Promoting the well-being of children whose parents are gay or lesbian

Lesbian shared IVF: the ROPA method: a systematic review

The ROPA (Reception of Oocytes from PArtner) method, also known as lesbian shared IVF (in vitro fertilization), is an assisted reproduction technique for female couples, in which one of the women provides the oocytes (genetic mother) and the other receives the embryo and gestates (gestational mother). As a double parented method, it is the only way lesbian women may biologically share motherhood. This is a narrative review of data concerning ROPA published in PubMed, Scopus, and Cochrane Library. A total of 35 articles were included, 10 about motivations for undergoing ROPA, 13 about ethics or legislation, 4 about motherhood, and 8 studies reporting clinical outcomes. Despite being used for more than a decade, there is a paucity of data regarding this technique in scientific literature. Most women choose this technique to share biological motherhood, but medical issues may also justify its use. Many ethical and legal issues are still to be solved. Despite the small number of studies, data regarding the outcomes of this technique and the resulting motherhood are reassuring.

What Decides the Well-Being of the Relationship between Parents and Adolescents

The literature indicates a variety of factors that contribute to adolescent well-being: among these, the parent-adolescent relationship has a key role. The present article offered an overview of studies on parent-adolescent relationships across diverse family forms, not limited to the traditional family but also including "non-traditional" and "modern" families. To do so, this article described the evolution of the concept of family over the last fifty years and traced the significant family variables that guarantee adolescent well-being. Additionally, this article discussed the changes that occurred in family research, shifting from studies that considered only the family structure to more recent studies that investigated family processes and contextual factors. Overall, the reviewed studies indicated that the quality of parent-adolescent relationship, the interparental conflict and the consequent spillover effect on the child subsystem, and the changes in the economic situation following parental separation/divorce override the effect of the family structure. Finally, this article pointed out the need to examine, in the future research, adolescent well-being across diverse families by adopting more fine-grained methodologies, collecting data from the entire family system, and using a multi-method assessment to obtain a more ecological view of family complexity.

Catholic Arguments against Homosexual Acts and Relationships: Emotional Revulsion or Rational Argument?

Most men engaging in homosexual sex have been socially construed as pariahs for much of human history, and women engaging in such sex in the modern age are subject to similar social disapproval. Same-sex marriage has, therefore, been similarly disapproved, and there are several arguments offered in objection to it. The thesis of this essay is that those arguments are not rationally probative and that they are, in fact, cloaks to hide the emotion of revulsion toward homosexual sex. We consider that emotion of revulsion, neuroscientific data related to it, and the arguments of the Catholic Church against homosexual acts, and conclude that those arguments arise, at least in part, from that emotion of revulsion and are not rationally probative.

Same-sex mothers' experiences of equal treatment, parenting stress and disclosure to offspring: a population-based study of parenthood following identity-release sperm donation

STUDY QUESTION

What are the experiences of same-sex mothers following identity-release sperm donation regarding equal treatment in society, parenting stress and disclosure to child?

SUMMARY ANSWER

Mothers predominantly reported equal treatment in society, low levels of parenting stress and early disclosure of the donor conception to the child, and half of the couples had also informed the child of his/her right to obtain the donor’s identity.

WHAT IS KNOWN ALREADY

The number of two-mother families is increasing, and previous studies have reported about challenges related to heteronormativity, discrimination and the status of the non-birth mother. Same-sex mothers have been found to disclose the child’s donor conception earlier than different-sex parents, but little is known regarding disclosure of the child’s right to obtain identifying information about the donor.

STUDY DESIGN, SIZE, DURATION

The present study concerns the fourth wave of data collection of a nation-wide longitudinal study. A total of 143 same-sex mothers (73% response rate) following identity-release sperm donation completed individual surveys when their donor-conceived child had reached age 7. These women represent a total of 82 couples who had undergone sperm donation treatment.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The study is part of the longitudinal Swedish Study on Gamete Donation (SSGD). Couples accepted for gamete donation treatment at seven Swedish University hospitals were recruited between 2005 and 2008 and were requested to complete postal surveys during four waves of data collection. The present study sample includes same-sex mothers who completed a survey when their donor-conceived child had reached 7 years of age. Data were collected with the Swedish Parenting Stress Questionnaire (SPSQ), and study-specific items on experiences of treatment in society and disclosure behavior. Group comparisons (birth mothers vs non-birth mothers) were conducted using Chi²-tests, independent t-tests and Mann–Whitney U-tests, and written comments provided for open-response items were analyzed by qualitative content analysis.

