Report

Health and Socioeconomic Well-Being of LBQ Women in the US

March 2021

 The majority of the LGBTQ community identifies as women and girls. Using a variety of data sources, this study provides a comprehensive overview of the demographics, health, and socioeconomic status of cisgender and transgender LBQ women and girls in the U.S.

Highlights
LBQ women and girls experience disparities in many areas of life, including poverty, depression, criminalization, discrimination, and violence.
Nearly one-half of all LBQ women report being physically or sexually assaulted since they were 18 years old.
One-third of LBQ women have experienced a financial crisis, declared bankruptcy, or were unable to pay their bills on time in the past year.
Data Points
7M
cisgender and transgender women identify as LBQ
3M
high school girls identify as LBQQ
55%
of the LGBTQ population are LBQ women
66%
of the LGBTQ youth population are LBQQ girls
46%
of LBQ women report having experienced physical or sexual assault
24%
of LBQQ girls experienced sexual violence in the last year
75%
of LBQ women experienced at least one discriminatory event in the past year
48%
of LBQ women live with incomes below 200% of the FPL
46%
of LBQ women have been diagnosed with depression
23%
of straight women have received a similar diagnosis
44%
of LBQQ girls report having considered suicide in the last year
18%
of straight girls contemplated suicide
33%
of women in prison are LBQ cisgender women
61%
of them are women of color
39%
of cisgender girls in juvenile detention are LBQQ
64%
of them are girls of color, particularly Black and Latinx
66%
of cisgender LBQ women feel connected to the LGBT community
68%
of transgender LBQ women feel connected
Report

Executive Summary

The majority of the LGBTQ community identifies as women and girls.1 Yet the lives of lesbian, bisexual, and queer (LBQ) women and girls, whether cisgender or transgender and their unique challenges to well-being and opportunities for resilience are severely underrepresented topics in public discourse in the U.S. The major gaps in research,2 3 4 services,5 6 7 8 and funding9 10 for LBQ women’s issues and initiatives have been highlighted in numerous publications. Public awareness of the significant forms of violence and stigma experienced specifically by transgender girls and women, of all sexual orientations, is growing.111 12 Recent reports on the impact of the largest pandemic in a century have further put a spotlight on the inequities experienced by women in general in the U.S.13 14 15 This report is intended to serve as a broad overview of what we know about lesbian, bisexual, and queer (LBQ) women’s and girls’ social, economic, physical, and psychological well-being from a population level and to identify needed next steps in public policy, services, and research. 

Our approach to documenting the well-being and concerns of LBQ women is inclusive of transgender women, cisgender women, and women who identify on surveys as both “woman”/“female” and gender nonbinary/genderqueer and as sexual minorities. The focus of the report is on sexual minority status among women. As such, straight transgender and cisgender women are only included in the report as comparison groups to understand the impact of sexual orientation on women’s lives. We recognize that this approach prioritizes the social experience of individuals currently identifying as a woman; the overlap in outcome and experiences between women and transgender men and nonbinary people is a goal for a future project. At this moment, our objective is to understand the well-being outcomes for those who sit at the intersection of being an LBQ-identified and woman-identified person in the context of key public policy domains. Where possible, we also assess the relevance of sexual orientation in the status of health and well-being among lesbian, bisexual, queer, and questioning (LBQQ) girls and LGBQQ transgender youth.16 Our overall analytic approach was to provide data on LBQ women’s and girls’ well-being and compare their outcomes to other sexual orientation and gender identity (SOGI) groups that were in more dominant social categories in some way (i.e., men, heterosexual/straight) (See Figure A). This approach reflects our theoretical orientation, which emphasizes the impact of multiple social statuses and forms of stigma in the lives of LBQ women.

We use multiple datasets to achieve the goal of presenting information on such a wide variety of topics. Almost all datasets used to assess the well-being of LBQ women and LBQQ girls in this report are national population-based (random sample) surveys, except for a few datasets available on specialized topics and subgroups (e.g., foster youth, transgender women). While randomized national surveys are not the only form of rigorous data collection, they provide the highest degree of confidence that the estimates reflect the larger population in the U.S. 

