At a time when conservative state politicians are launching coordinated attacks on LGBTQ+ and reproductive rights, the data on the intersecting identities targeted by these types of legislation is especially important. Previous research has found that there is diversity in sexual orientation and gender identity among people who have had abortions in the United States. New research from the Guttmacher Institutes Abortion Patient Survey adds to this body of work, indicating that LGBTQ+ people, including people who do not identify as women, make up a whopping 16 percent of abortion patients in the United States. Ensuring that abortion research captures the needs and perspectives of the broad range of people with the ability to become pregnant is critical to creating inclusive policies, combating harmful legislation, and providing patient-centered care.
Diversity in sexual orientation and gender identity among abortion patients
Guttmacher’s most recent abortion patient survey provides data on a national sample of 6,674 individuals who obtained an abortion at 56 health care facilities across the United States in 2021-2022 (see Methodology below for more details). About 1.1% of respondents reported their gender identity as something other than female or female: 0.7% identified as gender non-binary, 0.3% as transgender male, and 0.1% like something else. Sixteen percent of respondents said they were non-heterosexual: 12% said they were bisexual, 2% pansexual, 0.3% lesbian, and 2% something else. The majority of respondents who identified as anything other than cisgender also reported that they were not heterosexual. Applying the overall percentage of respondents who identified as LGBTQ+ to the number of total abortions nationwide in 2020 indicates that as many as 149,000 individuals who obtained abortion care that year identified as something other than cisgender and / or heterosexual.
The percentage of respondents reporting sexual orientations other than heterosexual varies widely by age group, less so by racial or ethnic identity, and less so by geographic area.
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The proportion of abortion patients who reported their sexual orientation as anything other than heterosexual was highest among younger respondents (27%) and lowest among older respondents (10%).
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20% of white respondents, 16% of Asian respondents, 15% of Hispanic respondents, and 12% of black respondents identified as anything other than heterosexual.
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For major US regions, 14% of respondents identified as something other than heterosexual in the South, along with 16% in the Northeast, 17% in the West, and 19% in the Midwest.
LGBTQ+ people face unique barriers to care
The U.S. healthcare system fails to deliver adequate care to LGBTQ+ people, leading to disparities in sexual and reproductive health outcomes. Specific challenges disproportionately faced by LGBTQ+ people include inadequate sex education, lack of health insurance, and discrimination by health care providers and systems. The results of the abortion patient survey suggest that a substantial number of LGBTQ+ people are receiving abortion assistance. However, the lack of inclusive and targeted care may discourage some LGBTQ+ people from seeking sexual and reproductive health services, including abortion services.
Across the country, state lawmakers have introduced a series of bills seeking to undermine the health and rights of LGBTQ+ people, most notably anti-trans legislation focused on limiting gender-affirming care for young people. These bills have accelerated dramatically in the wake of the Dobbs v. Jackson Women’s Health Organization decision, the 2022 US Supreme Court case that eliminated the federal right to abortion and led to a proliferation of state bans and restrictions on abortion. So far in the 2023 legislative session, 17 states have limited or banned gender-affirming assistance for young people. Fourteen of these states also have abortion bans in place that previously would have been blatantly unconstitutional Dobbs. LGBTQ+ people are forced to navigate an often hostile healthcare system, and when abortion restrictions are superimposed on existing barriers, access to care is even more unattainable.
Conclusion
LGBTQ+ people in the US want, need, and have abortions. Even beforeDobbs decision reversedRoe versus Wade, abortion was out of reach for many, especially people who are part of one or more marginalized LGBTQ+ groups, but also young people, Black and Brown, and those living on low incomes, to name a few. While some states have enacted laws protecting health care for LGBTQ+ people, restrictions in any state have the potential to harm LGBTQ+ people across the country.
Collecting and disseminating accurate data on the sexual orientation and gender identity of abortion seekers can help illuminate the experiences of LGBTQ+ people seeking essential health care. This information is critical to creating reproductive health policies that center on the needs and rights of LGBTQ+ people, as well as helping providers deliver inclusive, patient-centered care. Sexual and reproductive health services that support the reproductive health needs of LGBTQ+ people are necessary to achieve bodily autonomy for all.
Methodology
The 2021-2022 Abortion Patient Survey was conducted from June 2021 to July 2022. Facilities were randomly selected from the Guttmacher Institutes National Database of Abortion Providers; staff at participating facilities provided a flyer or collected contact information from people accessing care. Interested respondents filled out an online survey and received a $20 gift card upon completion. Sexual orientation analyzes excluded 288 individuals (4%) who did not provide a response, and gender identity analyzes excluded 212 individuals (3%) who did not respond to this item. Data for this analysis were not weighted.
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