MAIN RESULTS AND ROLE OF CHANCE

The mothers were generally open about the child’s donor conception and the large majority (>80%) reported being treated positively and in the same way as other parents. However, satisfaction with treatment in health care settings was significantly lower than that reported in contacts with the child’s school and recreational activities (P < 0.001) and open-response comments indicate that this may be related predominantly to heteronormative language and assumptions. Birth mothers and non-birth mothers reported similar treatment in society and similar levels of parenting stress. All but one couple had already talked with their 7-year-old child about his/her conception with donor sperm. Half of the couples had also informed the child about his/her opportunity to obtain identifying information about the donor, and remaining couples planned later disclosure. Children’s reactions were generally described as neutral, positive or characterized by interest and curiosity.

LIMITATIONS, REASONS FOR CAUTION

The present study was performed within the context of the Swedish legislation on identity-release donation, which limits the generalizability to same-sex couples using anonymous or known sperm donors. Although no evidence of attrition bias was found, it is possible that those couples who initially declined participation in the SSGD (23%) or dropped out at the fourth wave of data collection (27%) differ from the study sample in terms of variables that we were unable to control for.

WIDER IMPLICATION OF THE FINDINGS

The present finding that most same-sex mothers in a population-based sample experience equal treatment in society is encouraging and validates previous results from predominantly qualitative studies. Nevertheless, the fact that a subgroup experiences discrimination and less favorable treatment indicates that further action is needed, particularly in child health care settings. The present study is the first to report on the timing of parents’ disclosure of the child’s right to identifying donor information and suggests that disclosure during preschool ages is feasible and does not appear to be related to negative consequences. In view of the increased availability and use of identity-release donation, there is a pressing need to investigate parents’ intentions, behaviors and needs with regard to talking with their child about his/her opportunity to obtain the donor’s identity.

STUDY FUNDING/COMPETING INTEREST(S)

Financial support from the Swedish Research Council (2013-2712) and the Swedish Research Council for Health, Working Life and Welfare (2014-00876). There are no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Minority Stress and Positive Identity Aspects in Members of LGBTQ+ Parent Families: Literature Review and a Study Protocol for a Mixed-Methods Evidence Synthesis

BACKGROUND

Parents and children in LGBTQ+ parent families face unique stressors (i.e., minority stress), but also possess unique resources (i.e., positive identity aspects) related to their family identity. Empirical evidence and theory suggest that these minority stressors and positive identity aspects are situated on the individual, couple, and family level and may be associated with key outcomes, including parent and child health, family functioning, and school-related outcomes. A systematic evidence synthesis and a theoretical placement are currently lacking. The aims of the systematic review outlined in this protocol are thus to (1) map minority stressors and positive identity aspects according to multiple levels in the family system, and (2) to synthesize evidence on their associations with key outcomes.

METHODS

We will conduct a PRISMA-conform mixed-methods systematic review. Studies will be retrieved using a multi-tiered search strategy, including database searches (PsycInfo, PubMed, Scopus, Web of Science), cited literature searches, authors' publication lists, and study requests. The mixed-methods synthesis will follow a parallel-results convergent synthesis design, where quantitative results will be synthesized via meta-analysis and qualitative results via thematic synthesis.

CONCLUSIONS

Our proposed systematic review may add to the theoretical understanding of LGBTQ+ parent family functioning and advance social inclusion of LGBTQ+ parent families.

Examining Differences in Alcohol and Smoking Behaviors between Parenting and Nonparenting Lesbian Women

BACKGROUND

The transition to parenthood is a significant life event that has implications for health behaviors and health. Few studies have examined alcohol use and smoking by parenthood status (nonparent vs. parent) among women who identify as lesbian.

