- LBQ cisgender women are statistically as likely to have had abortions in their lifetime as straight cisgender women (22.8% vs 17.3%).
- Nearly half of LBQ cisgender women who have been pregnant became pregnant in their teen years.
- For bisexually identified women ages 15-44, the odds of an unwanted pregnancy are 1.75 times greater than their heterosexual peers.
- Sexually active, self-identified bisexual girls are 1.72 times more likely to become pregnant than their sexually active straight high school-aged peers.
- LBQ cisgender women, as well as transgender people whose sex assigned at birth is female, are less likely than their straight cisgender peers to have had cancer screenings, such as Pap smears or mammograms.
On June 24, 2022, the United States Supreme Court struck down Roe v. Wade and Planned Parenthood v. Casey by issuing the Dobbs v. Jackson Women’s Health Organization decision, which found that there is no right to abortion protected by the federal Constitution. As a result, abortion access is currently determined by individual states, and 26 states have already or are likely to ban or severely restrict abortion.Policies that restrict abortion care are often accompanied by decreased access to other reproductive health services, including contraception, and worsened health outcomes for both women and children.
Most conversations and media attention about the impact of Dobbs have focused on harms to the health and well-being of cisgender heterosexual women. However, restricting abortion access will also impact members of the LGBTQ community. It is essential to consider the unique and significant impacts on LGBTQ people who can get pregnant (including LBQ cisgender women and transgender people who can become pregnant) in discussions about the harm caused by the rollback of abortion and sexual and reproductive health care access across the country.
Access to General Health Care
LBQ cisgender women are more likely to lack health insurance coverage compared to straight women; 14.3% (nearly 1 in 6) reported having no health insurance compared with 10.1% of straight women. Slightly more LBQ cisgender women relied on Medicaid for health insurance coverage than their straight counterparts (13.3% vs 10.7%). In addition, LBQ cisgender women were more likely than straight women to report not having a regular health care provider (29.3% versus 15.7%). Within this group, bisexual women were significantly more likely to report not having a regular health care provider compared to lesbian women (31% versus 25%).
In general, transgender people experience discrimination, mistreatment, or denials of care when seeking health care and often have difficulty finding providers who are knowledgeable and able to provide trans-competent health care. In particular, transgender men and nonbinary people who can get pregnant can face difficulties finding inclusive and affirming reproductive health care, including providers who use gendered language or incorrectly assume that all of their patients identify as female. However, more research is needed on the specific reproductive health care experiences of transgender people.
Research indicates that LGBTQ people assigned female at birth are less likely to receive cancer screenings such as Pap tests and mammograms. An analysis of the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS) found that LBQ women are less likely to have received a Pap test in the last five years; 69% of LBQ women had received this screening, compared to 80% of straight women. LBQ women overall were less likely to have received a mammogram: only 42.8% of LBQ women had ever had a mammogram, compared with 70.8% of straight women. Transgender men are less likely to obtain regular Pap tests compared to cisgender women, and the 2015 U.S. Transgender Survey found that 13% of transgender respondents had been denied coverage by a health insurance company for supposedly gender-specific services such as Pap smears and mammograms.
Unplanned pregnancies are more common among cisgender bisexual girls and women than their heterosexual peers. Sexually active, self-identified bisexual girls are 1.72 times more likely to become pregnant than their sexually active straight high school-aged peers. For bisexually identified women ages 15-44, the odds of an unwanted pregnancy are 1.75 times greater than their heterosexual peers. In fact, a significant number of LBQ women—nearly half of those who have been pregnant— become pregnant in their teen years.
In addition, LBQ cisgender women are statistically similarly likely to have had abortions in their lifetime compared to straight cisgender women (22.8% vs 17.3%). It is possible that the Hyde Amendment’s prohibition on payment for abortion care through federal Medicaid funds has limited access to abortion for LBQ cisgender women; 13.3% of LBQ cisgender women are insured through Medicaid (compared to 10.7% of straight cisgender women). Although 16 states currently use state funds to pay for abortions in their state Medicaid programs, LBQ women enrolled in Medicaid in the majority of states cannot rely on their insurance and instead must pay out-of-pocket for abortion care.
Contraceptive use, abortion, and birth rates for transgender people are understudied. However, transgender people assigned female at birth do experience pregnancy and may face difficulties obtaining contraception and other reproductive health services.
LBQ cisgender women are less likely to have a doctor ask about their interest in getting pregnant than their straight cisgender counterparts, despite considerable interest in expanding and starting families. An analysis of the National Survey of Family Growth shows that 24.9% of LBQ cisgender women have had a doctor ask them if they wanted to get pregnant, compared to 32.8% of straight cisgender women. Some (14.6%) LBQ cisgender women have used insemination services intended to achieve pregnancy (compared to 19.1% of straight cisgender women). In general, more LGB cisgender women than straight women reported wanting but not being able to have children (15.3% vs 8%, respectively).
Transgender people who can get pregnant also face difficulties with services related to pregnancy, childbearing, and parenting, including limited access to fertility preservation and assisted reproductive services.
While the overturning of Roe v. Wade will allow states to restrict access to abortion and other sexual and reproductive health care, some states are using the Dobbs decision as an opportunity to preserve and expand access to care.Given existing barriers to sexual and reproductive health care access for LGBTQ people, these efforts in promoting health equity should include all LGBTQ people who can get pregnant. Providers should follow the CDC’s Sexual Health Assessment recommendations to identify patient needs and provide appropriate services and information about contraception, abortion, safer sex counseling, STI screening and treatment, and resources to facilitate family formation such as assisted reproductive technologies. Health service organizations that focus on the provision of reproductive health care, as well as those that specialize in the care of LGBTQ communities, should offer a range of LGBTQ-competent reproductive and sexual health care services. Efforts to track the effects of the Dobbs decision on women in the general population should include tracking the unique impact on LGBTQ people who can get pregnant. Better data collection and research into LGBTQ access to sexual and reproductive care generally is also needed, particularly for transgender people.