Findings

Population Demographics 

  • About 5% of women are LBQ and 22% of girls are LBQQ (transgender and cisgender women and girls combined), which means there are approximately 6,558,000 LBQ adult women and 2,256,000 LBQQ girls in the U.S. 
  • LBQ women make up 55% of the LGBTQ adult population; LBQQ girls make up 66% of the LGBTQ youth population. 
  • Among LBQ women, 2.7% are transgender and 97.3% are cisgender. 
  • 72% of LBQ women identify as bisexual; among LBQQ girls, 62% identify as bisexual and 25% as questioning. 
    • Approximately 39% of LBQ women are Latinx, Black, Asian American/Pacific Islander (AAPI), American Indian/Alaskan Native (AI/AN), or other ethnic minority identified. 57% of LBQQ girls are Latinx, Black, AAPI, AI/AN, or other ethnic minority identified. 

Stigma, Discrimination, and Victimization 

The study of stigma (also referred to as prejudice) has remained a core feature of social science research on the lives of sexual and gender minority people and has served as a foundation of many legal arguments in the interest of LGBT rights. Often conceptualized as flowing from stigma and prejudice, experiences with discrimination and victimization are related but distinct forms of oppression that have remained an important focus of LGBT research and policy discussions. We used data from the Generations/TransPop studies to examine transgender and cisgender LBQ women’s experiences with stigma, discrimination, and victimization, and compare them to transgender and cisgender GBQ men. We also use data from the Youth Risk Behavior Surveillance System to identify frequency of experiences of victimization among LBQQ girls compared to heterosexual girls, heterosexual boys, and GBQQ boys. 

  • LBQ women were more likely than GBQ (gay, bisexual, and queer) men to live in communities they feel are not great places for marginalized groups (racial minorities, LGBT people, and immigrants). 
  • About 75% of all LBQ women experienced at least one everyday discriminatory event in the past year.
    • Bisexual and queer women were more likely to report everyday discrimination compared with lesbian women. 
    • However, lesbians were significantly more likely to report sexual orientation-based discrimination events than bisexual and queer women (57% vs 31%).
  • Nearly 46% of LBQ women reported an experience of being physically or sexually assaulted since they were 18 years old, compared with 35% of GBQ men. 
  • Approximately 24% of LBQQ girls experienced sexual violence in the last year, compared to 15% of both heterosexual girls and GBQQ (gay, bisexual, queer, and questioning) boys. 

Socioeconomic Status and Economic Insecurity 

Socioeconomic status refers to the social standing or class of an individual or group and reflects a combination of education, income, and occupation. With regard to LBQ women, economic stability has also remained a key area of disparity, either in comparison to heterosexual women or to men in general. Using a combination of the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) and Youth Risk Behavior Surveillance (YRBS) Survey, and the Generations/TransPop Studies, we assessed how transgender and cisgender LBQ women and LBQQ girls fared on indicators of economic security prior to the COVID-19 pandemic. 

Education

  • Among youth, fewer LBQQ girls reported earning A’s and B’s in high school than straight girls, but more so than GBQQ boys.
  • Among adults, more LBQ women (28.2%) completed college compared to straight men, but at a similar rate compared to straight women.
    • However, among LBQ women, women of color and bisexual women had lower rates of college or high school completion compared with White and lesbian women.

Income and Poverty 

  • Only 25% of LBQ women have household incomes over $75,000 compared with 33% of heterosexual women, 40% of heterosexual men, and 32% of GBQ men. 
  • 48% of LBQ women are living in a lower-income household (with an income less than 200% of the federal poverty line), compared with 42% of straight women, 38% of GBQ men, and 34% of straight men.
    • Among LBQ women who are parents, the lower-income rates are even higher. (See Figure B.) 
  • In their lifetime, approximately 33% of LBQ women have experienced a major financial crisis, declared bankruptcy, or were more than once unable to pay their bills on time in the year before the survey. In contrast, far fewer GBQ men (23%) and heterosexual men (15%) reported the same experiences. 
  • Fewer LBQ women (46%) were employed than heterosexual women (52%) and either heterosexual (64%) or GBQ (55%) men.