METHODS

This study used data from two longitudinal studies, the Chicago Health and Life Experiences of Women Study (n = 135) and the U.S. National Longitudinal Lesbian Family Study (n = 116), to compare problem drinking and cigarette smoking trajectories among lesbian-identified women by parenthood status. We used mixed models to investigate differences in problem drinking and cigarette smoking in three waves of data in each study.

RESULTS

Lesbian parents reported significantly less problem drinking, but not cigarette smoking, than nonparent lesbian women. When considering the interaction between parental status and time, problem drinking was significantly higher among nonparents than parents at each time interval.

CONCLUSIONS

Parenthood was associated with positive changes in drinking among lesbian women; however, more research is needed to understand how to support smoking cessation among parenting lesbian women.

The Legal Vulnerability Model for Same-Sex Parent Families: A Mixed Methods Systematic Review and Theoretical Integration

Globally, parents and children in same-sex parent families are impacted by many laws related to the parental sexual orientation. These laws vary considerably from one country to another, ranging from full legal recognition to criminalization. The psychological consequences of living in an ambiguous or hostile legal climate likely interfere with parental health, family functioning, and child development. However, a systematic evidence synthesis of the pertinent literature and its placement within a broader psychological model are currently lacking. The aims of this review were thus (1) to systematically review qualitative and quantitative evidence on the impact of sexual orientation laws on same-sex parent families in key domains and (2) to place these findings within a broader model informed by minority stress and family theories. Our review was preregistered and conducted in line with PRISMA guidelines. We searched for qualitative, quantitative, and mixed methods studies on the impact of sexual orientation laws on target outcomes (parental health, family functioning, child outcomes) via systematic database search (PubMed, Scopus, Web of Science) and forward-backward searches. Fifty-five studies published between 1999 and 2020 were eligible for inclusion and were synthesized using a data-based convergent synthesis design. Thirteen descriptive and three overarching analytical themes were identified through thematic synthesis. Linking our findings with minority stress and family theories, we propose a novel legal vulnerability model for same-sex parent families. The model posits that legal vulnerability constitutes an increased risk for parental and child health as well as family functioning through individual and shared pathways between family members. Additionally, the model introduces counteractions that families engage in on the personal, familial, and systemic level to mitigate the impact of legal vulnerability, as well as moderators on the contextual, familial, couple, and individual level that modulate this impact. Implications for research and clinical practice are discussed.

Pediatrician Guidance in Supporting Families of Children Who Are Adopted, Fostered, or in Kinship Care

The child welfare system strives to provide children and adolescents in foster care with a safe, nurturing environment through kinship and nonkinship foster care placement with the goal of either reunification with birth parents or adoption. Pediatricians can support families who care for children and adolescents who are fostered and adopted while attending to children's medical needs and helping each child attain their developmental potential. Although this report primarily focuses on children in the US child welfare system, private and internationally adopted children often have similar needs.

Lesbian Women Undergoing Assisted Reproduction: Diverse, But Not Different

The use of assisted reproduction among women in relationships with other women has increased in the United States over the past decade as a result of increased legal access and social acceptance. Despite this shift, limited studies currently exist to guide optimal fertility care for this growing patient population of women seeking assisted reproduction. In this Commentary, assisted reproduction will be meant to include ovulation induction, intrauterine insemination (IUI), and in vitro fertilization (IVF). Conflicting studies suggest that self-identified lesbian women may demonstrate an increased prevalence of polycystic ovarian syndrome. Most available studies find that a woman's sexual orientation does not affect the outcome of fertility treatment. Self-identified lesbian women undergoing donor sperm IUI and IVF have similar pregnancy and live-birth rates as heterosexual women. Better evidence regarding patient demographics and comorbidities, underlying etiologies of subfertility, and assisted reproductive outcomes among women building families with other women is needed to optimize care.

