteria were being one of the first adults for each donor to obtain their identity and being at least 1-year post donor-information release.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants (aged 19–29 years, 68.1% women) were born to female same-sex couple parents (46.8%), a single mother (29.8%) or heterosexual couple parents (23.4%); all parents had conceived through the same US open-identity sperm donation program. The dataset was analyzed thematically and included interviews from only one participant per family. Each participant had a different donor.

MAIN RESULTS AND THE ROLE OF CHANCE

Interest in, and experiences with, same-donor peers suggested that they occupy a unique position in the lives of donor-conceived young adults who share their open-identity donor. Contact can provide identity-relevant information and support through the availability of relationships (whether actualized or potential), shared experiences, and easier relationships than with their donor. Most donor-conceived young adults felt positively about their contact experiences. Of those not yet linked, almost all expressed an interest to do so. Some had met the children raised by their donor. When asked, all expressed an interest in doing so.

LIMITATIONS, REASONS FOR CAUTION

Interviews were conducted with donor-conceived young adults who were uncommon in their generation in terms of: having an open-identity sperm donor; the majority knowing about their family’s origins from childhood; and having parents that accessed at the time one of the only open-identity sperm donation programs. Further research is needed to assess applicability to all donor-conceived adults; findings may be more relevant to the growing number of people who have an open-identity donor and learned in childhood about their family’s origins.

WIDER IMPLICATIONS OF THE FINDINGS

Participants were among the first generation of donor-conceived adults with an open-identity sperm donor. Their experiences and perspectives can provide essential guidance to programs and others with similar origins. Early disclosure of family origins and identifying the donor did not diminish the young adults’ interest in their same-donor peers. Positive experiences suggest that the benefits of contact include not only identity-relevant information (through shared traits and experiences), but also relationships with and support from people who understand the uncommon experience of being donor conceived. Implications include the need to educate families and intended parents about the potential benefits of knowing others who are donor conceived, and the risk of unexpected linking across families by donors, regardless of donor-conceived person or family interest.

STUDY FUNDING/COMPETING INTEREST(S)

The study was funded by the Lesbian Health Fund of GLMA: Health Professionals Advancing LGBTQ Equality. The authors have no conflict of interest to declare.

CE: An Evidence-Based Update on Contraception

Contraception is widely used in the United States, and nurses in all settings may encounter patients who are using or want to use contraceptives. Nurses may be called on to anticipate how family planning intersects with other health care services and provide patients with information based on the most current evidence. This article describes key characteristics of nonpermanent contraceptive methods, including mechanism of action, correct use, failure rates with perfect and typical use, contraindications, benefits, side effects, discontinuation procedures, and innovations in the field. We also discuss how contraceptive care is related to nursing ethics and health inequities.

Gender Development in Children with Gay, Lesbian, and Heterosexual Parents: Associations with Family Type and Child Gender

OBJECTIVE

To examine whether the gender development of 120 Italian children (40 born to gay fathers [GFs] through surrogacy, 40 born to lesbian mothers [LMs] through sperm donation, and 40 born to heterosexual parents [HPs] through sexual intercourse) aged 3 to 9 years differed as a function of family type and/or child gender.

METHODS

Children took part in observed free-play sessions while primary caregivers and nonparent caregivers were administered standardized interviews. Hierarchical linear modeling, analysis of covariance, simple effects analysis, and bootstrapping were conducted.

RESULTS

Boys and girls of GFs and HPs were reported to show less gender flexibility in their activities and characteristics than boys and girls of LMs. They also received higher scores of gender conforming dress-up play and spent more time playing with gender-conforming toys. In all family types, boys and girls were reported to show low levels of gender-nonconforming dress-up play and observed to spend less time playing with gender-nonconforming toys. Overall, comparisons within genders indicated that boys and girls of GFs and HPs were considered more masculine and feminine, respectively, in their behavior and play, relative to boys and girls in LM families. Age was not a significant covariate in any analysis.

CONCLUSION

Our findings do not support the idea that children of gay or lesbian parents show greater gender nonconformity relative to children of HPs. The findings are informative to those concerned with the effects of the absence of a male or female live-in parent on child gender development.