Housing and Homelessness 

  • More LBQ women (4%) had experienced recent homelessness and unstable housing compared to straight women (2%), but this finding is likely driven by the high rate of homelessness among LBQ transgender women (23%).
  • Fewer LBQ women (60%) than heterosexual women (69%) and men (70%) reported owning their home. 

Health

The health inequities faced by LBQ girls and women are fundamentally affected by the social and policy environment. In the past two decades, research on the physical and mental health of LGBTQ populations has grown exponentially. Yet attention to the specific health experiences of diverse populations of sexual minority women—and implications for public health practitioners, policymakers, and community advocates—is lacking. In this section, we use data from BRFSS/YRBS and the Generations/TransPop studies to highlight key indicators of population physical and mental health for transgender and cisgender LBQQ adolescent girls and LBQ adult women. 

Mental and Behavioral Health Among Youth 

  • 44% of LBQQ girls reported having considered suicide in the last year, compared to 18% of straight girls, 13% of straight boys, and 32% of GBQQ boys.
    • The percent of LBQQ girls who considered suicide did not differ significantly by race, but all groups reported relatively high levels: AI/AN (56%), another race/ethnicity (49%), White (45.0%), Latinx (44%), Black (39%), and AAPI girls (37%).
    • Bisexual girls had higher odds of feeling sad or hopeless compared with lesbian and questioning girls.
    • Lesbian and bisexual girls were equally likely to report having attempted suicide in the past year. 
  • LBQQ girls were nearly three times more likely than heterosexual girls to use cigarettes. 
  • LBQQ girls were more likely than heterosexual girls and boys and GBQQ boys to report current alcohol and marijuana use. 

Mental and Behavioral Health 

  • More LBQ women (46%) had been diagnosed with depression compared to straight women (23%), straight men (13%), and GBQ men (31%).
    • Over half of AI/AN and White LBQ women reported having been diagnosed with depression in their lifetime. 
  • LBQ women are more likely to smoke cigarettes and binge drink compared with heterosexual men and women, but less likely than men in general to use smokeless tobacco products.

Physical Health

  • Nearly 29% of LBQ women described their health as fair or poor, compared to 19% of straight women.
    • A higher proportion of LBQ women of color described their health as fair or poor compared with White LBQ women. 
    • Bisexual women were more likely to report fair or poor health compared to lesbians. 
  • More LBQ women (35%) reported up to 14 days a month of limited mobility due to physical health (i.e., mild disability), compared to straight women, straight men, and GBQ men (28%, 25%, and 30%, respectively). 
  • More LBQ women (32%) reported a BMI over 30 compared to straight women (29%) and GBQ men (27%). 
  • More LBQ women than all other groups reported having been diagnosed with asthma, arthritis, or cancer, but significantly fewer reported high blood pressure compared with heterosexual and GBQ men. 
  • More LBQ women reported a diagnosis of heart disease, high blood pressure, and diabetes compared to straight women. 
  • Overall, LBQ women reported few cases of being HIV positive, though 7% of LBQ trans women reported being HIV positive. 

Health Care Access 

  • 14% of LBQ women were uninsured compared with 10% of heterosexual women. 
  • Women of color were generally more likely to be uninsured compared with White women.
    • Lesbian and bisexual women had similar rates of being uninsured. 
  • 29% of LBQ women were without a regular health care provider, a similar percentage to GBQ men, but higher than the percentage of heterosexual men and women. 
  • Over half of LBQ women fear being negatively judged by their health care provider, and many feared anti-LGBT bias might impact their care. 
  • LBQ women were more likely (90%) to never visit LGBT centers for health care compared to GBQ men (77%). 