The Perceptions of New Zealand Lawyers and Social Workers About Children Being Adopted by Gay Couples and Lesbian Couples

Global trends increasingly appear to be legitimizing same-gender relationships, yet international research shows that despite statutory rights to marry—and by extension, adopt children—same-gender couples continue to experience difficulties when trying to adopt. Primary among these barriers are the persistent heteronormative beliefs, which strongly underpin the unfounded myths about parenting abilities of same-gender couples. Such biased beliefs are perpetuated by some adoption professionals who oppose placing children with lesbian or gay couples. In 2013, New Zealand passed the Marriage Equality Act, making it possible for same-gender couples to legally marry—and by extension, adopt. This provided an opportunity to investigate the perceptions of New Zealand professionals about children being placed with same-gender couples, in a country often perceived to be more tolerant of LGBT people. New Zealand social workers and lawyers (an under-studied group)—the professions most likely involved in adoption—were recruited via professional bodies. Because studying perceptions and beliefs on socially sensitive topics are highly susceptible to social desirability, we designed an instrument utilizing multiple methods to assess and corroborate participants’ views about placing children for adoption with couples of the same gender. Administered online and anonymously, the survey included demographic questions, evaluation of negative-meaning and positive-meaning statements, and used a scenario describing a prospective adoptive couple whose gender was ambiguous, in the context of adopting children of varying needs. Overall, the study found that while New Zealand lawyers and social workers (N = 314) had generally favorable views of gay and lesbian adoption, they still reported a preference to see children adopted by heterosexual couples over same-gender couples, within which lesbian and gay couples were preferred equally. Moreover, being religious and politically conservative were characteristics associated with more negative views toward placing children with same-gender couples. We conclude that, despite winning the rights to marry (and adopt as couples), such legislative wins might be merely the first hurdle to be overcome; normalizing same-gender parenting is what needs to happen next. Our study adds to the research focused on adoption professionals in various countries, with the ultimate aim to inform practices and policies supportive of families headed by same-gender couples and formed through adoption.

Disparities in Health Insurance Coverage and Access to Care for Children By Mother's Sexual Orientation

OBJECTIVE

Few population-based studies have examined the health care experiences of children with sexual minority parents. The purpose of this study was to compare health insurance status, access to care, and health services utilization for children by mother's sexual orientation.

METHODS

We used data on children with lesbian mothers (n = 195), bisexual mothers (n = 299), and heterosexual mothers (n = 23,772) in the 2013-2017 National Health Interview Survey. Logistic regression models were used to compare health insurance status, access to care, and health services utilization while adjusting for demographic and socioeconomic characteristics of the child, mother, and household.

RESULTS

After controlling for sociodemographic factors, there were no statistically significant differences in health insurance coverage, access to care, or health services utilization between children of lesbian mothers and children of heterosexual mothers. Compared to children with heterosexual mothers, children with bisexual mothers were more likely to have public health insurance (OR 2.33; 95% CI 1.07-7.68), delayed medical care due to cost (OR 2.33; 95% CI 1.12-4.86), unmet medical care due to cost (OR 2.86; 95% CI 1.07-7.68), and a visit to the emergency room (OR 1.74; 95% CI 1.27-2.39) in the prior year after controlling for child-level characteristics. Some of these differences were attenuated after controlling for maternal demographics and household characteristics.

CONCLUSIONS FOR PRACTICE

Children with bisexual mothers experience barriers to routine medical care. Addressing socioeconomic dimensions of health care access and targeted outreach to bisexual parents will help promote health equity for children growing up in sexual minority households.

Barriers and Stigma Experienced by Gay Fathers and Their Children

BACKGROUND

Gay men have become fathers in the context of a heterosexual relationship, by adoption, by donating sperm to 1 or 2 lesbian women and subsequently sharing parenting responsibilities, and/or by engaging the services of a surrogate pregnancy carrier. Despite legal, medical, and social advances, gay fathers and their children continue to experience stigma and avoid situations because of fear of stigma. Increasing evidence reveals that stigma is associated with reduced well-being of children and adults, including psychiatric symptoms and suicidality.

