Background

This study assesses the differences in condom, and contraceptive use among cisgender, transmasculine, and gender diverse college-attending young adults.

Methods

This study used data from the Fall 2015 through Spring 2018 administrations of the National College Health Assessment. Our analytic sample includes 120,397 cisgender women, 1,388 genderqueer/gender diverse individuals, and 490 transmasculine individuals, aged 18-26, who were assigned female at birth. Multivariable logistic regressions were used to assess differences in the use of contraception and condoms by gender identity. The fully adjusted models included age, race/ethnicity, the semester of survey administration, as well as the geographic region of the school, and whether the school was private or religious.

Results

While gender diverse (AOR: 0.81; 95%CI: 0.66, 0.99) and trans-masculine (AOR: 0.68; 95%CI: 0.49, 0.99) respondents were less likely than cisgender women to report using any contraceptive method at their last vaginal intercourse, both groups were more likely than cisgender women to report using very effective contraceptive methods (AOR: 1.49; 95%CI: 1.27, 1.75; AOR:1.42; 95%CI: 1.04, 1.92) including implants, IUDs, and sterilization. Gender diverse and trans-masculine respondents were less likely to report using condoms “always” or “most of the time” in the past 30 days than cisgender women (AOR: 0.72; 95%CI: 0.63, 0.83; AOR: 0.77; 95%CI: 0.62, 0.97).

Conclusions

Overall, gender diverse and transmasculine college students are more likely than their cisgender peers to engage in vaginal intercourse without condoms or other contraceptive methods. College health services should adopt strategies to encourage contraceptive uptake among this population.

Background: Transmasculine individuals can experience unintended pregnancy. However, research that examines contraception among transmasculine individuals is extremely limited. Thus, we conducted a qualitative study to elicit comprehensive and detailed information about contraceptive use and its social determinants among transmasculine people.

Methods: Using purposive sampling, we conducted in-depth interviews with transmasculine individuals (N=21) aged 18-29 years with an assigned male at birth sexual partner in the last 5 years. Interviews were transcribed verbatim and analyzed using thematic analysis.

Results: Most participants believed that contraception was necessary to effectively prevent pregnancy among transmasculine individuals, including those using testosterone. Many participants chose a contraceptive method based on how it affected their gender dysphoria, testosterone use, and menstruation and expressed a preference for condoms and contraceptive implants. Participants’ contraceptive beliefs and decisions occurred in the context of a lack of knowledge, accurate information, and support regarding contraception, especially in relation to testosterone use. Gender bias, discrimination, and stigma in clinical settings negatively influenced transmasculine young adults’ contraceptive care experiences.

Conclusion: Transmasculine young adults have specific contraceptive needs and tailored educational resources that provide accurate information about the full range of contraceptive methods in the context of gender dysphoria and testosterone use are needed. Health care providers can deliver high-quality contraceptive care to transmasculine individuals by supporting patients in choosing the contraceptive method that best meets their needs in the context of social and medical gender affirmation, avoiding hetero- and cis-normative assumptions, and creating environments and practices that are inclusive and respectful of transmasculine patients.

Objectives: Research has shown that sexual minority women (SMW) and women of color (WOC) are at increased risk of unintended pregnancy. We explore disparities in pregnancy intention at the intersection of sexual orientation identity and race/ethnicity.

Methods: Data come from the National Longitudinal Study of Adolescent to Adult Health. Longitudinal data were leveraged to measure several preconception risk factors including age, education, sexual assault, age of sexual debut, childhood sexual and physical abuse, and depressive symptoms. We used pregnancy as the unit of analysis (n=14,828) and employed multilevel logistic regression models to account for the clustering of pregnancies among women. Significant interactions by sexual identity and race/ethnicity supported stratified models by White vs. non-White women.

Results: Among white women, pregnancies reported by gay (OR=2.45 p < .10) and mostly heterosexual (OR=1.31, p<.05) were more likely to described as unintended than heterosexual women’s pregnancies. Conversely, pregnancies reported gay WOC were less likely to be described as unintended than those of heterosexual WOC (OR= 0.24, p<.001)). Identity-stratified models show a similar reversal of trends: among heterosexual women, white women were less likely to describe pregnancies as unintended (OR= 0.54, p<.001)), whereas among gay women, white women were more likely to describe pregnancies as unintended (OR= 10.03, p<.001).

Conclusion: Opposite trends in sexual orientation disparities in pregnancy intention were observed by race/ethnicity. White respondents may drive results from previous studies that demonstrated elevated unintended pregnancy risk among SMW. More research is needed to understand sexual minority WOC’s experiences of pregnancy.

Sexual and/or gender minority (SGM) adolescents are at greater risk than their heterosexual, cisgender peers for adverse sexual and reproductive health outcomes, including teen pregnancy. SGM adolescents face a number of healthcare barriers (e.g., discrimination) that may contribute to teen pregnancy disparities. Previous research has not examined these disparities from the perspectives of health care providers (HCPs). This study aimed to characterize the multilevel barriers to sexual and reproductive health experienced by SGM adolescents—including within the healthcare system—and elucidate ways to improve SGM teen pregnancy risk profiles. We conducted semi-structured interviews with 10 U.S.-based HCPs who provide reproductive healthcare to SGM adolescents. Interview questions addressed providers’ experiences caring for pregnant SGM adolescents, including their perceptions of SGM-specific pregnancy-related risk and protective factors. Interview questions also examined ways that providers and the broader healthcare system can reduce teen pregnancy disparities for SGM adolescents. Audio-recorded interviews were professionally transcribed and analyzed using thematic analysis (Braun & Clarke, 2006). Five themes were developed and organized into a conceptual model: 1) external factors (e.g., societal culture, access to care), 2) clinic factors (e.g., patient-staff interactions, verbal/nonverbal/visual cues of support), 3) patient factors (e.g., mental health, sex education), 4) provider factors (e.g., education, assumptions), and 5) reproductive healthcare visit experience (e.g., sexual history taking, contraceptive counseling). Study findings illustrate the ways that providers and public health practitioners can improve reproductive care for SGM adolescents, including those who want to avoid pregnancy.