Female sexual orientation differences in contraceptive choices and utilization

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.