METHODS

Men throughout the United States who identified as gay and fathers completed an online survey. Dissemination of the survey was enhanced via a "snowball" method, yielding 732 complete responses from 47 states. The survey asked how the respondent had become a father, whether he had encountered barriers, and whether he and his child(ren) had experienced stigma in various social contexts.

RESULTS

Gay men are increasingly becoming fathers via adoption and with assistance of an unrelated pregnancy carrier. Their pathways to fatherhood vary with socioeconomic class and the extent of legal protections in their state. Respondents reported barriers to becoming a father and stigma associated with fatherhood in multiple social contexts, most often in religious institutions. Fewer barriers and less stigma were experienced by fathers living in states with more legal protections.

CONCLUSIONS

Despite growing acceptance of parenting by same-gender adults, barriers and stigma persist. States' legal and social protections for lesbian and gay individuals and families appear to be effective in reducing experiences of stigma for gay fathers.

A Comparative Study of Attitudes Toward Same-Gender Parenting and Gay and Lesbian Rights in Portugal and in Mexico

The belief that gay men and lesbians are unable to provide a stable environment in which to raise children fuels manifestations of sexual prejudice that are still highly prevalent in Portugal and Mexico. The aim of this study was to assess attitudes toward same-gender parenting and gay and lesbian rights, as well as beliefs about the controllability of homosexuality among a sample of 531 university students. A further aim was to assess the predictors of attitudes toward same-gender parenting. Results revealed the existence of ambivalent attitudes toward same-gender parenting. The belief that homosexuality is a choice and thus controllable in particular explained over 50% of the total variance of attitudes toward same-gender parenting. Being a man, older, and highly religious predicted higher levels of sexual prejudice regarding same-gender parenting. Comparative cross-cultural studies have the potential to highlight common features but also specificities of sexual prejudice.

Same-Sex Parenting: Identification of Social Representations in a Sample of Portuguese Professionals

Although international scientific research and the position of professional associations reiterate that the parents' sexual orientation is not a criterion of parenting quality, the social recognition of same-sex parenting remains difficult in Portugal. Given the importance of forensic issues in this field, this study aims to identify the representations of psychologists, social workers, lawyers/attorneys, and judges regarding same-sex parenting. The study involves five homogeneous focus groups with a total of 19 professionals. Content analysis reveals reservations regarding same-sex couples' access to parenting, in particular among lawyers/attorneys. There also emerged narratives that highlight specific competencies in these families and that argue that sexual orientation does not define the quality of parenting. Social narratives are more expressive than scientific knowledge in support of professional representations. These findings have critical implications for professional practice and formation.

Parental Sexual Orientation and Children's Psychological Well-Being: 2013-2015 National Health Interview Survey

Debate persists about whether parental sexual orientation affects children's well-being. This study utilized information from the 2013 to 2015 U.S., population-based National Health Interview Survey to examine associations between parental sexual orientation and children's well-being. Parents reported their children's (aged 4-17 years old, N = 21,103) emotional and mental health difficulties using the short form Strengths and Difficulties Questionnaire (SDQ). Children of bisexual parents had higher SDQ scores than children of heterosexual parents. Adjusting for parental psychological distress (a minority stress indicator) eliminated this difference. Children of lesbian and gay parents did not differ from children of heterosexual parents in emotional and mental health difficulties, yet, the results among children of bisexual parents warrant more research examining the impact of minority stress on families.

Experiences of Children With Gay Fathers

An online survey was distributed via snowball sampling and resulted in responses from 61 gay fathers raising children in 2 states. Fathers reported on the barriers they experienced and the pathways they took to becoming parents. They reported also on experiences of stigma directed at them and their children, especially from family members, friends, and people in religious institutions. Despite these difficulties they reported that they engaged actively in parenting activities and that their child(ren)'s well-being was consistent with national samples.