Reproductive Health 

  • 27% of LBQ women had a child under 18 in their household.
    • 32% of LBQ women of color had minor children in their home. 
  • 18% of LBQ women reported wanting children but were not able to have them. 
  • Data on the experiences, needs, and hopes of trans women related to family formation are severely lacking in reproductive-focused datasets.
  • Among LBQ cisgender women who had children, there were several ways their families came to be, including 80% through a current or previous sexual relationship, 23% through step-parenthood, 10% through alternative insemination using a sperm donor, and 5% through adoption. 
  • Cisgender LBQ women of childbearing age (18–49 years) used abortion services at similar rates to heterosexual cisgender women. 
  • Black and Latinx LBQQ girls had the highest prevalence of having accessed HIV testing (19% and 14%, respectively). Black LBQQ girls and those of another race/ethnicity had the highest prevalence of having accessed STI testing (18% and 16%, respectively). 
  • About 33% of LBQ women and 25% of GBQ men have never been tested for HIV. 
  • Fewer LBQ cis women (43%) than straight cis women (71%) age 40+ years had ever had a mammogram. 
  • About 22% of LBQ cis women reported having a child for whom they have no legal recognition as their parent. 

System Involvement 

The term we use to refer to people’s interactions with the child welfare and/or criminalization systems is “system-involved.” System involvement has long been identified as an area in which racial, gender, and socioeconomic disparities exist, particularly for youth. Our previous research has shown the overrepresentation of LGBT youth and adults in these systems, noting the high rates among LGBT youth and adults who are also racial minority women. Here we highlight findings from these prior studies that describe the system involvement of cisgender LBQ women and cisgender and transgender girls. To do this, we use a combination of datasets: Generations/TransPop studies, Los Angeles Foster Youth Study, National Youth in Custody Survey, and National Inmates Survey. Unfortunately, the youth and adult incarceration data and adult foster care history data were not available for transgender women. 

  • 39% of cis girls in juvenile detention are LBQQ.
    • The majority of LBQQ cis girls (64%) who were incarcerated are girls of color, particularly Black and Latinx. 
  • LBQ cis women make up 33% of women in prison; again, the majority (61%) are women of color. 
  • Almost 8% of transgender and cisgender LBQ women of color compared with 3% of White LBQ women report experiencing serious trouble with the police or the law. 
  • In a survey of youth, LBQQ cis and trans girls were found to represent 9% of the foster youth population, which indicated slight overrepresentation at the time the survey was conducted. 
  • About 4% of cisgender adult LBQ women (ages 18–41) reported having lived in foster homes as a child; lesbians (9%) were slightly more likely than bisexual (1%) and queer (7%) women to report a history of foster care.
    • Among LBQ women and GBQ men who had child welfare experiences, nearly 40% reported that they moved to different placements because of how people treated them due to their minority sexual orientation or gender identity.

Resilience

Resilience refers to surviving and thriving despite ongoing challenges, and the concept has particular relevance for understanding how LGBTQ people negotiate oppression and minority stress. This next section examines indicators of and resources for resilience through different support systems, using questions asked in the Generations/TransPop surveys. Unfortunately, resilience is not a focus of national health data and therefore we do not have any resilience findings for LBQQ girls. 

  • About 68% of LBQ transgender women felt connected to the transgender community, which was more than we found among GBQ transgender men.
    • 66% of cisgender LBQ women felt connected to the LGBT community, which was about the same number of GBQ cis men. 
    • Bisexual cis women (59%) were less likely to feel connected to LGB communities compared with cis lesbians (81%). 
  • Fewer LBQ women (60%) felt social support compared with heterosexual women (76%). 
  • Fewer LBQ women (30%) felt moderate levels of social well-being compared with 37% of GBQ men, 42% of heterosexual women, and 50% of heterosexual men. 
  • In terms of political engagement, LBQ cis women were much more likely to participate in political or civic activities focused on a mix of issues (around LGBT, race, women’s issues, etc.) compared with cis GBQ men, who primarily focused on LGBT issues. 
  • A notable indicator of resilience across the outcomes covered in this report is that we identified no disparities specific to Asian- American and Pacific Islander LBQ women compared to other racial groups. However, research also shows that there is diversity in health and well-being among AAPI people. As such, future research should examine the distinct experiences among AAPI LBQ women of various ethnicities. 

