Online Program

Female sexual orientation differences in contraceptive choices and utilization

Tuesday, November 3, 2015 : 10:56 a.m. - 11:09 a.m.

Brittany Charlton, ScD, Harvard Medical School and Boston Children's Hospital, Boston, MA
Stacey Missmer, ScD, Division of Reproductive Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, Boston, MA
Amy DiVasta, MD, MMSc, Division of Adolescent Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
Margaret Rosario, PhD, Department of Psychology, The City University of New York - City College and Graduate Center, New York, NY
S. Bryn Austin, ScD, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
Compared to heterosexuals, sexual minority females (e.g., bisexual, lesbian) are more likely to experience a teen pregnancy and less likely to receive preventative gynecologic care. These disparities are, in part, due to differences in contraceptive utilization despite sexual minorities being just as likely as heterosexuals to have ever had heterosexual intercourse. There is particular concern that sexual minorities don’t use highly effective methods of pregnancy prevention and prescription-based methods (e.g., birth control pills) that bring them into the healthcare system for routine care as much as heterosexuals. Prospective survey data were used from 100,062 women in the Nurses’ Health Study (NHSII) and 7,970 adolescents in the Growing Up Today Study (GUTS), all of whom had a history of sexual activity with males. Log-binomial models controlled for age, race, and geographic region. By the end of follow-up in 2011, use of a prescription-based contraceptive was reported by 90% of NHSII participants (ages 47-64 years) and 78% of GUTS participants (ages 24-30 years). In NHSII, compared to heterosexuals, bisexuals were 23% less likely (RR [95%CI]: 0.77 [0.74, 0.81]) and lesbians 17% less likely (0.83 [0.77, 0.89]) to use prescription-based methods. Similarly, GUTS lesbians were 20% less likely to use prescription-based methods (0.80 [0.68, 0.93]) compared to heterosexuals. Other methods (e.g., barrier [condoms]) were not being substituted in lieu of prescription-based methods; sexual minorities were no more likely than heterosexuals to use these methods in either cohort. These contraceptive disparities put sexual minority females at risk of unintended pregnancies and inadequate healthcare access.

Learning Areas:

Diversity and culture
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe the full range of contraceptive use across sexual orientation groups Compare contraception choice and utilization between sexual minorities and heterosexuals

Keyword(s): Contraception, Lesbian, Gay, Bisexual and Transgender (LGBT)

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have published a number of papers on LGBT reproductive health disparities and am the PI on a federal grant to study this topic.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.