A Review and Critique of Research on Same-Sex Parenting and Adoption

Are the outcomes for children of gay, lesbian, or bisexual parents in general the same as those for heterosexual parents? That controversial question is discussed here in a detailed review of the social science literature in three parts: (1) stability of same-sex parental relationships, (2) child outcomes, and (3) child outcomes in same-sex adoption. Relationship instability appears to be higher among gay and lesbian parent couples and may be a key mediating factor influencing outcomes for children. With respect to part 2, while parental self-reports usually present few significant differences, social desirability or self-presentation bias may be a confounding factor. While some researchers have tended to conclude that there are no differences whatsoever in terms of child outcomes as a function of parental sexual orientation, such conclusions appear premature in the light of more recent data in which some different outcomes have been observed in a few studies. Studies conducted within the past 10 years that compared child outcomes for children of same-sex and heterosexual adoptive parents were reviewed. Numerous methodological limitations were identified that make it very difficult to make an accurate assessment of the effect of parental sexual orientation across adoptive families. Because of sampling limitations, we still know very little about family functioning among same-sex adoptive families with low or moderate incomes, those with several children, or those with older children, including adolescents or how family functioning may change over time. There remains a need for high-quality research on same-sex families, especially families with gay fathers and with lower income.

Same-Sex and Different-Sex Parent Households and Child Health Outcomes: Findings from the National Survey of Children's Health

OBJECTIVE

Using the 2011-2012 National Survey of Children's Health data set, we compared spouse/partner relationships and parent-child relationships (family relationships), parenting stress, and children's general health, emotional difficulties, coping behavior, and learning behavior (child outcomes) in households of same-sex (female) versus different-sex continuously coupled parents with biological offspring. We assessed whether associations among family relationships, parenting stress, and child outcomes were different in the 2 household types.

METHODS

Parental and child characteristics were matched for 95 female same-sex parent and 95 different-sex parent households with children 6 to 17 years old. One parent per household was interviewed by telephone. Multivariate analyses of variance and multiple linear regressions were conducted.

RESULTS

No differences were observed between household types on family relationships or any child outcomes. Same-sex parent households scored higher on parenting stress (95% confidence interval = 2.03-2.30) than different-sex parent households (95% confidence interval = 1.76-2.03), p = .006. No significant interactions between household type and family relationships or household type and parenting stress were found for any child outcomes.

CONCLUSION

Children with female same-sex parents and different-sex parents demonstrated no differences in outcomes, despite female same-sex parents reporting more parenting stress. Future studies may reveal the sources of this parenting stress.

The Long-Term Economic Benefits of Natural Mentoring Relationships for Youth

Natural mentors have been shown to help improve psychological and educational outcomes of youth, and may serve an important role for youth experiencing risk in the home. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we investigated the associations between natural mentors during youth and income during early adulthood, including how these relations were moderated by the absence of a father figure and race. We also estimated the lifetime economic benefits to having a natural mentor. The presence of a natural mentor alone did not have a significant impact on annual earnings during adulthood. However, youth without a father but who had a male mentor earned significantly more, on average, than those without a male mentor. These effects were more pronounced in a subsample of African American youth. The net present value of total lifetime benefits to having a male natural mentor was approximately $190,000 for all fatherless youth and $458,000 for African American fatherless youth. These results suggest that natural mentors play a crucial role in economic outcomes for youth, which may vary by sociodemographic factors.

HOMOPARENTALIDADE: DA ABORDAGEM CIENTÍFICA AOS NORMATIVOS LEGAIS EM PORTUGAL

A homoparentalidade é uma temática que ativa opiniões e tomadas de posição nos vários setores da sociedade que, por sua vez, podem influenciar a postura de cada profissional que trabalha na área das responsabilidades parentais. Neste artigo pretende-se analisar as convergências e dissonâncias entre as disposições da Ordem Jurídica portuguesa e os princípios emergentes da investigação científica adotados por associações como a American Psychological Association (APA) e a American Academy of Pediatrics (AAP) na área da homoparentalidade. Pretende-se, ainda, fazer uma análise crítica dos estudos reportados pela literatura, ponderando possíveis implicações para a investigação e para as práticas profissionais.

How do lesbian couples compare with heterosexual in vitro fertilization and spontaneously pregnant couples when it comes to parenting stress?

