Supportive healthcare network for diverse pregnant women.

Pregnancy and Sexual Orientation: Understanding the Disparities in Women's Health

Kai Mendoza monogram
Kai Mendoza in Health & Wellness October 2026 • 3 min read.

"A closer look at how sexual orientation impacts health access and outcomes for pregnant women, and what can be done to bridge the gap."


For years, research has highlighted the disparities in health and healthcare access experienced by sexual minority populations. While this knowledge is crucial, there’s a significant gap in understanding the specific healthcare needs of pregnant women within these communities. Sexual minority women often encounter stressors, discrimination, and stigma, which can significantly affect their well-being during pregnancy.

A recent study published in Women's Health Issues sheds light on these critical issues. The study, which analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS), examines the health status, healthcare access, and health behaviors of reproductive-age women, comparing heterosexual women with lesbian and bisexual women, both pregnant and non-pregnant.

By understanding the unique challenges faced by pregnant sexual minority women, healthcare providers, policymakers, and community organizations can work together to create more inclusive and supportive environments, ultimately improving maternal and infant health outcomes. This article aims to break down the study's findings and discuss their practical implications.

AI Search Multiple angles on this topic

Documented Health Disparities

The CDC's 2023 Youth Risk Behavior Survey found substantial health disparities among LGBTQ+ students, including poor mental health, suicidal thoughts and behaviors, experiences of violence, and sexually transmitted infections. National Center for Health Statistics data systems have included measures of sexual orientation for several years. The 2011 Institute of Medicine report called for expanding federally funded data collection on lesbian, gay, bisexual, and transgender people.

Inclusive Care and Evidence Gaps

A 2023 qualitative systematic review synthesized LGBTIQA+ people's experiences navigating preconception, pregnancy, and childbirth care, alongside the perspectives of health professionals. The American Society for Reproductive Medicine emphasizes special considerations when evaluating and treating LGBTQ+ people pursuing fertility care and family building. Existing guidance also recognizes that LGBTQ+ individuals may approach perinatal and reproductive care with higher anxiety than heterosexual women, while the available research and professional training remain important areas for development.

From Exclusion to Recognition

Historical accounts describe an LGBTQ+ healthcare system shaped by fear, violence, discrimination, and homophobia. Despite progress in LGBTQ+ rights, these histories continue to contribute to access barriers and behavioral and physical health disparities. The legalization of same-sex marriage in the United States and Canada expanded access to joint insurance plans, hospital visitation, and medical decision-making authority.

What Challenges Do Pregnant Sexual Minority Women Face?

Supportive healthcare network for diverse pregnant women.

The study revealed several key disparities between pregnant sexual minority women and their heterosexual counterparts. Approximately 3% of reproductive-age sexual minority women reported being pregnant. These women were more likely to experience:

Approximately 3% of reproductive-age sexual minority women reported being pregnant. These women were more likely to experience:

  • Unmet medical care needs due to cost.
  • Frequent mental distress, depression, and poorer self-rated health.
  • Activity limitations and chronic health conditions.
  • Risky health behaviors, such as smoking and alcohol consumption.
AI Search Multiple angles on this topic

Emerging Research Priorities

Recent work has examined LGBTQ+ pregnancy loss and LGBTQ+ people's experiences of parenthood within maternal and child healthcare. A 2026 study on LGBTQ+ couples' sexual health during pregnancy and postpartum notes that sexual health is often negatively affected during these periods in the general population. It also reports that some LGBTQ+ individuals fear disclosing their sexual activities, which may reduce communication about sexual health.

Limits of Existing Evidence

The available literature does not represent every LGBTQ+ pregnancy experience equally. A review describes two detailed Australian case studies involving trans and non-binary people who received pregnancy and birth care through a Midwifery Group Practice, illustrating the value and limitations of small qualitative samples. Another 2025 report claims that LGBTQ+ people experience twice the rate of pregnancy complications because of systemic discrimination, but this specific figure is not corroborated by the other listed source.

Toward Affirming Reproductive Care

The American Society for Reproductive Medicine's 2026 committee opinion provides clinicians with strategies and special considerations for LGBTQ+ people pursuing fertility care and family building. The National LGBTQIA+ Health Education Center likewise promotes affirmative, high-quality, cost-effective care for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority people. Together, these sources frame inclusive care as a clinical and organizational responsibility rather than a one-size-fits-all approach.

