In 1970 the first Pride month parade marched the streets, just one year after the horrific events at the Stonewall Riots. Since then June has been globally recognized as Pride Month. This isn't just a time to buy rainbow flags and watch as corporations perform activism for their own interest but a time to celebrate diversity, commemorate lives lost and continue to advocate for equity, acceptance, and respect for all, regardless of sexual orientation or gender identity.
For LGBTQIA+ individuals, navigating the perinatal world can be a reminder of how little progress has actually been made. Our queer community faces unique challenges in their perinatal journeys due to systemic barriers, continued stigma, discrimination, health care disparities, unequal access and even adverse health outcomes.
All of these barriers, stigma, discrimination, unequal access, and lack of insurance support have resulted in massive effects on the LGBTQIA community. The Department of Health found that over 35% of sexual minority women screened for perinatal depression. Research has also shown bisexual and lesbian women are more likely to experience pregnancy and infant loss, low birth weight infants, and more preterm births when compared to their heterosexual counterparts. Research also indicates that LGBTQIA individuals report worse birthing experiences when compared to cis-heterosexual individuals. Additionally, 51% of people polled report that their perinatal care was impacted by bias and discrimination. LGBTQIA individuals consistently report a higher rate of complications following childbirth compared to cis-heterosexual individuals.
The creation of more inclusive perinatal spaces starts with understanding the needs of the community. Although broad brush strokes are helpful when addressing the needs it is also important to understand each individual's unique needs. So ask!
The perinatal world tends to be focused on women but not all those who are pregnant are women. This can lead to our pregnant people feeling unrepresented in these conversations and in the media. To combat this on a large scale we need more inclusive media, we can advocate for this representation and uplift voices sharing their stories online. On a smaller scale we agree to use more inclusive language like ‘chest feeding’, ‘pregnant person’, or ‘birthing parent’. Using ‘they/them’ pronouns until you get clarification and avoiding ‘mr.’/’ms.’ can support inclusion and invite people to share their own preferences. Providers can be doing the same!
LGBTQIA+ people are also at a higher risk for mental health concerns and substance use which may impact care received. Assessing for additional needs and screening for mental health concerns should be standard practice but especially when interacting with marginalized populations. The next step is providing resources to get these needs met. Individuals in the LGBTQIA community are also more likely to face challenges accessing family and social support networks which may exacerbate feelings of isolation and vulnerability at an already difficult time. We can support our LGBTQIA+ community by proactively reaching out and helping them connect with resources to build their network and meet others going through similar experiences.
Additionally, transgender and non-binary individuals may require more specific reproductive care including fertility preservation and hormone therapy. Same-sex couples may also face legal and societal barriers to accessing reproductive technologies and fertility treatments. These concerns need to be addressed with continued legal and policy change.
Advocacy efforts should focus on expanding legal reach and protecting this community's access to perinatal care. We can also work to create local and global resources. Reducing stigma and discrimination requires continued education and normalization. This includes improving the training of medical staff and other providers with gender affirming and sexuality competent care. Policies also need to be implemented to address economic barriers to perinatal care; this includes comprehensive insurance coverage for fertility treatment, hormone therapy, medical appointments, adoption services, and other needed perinatal care.
As pride month continues our efforts should too. Since 1970 we have continued to make progress but the progress is not over. There are 516 anti-LGBTQ bills currently proposed in the US; the work is not done. Our commitment to supporting our LGBTQIA friends, family, and community members has never been more important as their rights are under attack. Celebrating this pride intentional also means remembering there is no pride in genocide.
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