Reproductive and Pregnancy Experiences of Diverse Sexual Minority Women: A Descriptive Exploratory Study

Objectives This study sought to explore how sexual minority women (SMW) and heterosexual women compare in terms of reproductive history, with a particular focus on examining within-group differences among SMW. Methods Women were predominantly recruited through consecutive sampling during presentation for prenatal care in Toronto Canada, and Massachusetts, USA. In total, 96 partnered pregnant women (62 SMW, 34 heterosexual) completed an internet survey during 2013-2015. Results We found few significant differences in reproductive history outcomes when comparing SMW and heterosexual groups. However, when we compared male-partnered SMW to female-partnered SMW, we found potentially important differences in rates of miscarriage and pregnancy complications, indicating that partner gender may be an important contributor to differences in reproductive history among SMW. Conclusions for Practice These findings highlight the need to recognize the unique health risks with which male-partnered SMW may present. Considering that this group is often invisible in clinical practice, the findings from this exploratory study have important implications for providers who treat women during the transition to parenthood. Future research should further examine the differences in social and health access within larger samples of SMW groups, as well as seek to understand the complex relationships between sexual identity and perinatal health for this understudied group of women.

Sexual Attraction, Sexual Identity, and Same-Sex Sexual Experiences of Adult Offspring in the U.S. National Longitudinal Lesbian Family Study

The U.S. National Longitudinal Lesbian Family Study has followed offspring with sexual minority parents from conception into adulthood. It was initiated in 1986, and it has a 92% retention rate to date. In the current investigation, the 25-year-old offspring answered questions about sexual attraction, sexual identity, and sexual experiences; their responses were compared with those of same-age adults from a population-based survey. The analytic samples consisted of 76 offspring of lesbian parents and 76 demographically matched participants from the National Survey of Family Growth. All 152 respondents were 25 years old, 48.7% were female, 90.8% identified as White, 9.2% were people of color, and all had attended at least some college. Although most respondents in each sample identified as "heterosexual or straight," compared to their matched counterparts in the population-based survey, the female and male offspring of lesbian parents were significantly more to likely to report same-sex attraction, sexual minority identity, and same-sex experience. These findings suggest that adult offspring from planned lesbian families may be more likely than their peers to demonstrate diversity in sexual attraction, identity, and expression.

Prejudice and discrimination in the everyday life of same-sex couples raising children

Abstract The present study investigated the experiences of prejudice and discrimination in the everyday lives of five same-sex couples raising children. Data were collected using a questionnaire and an interview and were analyzed by thematic analysis. Participants attributed meanings to their experiences of being homoparental families: they assumed their social role as they managed to develop their own conjugality and parental projects in the struggle within a social context permeated by the hegemony of heteronormative values. The participants experienced prejudice related to their lifestyle and attained parenthood status, challenging social norms and gender stereotypes. However, it was also found that attitudes of willingness and perseverance in their fight for their rights proved to be protective measures against prejudice and social intolerance. A limited number of studies have examined the prejudice and discrimination towards same-sex families in Brazil; therefore, there is a need for greater visibility and further discussion about this phenomenon.

Measuring Sexual Orientation: A Review and Critique of U.S. Data Collection Efforts and Implications for Health Policy

The U.S. Department of Health and Human Services' (HHS) Healthy People 2020 goals sought to improve health outcomes among sexual minorities; HHS acknowledged that a dearth of sexual orientation items in federal and state health surveys obscured a broad understanding of sexual minority-related health disparities. The HHS 2011 data progression plan aimed to advance sexual orientation data collection efforts at the national level. Sexual orientation is a complex, multidimensional construct often composed of sexual identity, sexual attraction, and sexual behavior, thus posing challenges to its quantitative and practical measurement and analysis. In this review, we (a) present existing sexual orientation constructs; (b) evaluate current HHS sexual orientation data collection efforts; (c) review post-2011 data progression plan research on sexual minority health disparities, drawing on HHS survey data; (d) highlight the importance of and (e) identify obstacles to multidimensional sexual orientation measurement and analysis; and (f) discuss methods for multidimensional sexual orientation analysis and propose a matrix for addressing discordance/branchedness within these analyses. Multidimensional sexual orientation data collection and analysis would elucidate sexual minority-related health disparities, guide related health policies, and enhance population-based estimates of sexual minority individuals to steer health care practices.

Theory in Highly Cited Studies of Sexual Minority Parent Families: Variations and Implications

This article includes a systematic review and citation analysis of the literature regarding sexual minority parent families, particularly attending to what theories have been used, and how. We consider the importance of theoretical frameworks for future research and implications for policy, practice, and law related to sexual minority parent families. Our review targets 30 highly cited studies located through Google Scholar (as an interdisciplinary search engine) and published within a specific timeframe (2005-2010). We highlight the dominant theoretical models employed across disciplines studying sexual minority parent families. Although the majority of studies reviewed referred to theoretical models or perspectives, explicit theoretical grounding was frequently lacking. Instead, the empirical work reviewed appeared to have a predominantly applied focus in addressing public debates on sexual minority parent families. We provide recommendations for how theory might be more fully integrated into the social science literature on sexual minority parents and their children.

