"One of the greatest threats to the health of lesbian, gay, and bisexual Americans is the lack of information about their health." This quote is from a 2001 paper written by Dr. Randy Sell and Dr. Jeffrey Becker addressing the lack of LGB-inclusive data collected by the U.S. Department of Health and Human Services when monitoring the health of the nation. The authors contend that the only way to identify and eliminate health disparities among LGB populations is to ask about sexual orientation in national health surveys.
We couldn't agree more, especially given results from our recent study on pregnancies among LGB high school students in New York City. Since the early 1990s much research and attention has been paid to reducing teen pregnancy in the U.S., with significant success. However, LGB youth, and especially transgender youth, have been noticeably absent from this research and its programmatic efforts -- an important oversight, according to our study results. We found that among New York high school students who'd ever engaged in vaginal intercourse, LGB-identified students and students who'd had sex with the same sex, regardless of sexual identity, were significantly more likely to get pregnant or to cause a pregnancy than students who identified as straight or who had only had sex with the opposite sex. This was true for male and female students. (Note: The survey did not include measures to identify transgender, genderqueer, or gender-nonconforming students).
Our results shed light on an issue -- teen pregnancy among LGB youth -- that has long been ignored. Just last week, a public health colleague who used to run a Title X family planning program told us in an email, "We totally ignored the LGB community [in our pregnancy prevention efforts]. Our assumption was they were not at risk. Your research proves that we were so very wrong."
Reproductive health care providers and individuals working in teen pregnancy prevention programs should not assume that young people who are pregnant or who got someone pregnant are heterosexual (or cisgender) or that LGBTQ youth don't need reproductive health care, contraceptive services, or information. In addition, all health care providers, not just reproductive health care providers, should be properly trained in LGBTQ health issues and how to provide culturally competent services to diverse sexual and gender minority populations.
Public schools can also be important allies in preventing pregnancies among sexual minority youth, ideally by providing age-appropriate, medically accurate, comprehensive sexuality education that address issues beyond abstinence and the basic "plumbing" of reproductive anatomy and physiology. Information about sexual orientation, gender identity, body image, different types of relationships, healthy versus unhealthy relationships, HIV/STI prevention, and methods of contraception as well as the importance of regular sexual and reproductive health care should be provided to all students. At the very minimum, current pregnancy prevention programs should become inclusive of sexual and gender minority teens.
Since its release May 14, our study has received a lot of attention on social media. Most people making comments admitted to not reading the actual study, something we encourage everyone to do (read more about the study here). Many mentioned that they were "not surprised" by the study's results because, they said, "the issue is real" and "unplanned pregnancies happen" regardless of someone's sexual or gender identity. Several people shared their personal experiences with unintended pregnancies as members of the LGB community and reiterated the importance of this issue, while others had hoped there would be "more to the study" than just a reporting of disparities by sexual orientation.
We agree that more research is needed to better understand teen pregnancy among sexual minority youth. Here are just a few questions that need to be answered: What, if any, birth control methods do LGB youth use and do they use them correctly and consistently? Are pregnancies among LGB youth intended or unintended? If they are intended, why are LGB young people choosing to get pregnant/get someone else pregnant? To conceal their sexual orientation? To fit in? To have someone to love (like many straight youth)? At what point during a pregnancy do LGB youth seek prenatal care? What are the outcomes of their pregnancies? Did they result in a birth? An abortion? A miscarriage? And of course, we know even less about these issues when it comes to transgender, genderqueer, or gender-nonconforming youth.
There is so much that is not known and so much more work that needs to be done when it comes to the health of LGBTQ populations. We look forward to exploring these issues, particularly with regard to unintended pregnancy prevention among sexual and gender minority youth.
DR. LISA LINDLEY (left) and KATRINA WALSEMANN (right)are the co-authors of Invisible and at Risk: STDs Among Young Adult Sexual Minority Women in the United States. Lindley is an Associate Professor in the Department of Global and Community Health at George Mason University in Fairfax, Virginia. Walsemann is an Associate Professor in the Department of Health Promotion, Education & Behaviorat the University of South Carolina.