Non-pregnant sexual minority women also reported significant challenges, including barriers to healthcare access, activity limitations, chronic conditions, and higher rates of smoking and binge drinking. While health outcomes were similar between pregnant and non-pregnant sexual minority women, pregnant sexual minority women were more likely to smoke cigarettes daily.

Moving Towards Inclusive Perinatal Care

This study reinforces the need for a more focused approach to perinatal care that is inclusive of diverse families and sexual orientations. By addressing the unique challenges faced by pregnant sexual minority women, healthcare providers and policymakers can work to reduce health disparities and improve outcomes for both mothers and their children. Further research and tailored programs are essential to ensure that all women receive the support and care they need during pregnancy and beyond.

AI Search Multiple angles on this topic

Parenthood and Maternal Care

A 2023 meta-ethnography integrates research on LGBTQ+ people's experiences of parenthood in maternal and child healthcare. Its focus reflects the need to understand care experiences across LGBTQ+ identities rather than treating the population as a single group. Such synthesis can help connect individual accounts with broader questions about how maternal and child health services are delivered.

The Future of Inclusive Prenatal Care

The Mayo Clinic Health System reports that LGBTQ+ people face challenges affecting pregnancy and emphasizes that prenatal care is essential regardless of gender or identity. Future care models therefore need to address pregnancy support without assuming a patient's gender, sexual orientation, or family structure. The source presents inclusive prenatal care as an important direction for improving care experiences across the LGBTQ+ community.

Systems Shape Health

Pregnancy-related experiences for LGBTQ+ people may be shaped not only by clinical needs but also by the inclusiveness of healthcare systems and social institutions. Barriers can vary across identities, family structures, and stages of care. A broader understanding of these contexts may help explain why equal treatment on paper does not always produce equal experiences in practice.

Care Experiences Matter

For LGBTQ+ people pursuing pregnancy or parenthood, interactions with healthcare professionals can influence whether care feels safe, respectful, and usable. Experiences may differ depending on identity, family situation, and the assumptions built into clinical settings. Listening to patients' accounts is therefore an important complement to statistics and clinical guidance.

Pregnancy outcomes and policy context

  • 17.4%; 21.4%; 18.4%; 14.97% miscarriage rateA separate source reports miscarriage rates of 17.4% for heterosexual women, 21.4% for bisexual women, and 18.4% for lesbian women; its quoted comparison gives 14.97% for heterosexual women as the reference rate, so the baseline is internally inconsistent.[1]
  • 0.19; 1.22 odds ratioCompared with heterosexual women, the odds ratio for ever having been pregnant was 0.19 for lesbian women and 1.22 for bisexual women.[2]

What the evidence says about pregnancy and care

A review of perinatal mental health describes care environments where gendered assumptions, isolation, stigma, exclusion, and provider knowledge gaps were part of participants' accounts. This places the reported experiences in a wider care context rather than reducing them to individual health differences.[3]

The cited background literature links lower healthcare access and stigma-related stress with physical and mental health outcomes, but describes these pathways as hypothesized. It therefore offers a possible explanation, not proof that a particular pathway caused a pregnancy outcome.[4]

How related sources frame the findings

A systematic review brought together 26 studies involving 1,199 LGBTQ2S+ childbearing participants, while another source says pregnancy, conception, and especially pregnancy loss remain understudied. Together, these accounts show a growing evidence base that still leaves important parts of the reproductive experience less examined.[3] [4]

What remains unclear about pregnancy disparities

  • How much do differences in pregnancy loss reflect differences in measurement, population, or time period, given that the cited sources report distinct prevalence and miscarriage estimates?[1] [4]
  • Which care-system conditions and stigma-related pathways are associated with pregnancy outcomes, and which are only proposed explanations?[3] [4]
  • How would more consistent measurement of sexual orientation and gender identity change comparisons across studies and subgroups?[4] [5]