(In)Visibilidade da Vivência Homoparental Feminina: entre Preconceitos e Superações

Resumo Este artigo teve como objetivo investigar a ambiguidade quanto à (in)visibilidade das vivências homoparentais femininas no cenário brasileiro: situações em que o preconceito se revela com crueldade; e, por outro lado, situações em que as mulheres superam esta discriminação e assumem as suas orientações afetivo-sexuais, bem como o projeto de ser mãe. Foram entrevistadas quatro mulheres que se assumem como lésbicas e têm filhos e a entrevista aberta foi o instrumento utilizado para colher os dados. A análise de conteúdo das entrevistas evidenciou que as famílias homoparentais chefiadas por lésbicas vivem um momento paradoxal em relação aos direitos humanos da população LGBT. Por um lado, verificam-se diversas expressões de preconceito e violência homofóbica na vida dessas mulheres; mas, por outro, também são relatadas circunstâncias em que as mulheres superaram esta discriminação e assumem as suas orientações afetivo-sexuais, bem como o projeto de ser mãe.

Concepções e Modos de Viver em Família: A perspectiva de Mulheres Lésbicas que Têm Filhos

RESUMO Investigaram-se as concepções e modos de viver em família de quatro mulheres lésbicas que têm filhos. Utilizou-se uma entrevista aberta para coleta de dados e a análise baseou-se no método fenomenológico crítico. Os resultados mostraram que: (a) as estratégias para acesso à parentalidade (adoção, coparentalidade e relações heterossexuais anteriores) são diversas e ora reproduzem o binarismo heterossexual, ora o desnaturalizam; (b) a família foi caracterizada como um espaço afetivo e de proteção; e (c) a legalização do casamento foi percebida como uma forma de garantir direitos sociais e jurídicos. Ressalta-se a pluralidade e complexidade dessas famílias, ao mesmo tempo em que se mostra a inviabilidade de se traçar uma concepção única sobre as famílias homoparentais.

Female-partnered and single women's contact motivations and experiences with donor-linked families

STUDY QUESTION

What are female-partnered and single mothers' motivations and experiences at one donor insemination (DI) program with regard to contacting other families who share the same sperm donor?

SUMMARY ANSWER

By and large, women reported seeking contact to obtain (i) support for their children and/or themselves, and (ii) information about shared traits and medical problems, ultimately describing a range of contact experiences, both positive (e.g. special bond created) and negative (e.g. uncomfortable encounters).

WHAT IS KNOWN ALREADY

There is a growing phenomenon of donor insemination families-parents and/or offspring-seeking others who share their donor (i.e. are 'donor-linked'). There is limited understanding about parental motivations and experiences-especially in the presence of a second parent-due to the methodological constraints of previous quantitative studies.

STUDY DESIGN, SIZE, DURATION

Semi-structured telephone interviews were conducted with 50 donor insemination mothers (14 single, 36 female-partnered). Participants were recruited by email invitation to parent members of a family-matching service at one donor insemination program in the USA. The criterion for inclusion was having matched to at least one donor-linked family.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Among the 50 mothers interviewed, all had at least one child conceived via donor insemination, who was between ages 0 and 15 years at first contact. Families matched with a median of three donor-linked families (range 1-10). Interview data were analyzed through qualitative (i.e. thematic) analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

Overarching themes emerged of seeking contact to obtain (i) support and (ii) information about children's shared physical and psychological traits. Some wanted to increase their child's family network, through adding a sibling, but more often as extended family. Data, from partnered parents especially, revealed the challenges of balancing the boundaries of family formed without the genetic link with the perceived benefits of exploring the child's donor origins.

LIMITATIONS, REASONS FOR CAUTION

Interviews focused on openness and information-sharing were conducted with parents from one American donor insemination program. Findings are limited to individuals who were open enough to share their experiences and able to take the time to do so.

WIDER IMPLICATIONS OF THE FINDINGS

As donor-linking services become established independently (e.g. donor insemination program registries) or by the government (e.g. Victoria, Australia's Voluntary Register), these findings provide evidence that linking services are valued by individuals affected by donor conception. Caution is warranted, however, in that some participants reported mismatched expectations, both across donor-linked families and within families (e.g. between partners), suggesting the need for information and guidance both during and after matching. Overall, the range and balance of reported positives and negatives indicate that donor-linking can provide individuals with support and donor origins information-which are particularly important when these are not available elsewhere.

STUDY FUNDING/COMPETING INTERESTS

Clark University provided support. No competing interests.