Lesbian, Gay, Bisexual, and Queer+ Patients' Preferences for Contraceptive Counseling and Experiences of Coercion in Contraceptive Care.

Abstract

Although one in three U.S. contraceptive clients identify as something other than heterosexual, research has overlooked associations between sexual identity and experiences of provider-based contraceptive coercion - that is, pressure from a healthcare provider to use or not use birth control. In 2023, we used the online Prolific panel to survey U.S. reproductive-age people assigned female at birth about their contraceptive care (N = 1,399; mean age = 32.6, SD = 8.24). We assessed differences in contraceptive care preferences and coercion across sexual identities and used open-ended survey responses to contextualize participants' contraceptive coercion experiences. More than one-third (36%) of the sample identified as lesbian/gay, bisexual, asexual, pansexual, queer, questioning, or preferred to self-identify (hereafter LGBQ+). Compared to heterosexual participants, LGBQ+ participants were more likely to experience misalignment in how often they would like contraceptive counseling versus how often they received it. Among those who ever received contraceptive counseling (n = 1,197), LGBQ+ individuals were also more likely than heterosexuals to experience pressure to use contraception. Open-ended responses revealed LGBQ+ clients' experiences with heteronormative assumptions during contraceptive care. Healthcare systems and providers must provide patient-centered contraceptive care to all individuals, with attention to how sexual identity can shape contraceptive needs.