AIM

To study parenting stress in lesbian parents and to compare that stress with heterosexual parents following in vitro fertilisation (IVF) or spontaneous pregnancies.

METHODS

This survey took place during 2005-2008 and was part of the Swedish multicentre study on gamete donation. It comprised 131 lesbian parents, 83 heterosexual IVF parents, who used their own gametes, and 118 spontaneous pregnancy parents. The participants responded to the questionnaire when the child was between 12 and 36-months-old and parenting stress was measured by the Swedish Parenting Stress Questionnaire (SPSQ).

RESULTS

Lesbian parents experienced less parenting stress than heterosexual IVF parents when it came to the General Parenting Stress measure (p = 0.001) and the subareas of Incompetence (p < 0.001), Social Isolation (p = 0.033) and Role Restriction (p = 0.004). They also experienced less parenting stress than heterosexual spontaneous pregnancy couples, according to the Social Isolation subarea (p = 0.003). Birth mothers experienced higher stress than co-mothers and fathers, according to the Role Restriction measure (p = 0.041).

CONCLUSION

These are reassuring findings, considering the known challenges that lesbian families face in establishing their parental roles and, in particular, the challenges related to the lack of recognition of the co-mother.

Disparities in health insurance among children with same-sex parents

OBJECTIVES

The objectives of this study were to examine disparities in health insurance coverage for children with same-sex parents and to investigate how statewide policies such as same-sex marriage and second-parent adoptions affect children's private insurance coverage.

METHODS

We used data from the 2008-2010 American Community Survey to identify children (aged 0-17 years) with same-sex parents (n = 5081), married opposite-sex parents (n = 1369789), and unmarried opposite-sex parents (n = 101678). We conducted multinomial logistic regression models to estimate the relationship between family type and type of health insurance coverage for all children and then stratified by each child's state policy environment.

RESULTS

Although 77.5% of children with married opposite-sex parents had private health insurance, only 63.3% of children with dual fathers and 67.5% with dual mothers were covered by private health plans. Children with same-sex parents had fewer odds of private insurance after controlling for demographic characteristics but not to the extent of children with unmarried opposite-sex parents. Differences in private insurance diminished for children with dual mothers after stratifying children in states with legal same-sex marriage or civil unions. Living in a state that allowed second-parent adoptions also predicted narrower disparities in private insurance coverage for children with dual fathers or dual mothers.

CONCLUSIONS

Disparities in private health insurance for children with same-sex parents diminish when they live in states that secure their legal relationship to both parents. This study provides supporting evidence in favor of recent policy statements by the American Academy of Pediatricians endorsing same-sex marriage and second-parent adoptions.

Promoting the well-being of children whose parents are gay or lesbian

To promote optimal health and well-being of all children, the American Academy of Pediatrics (AAP) supports access for all children to (1) civil marriage rights for their parents and (2) willing and capable foster and adoptive parents, regardless of the parents' sexual orientation. The AAP has always been an advocate for, and has developed policies to support, the optimal physical, mental, and social health and well-being of all infants, children, adolescents, and young adults. In so doing, the AAP has supported families in all their diversity, because the family has always been the basic social unit in which children develop the supporting and nurturing relationships with adults that they need to thrive. Children may be born to, adopted by, or cared for temporarily by married couples, nonmarried couples, single parents, grandparents, or legal guardians, and any of these may be heterosexual, gay or lesbian, or of another orientation. Children need secure and enduring relationships with committed and nurturing adults to enhance their life experiences for optimal social-emotional and cognitive development. Scientific evidence affirms that children have similar developmental and emotional needs and receive similar parenting whether they are raised by parents of the same or different genders. If a child has 2 living and capable parents who choose to create a permanent bond by way of civil marriage, it is in the best interests of their child(ren) that legal and social institutions allow and support them to do so, irrespective of their sexual orientation. If 2 parents are not available to the child, adoption or foster parenting remain acceptable options to provide a loving home for a child and should be available without regard to the sexual orientation of the parent(s).