Sources

  1. Adverse pregnancy and birth outcomes in sexual minority women from the National Survey of Family Growth (pmc.ncbi.nlm.nih.gov)
  2. Lesbian and bisexual women's likelihood of becoming pregnant: a systematic review and meta‐analysis (pmc.ncbi.nlm.nih.gov)
  3. LGBTQ2S+ childbearing individuals and perinatal mental health: A systematic review. (obgyn.onlinelibrary.wiley.com)
  4. Minority stress theory applied to conception, pregnancy, and pregnancy loss: A qualitative study examining LGBTQ+ people’s experiences (pmc.ncbi.nlm.nih.gov)
  5. Mapping the scientific literature on obstetric and perinatal health among sexual and gender minoritized (SGM) childbearing people and their infants: a scoping review (pmc.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.whi.2018.10.006, Alternate LINK

Title: Health And Access To Care Among Reproductive-Age Women By Sexual Orientation And Pregnancy Status

Subject: Maternity and Midwifery

Journal: Women's Health Issues

Publisher: Elsevier BV

Authors: Gilbert Gonzales, Nicole Quinones, Laura Attanasio

Published: 2019-01-01

Everything You Need To Know

1

What specific challenges do pregnant sexual minority women face regarding healthcare access and overall well-being?

Pregnant sexual minority women encounter several challenges, including unmet medical care needs due to cost, frequent mental distress, depression, and poorer self-rated health. They also report activity limitations, chronic health conditions, and risky health behaviors such as smoking and alcohol consumption. These disparities highlight the need for inclusive and supportive healthcare environments tailored to their specific needs. Addressing factors like discrimination and stigma is crucial to improving their well-being during pregnancy. The study in *Women's Health Issues* highlights these disparities using data from the Behavioral Risk Factor Surveillance System (BRFSS).

2

How does being a sexual minority woman impact access to medical care during pregnancy, and what are the potential consequences?

Sexual minority women, both pregnant and non-pregnant, often face barriers to healthcare access. This can include difficulty finding inclusive and understanding providers, experiencing discrimination, and facing financial constraints that lead to unmet medical needs due to cost. These barriers can result in delayed or inadequate prenatal care, potentially leading to poorer maternal and infant health outcomes. The intersection of sexual orientation and pregnancy creates unique challenges that require targeted interventions to ensure equitable access to care. The BRFSS data emphasizes this point.

3

Why are pregnant sexual minority women more likely to engage in risky health behaviors, such as smoking, and what can be done to address this?

Pregnant sexual minority women may be more likely to engage in risky health behaviors like smoking due to factors such as increased stress, discrimination, and a lack of tailored support systems. Addressing this requires comprehensive interventions that include smoking cessation programs designed specifically for this population, mental health support to cope with stress and discrimination, and inclusive healthcare environments that promote trust and open communication. Understanding and addressing these underlying factors is essential to improving maternal and infant health outcomes. The study published in *Women's Health Issues* used data from the Behavioral Risk Factor Surveillance System (BRFSS).

4

What does inclusive perinatal care entail for pregnant sexual minority women, and how can healthcare providers contribute to creating a more supportive environment?

Inclusive perinatal care for pregnant sexual minority women involves creating healthcare environments that are welcoming, respectful, and affirming of their identities. Healthcare providers can contribute by receiving training on LGBTQ+ health issues, using inclusive language, avoiding assumptions about family structures, and actively addressing discrimination and stigma. Additionally, providing access to mental health support and connecting women with LGBTQ+-affirming community resources are crucial steps. By addressing the unique challenges faced by this population, healthcare providers can help reduce health disparities and improve outcomes for both mothers and their children. The study in *Women's Health Issues* analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS).

5

What are the long-term implications of the disparities in healthcare experienced by pregnant sexual minority women, and what policy changes could help bridge the gap?

The long-term implications of healthcare disparities experienced by pregnant sexual minority women include poorer maternal and infant health outcomes, increased rates of chronic health conditions, and persistent mental health challenges. Policy changes that could help bridge the gap include expanding access to affordable healthcare, implementing non-discrimination policies in healthcare settings, increasing funding for research on LGBTQ+ health issues, and promoting cultural competency training for healthcare providers. Additionally, policies that support LGBTQ+ families, such as paid parental leave and access to adoption services, can contribute to creating a more equitable and supportive environment. The data analyzed for the study in *Women's Health Issues* came from the Behavioral Risk Factor Surveillance System (BRFSS).

Newsletter Subscribe

Subscribe to get the latest articles and insights directly in your inbox.