Policy Implications

Our findings highlight the need for an intersectional approach to policymaking that considers the needs of individuals based on their multiple marginalized characteristics, including race, sex, sexual orientation, and gender identity. Comprehensive, nationwide non-discrimination protections such as the Equality Act would ensure that LBQ women and girls are legally protected from discrimination based on their sexual orientation and gender identity, as well as their race and sex, in multiple settings including schools and public accommodations. Other policies that support survivors of violence, such as the Violence Against Women Act, could benefit LBQ women, who are more likely to experience certain types of violence and often lack access to equal resources. The findings also indicate a need for policies that seek to achieve equity in wages, reduce unemployment, and increase access to housing for women, people of color, and LGBTQ people. In addition, LBQ women and girls continue to face barriers in accessing health care and policies aimed at reducing or eliminating these barriers—such as policies that reduce administrative barriers to enrolling in Medicaid and expand insurance coverage for certain types of care would likely have a disproportionate impact on LBQ women and girls. Finally, criminal legal system reforms aimed at reducing or ending over-incarceration and over-policing generally, and in particular for LGBTQ people and people of color, would benefit LBQ women and girls who face higher rates of incarceration and victimization while in custody.

Summary

Our research highlighted the significance of sexual orientation in the lives of women in the U.S. Across the many issues we covered, it is clear that there are multiple areas of vulnerability in every policy domain for LBQ women and girls. Some of these areas of vulnerability are particularly heightened for sexual minority women (e.g., poverty, depression; criminalization); others are shared with either heterosexual women (e.g., physical and sexual assault) or sexual minority men (e.g., bullying, lack of healthcare access and insurance). Despite covering a broad range of topics relevant to the lives of LBQ women and girls, there are many topics we did not address here. Further research is needed to understand how the various disparities identified here are associated with one another (e.g., the relationship between race, sexual orientation, and weight-based stigma and health outcomes). National data on topics like interpersonal violence, sex work, and the role of gender expression and nonbinary identities among LBQ women are also needed. Many existing data sources still do not include adequate measures of sexual orientation and gender identity. SOGI data collection must be expanded on national and state surveys to get a fuller picture of the social, health, and economic outcomes of LBQ women. Further, it is critical to support ongoing efforts to engage in community-based research that aims to fill the gaps left by state-sponsored surveys.16 

An important point to make about the findings from this study across so many topics in this moment is that all the data were collected before the COVID-19 pandemic. Given the known mental and physical health and economic impacts of the COVID-19 pandemic, all of these findings must be understood in the context of vulnerability for the impact of the pandemic and essentially considered a baseline for what we see moving forward. Gender-focused research over the next five years should specifically look at not just women’s well-being as a function of the pandemic, but also the role of sexual orientation in those outcomes. 

Download the full report

Health and Socioeconomic Well-Being of LBQ Women in the US

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The primary focus of this report is the way sexual orientation and gender matters in the outcomes for LBQ girls (cis and trans). However, because of the limitations to how the national youth datasets measure gender identity, we have included data on LGBQQ transgender youth in comparison to heterosexual transgender youth as supplemental information on the role of sexual orientation in trans youth outcomes. These are provided in tables in the main report and appendices.

For example, there is a new effort by a diverse array of scholars and activists to gather data from a large community sample of sexual minority women in the US. The Survey will be in the field in 2021. www.LGBTQwomensurvey.org