LGBTQIA+ people across the U.S. are being warned by journalists and community members that because Roe v Wade has been overturned, "our rights could be next." But our rights are at risk right now. Cisgender women are more likely than cisgender men to identify as LGBQ (The Williams Institute, 2019). A sizable proportion of transgender and nonbinary people can become pregnant. This means that the rights of more than 60% of the LGBTQIA+ community (The Williams Institute, 2019) a re losing rights this very minute—not just when/if marriage equality is overturned. Now.
Unintended pregnancies
It is not just because of the threat to marriage equality under Obergefell that LGBTQIA+ people should be worried about the impacts of overturning Roe—it is because queer cisgender women, transgender men, intersex, two-spirit, and nonbinary people with the capacity for pregnancy have high rates of unintended/unwanted pregnancies. LGBQ white cisgender women in college are more than 1.5 times as likely to have an unintended pregnancy as their heterosexual peers (Reynolds et al., 2021). The risk is even higher—almost 2.5 times higher—among BIPOC (Black, Indigenous, and People of Color) LGBQ young cisgender women. Nonbinary and transgender college students assigned female at birth have rates of unintended pregnancies comparable to those of their cisgender peers (Reynolds & Charlton, 2021a). Among cisgender adults, more than 10% of bisexual women report unintended pregnancies in the past five years compared to 6% of heterosexual and 3% of lesbian women (Everett et al., 2017). More than half of transgender, intersex, and nonbinary adults (54%) report unintended pregnancies in their lifetimes and 11% felt that they were “at-risk” for unintended pregnancies (Moseson et al., 2021).
Teen pregnancies
The risk of teen pregnancies among LGBQ adolescents is higher than among their heterosexual peers a (Charlton et al., 2018) a nd one in ten transgender youth report having at least one pregnancy involvement (i.e., either pregnant themselves or got someone else pregnant; Veale et al., 2016).
Heightened risks
Risks for unintended and teen pregnancies among LGBTQIA+ people are heightened due to the unique stressors and discrimination from enacted stigma like homophobia and transphobia (Saewyc et al., 2008). Further, compared to heterosexual cisgender women, bisexual and lesbian cisgender women are much more likely to experience forced sex/rape; one in ten heterosexual cisgender women report such experiences and this number is one in three among bisexual and lesbian cisgender women (Tornello et al., 2014). Adolescent LGBQ cisgender girls also more commonly report childhood sexual abuse than heterosexual girls (Saewyc et al., 1999). Bullying and childhood abuse explain nearly half of the sexual orientation-related disparities in teen pregnancy alone (Charlton et al., 2018). Rates of violence victimization and bullying are even higher among transgender youth (Johns et al., 2019). LGBQ cisgender women are also more likely to report intimate partner violence (IPV) from their male pregnancy partners (Everett, Jenkins, et al., 2022; Jones et al., 2018), and when they give birth, are more likely to experience maternal health complications (Berrahou et al., 2022) a nd have a higher risk for adverse birth outcomes (Everett, Kominiarek, et al., 2019).
Sexual and reproductive healthcare
LGBQ cisgender women are less likely than heterosexual cisgender women to have a healthcare provider discuss sexual and reproductive health with them (Tabaac et al., 2021) o r to receive contraceptive counseling, even if they recently had sex with men (Everett, Higgins, et al., 2019). Limited cultural competence in sex education and healthcare plays an important role here. If, as has been suggested, the right to use contraception in Griswold v Connecticut is also overturned by the Supreme Court, this will have disproportionate impacts on bisexual cisgender women, transgender men, and nonbinary people with the capacity for pregnancy (Charlton, Janiak, et al., 2019; Light et al., 2018; Reynolds & Charlton, 2021b).
Abortion
Bisexual and lesbian cisgender women use emergency contraception more commonly than cisgender heterosexual women; about a quarter of bisexual and lesbian cisgender women report use compared to 16% of cisgender heterosexual women. Bisexual cisgender women also more commonly have induced abortions compared to their heterosexual counterparts; although severely underestimated, 12-14% of bisexual cisgender women report ever having had an abortion compared to 5-15% of cisgender heterosexual women (Charlton et al., 2020; Tornello et al., 2014). In a new report by the Human Rights Campaign (2022), LGBQ cisgender women (27% of bisexual and 23% of lesbian women), reported almost twice the rates of lifetime abortion as cisgender exclusively heterosexual women (15%). Even when abortion was legal across the U.S., transgender men and nonbinary people who have the capacity to get pregnant very frequently considered terminating a pregnancy (36% of those who had been pregnant); another 19% of those who had been pregnant tried to terminate a pregnancy without clinical supervision (Moseson et al., 2022). We anticipate these estimates to get much higher now that Roe has been overturned.
Assisted reproductive technologies
Overturning Roe may also make certain assisted reproductive technologies like in vitro fertilization (IVF) more expensive or higher risk given the questionable legal status of fertilized eggs (The Editors, 2022). Such changes may disproportionately impact LGBTQIA+ couples wishing to conceive children (Downing, 2019); this includes intersex people (e.g., those with Turner Syndrome), bisexual and lesbian cisgender women trying to conceive with donor sperm, and gay and bisexual men who use IVF with surrogates (Sylvestre-Margolis et al., 2015). Currently, individuals have the right to decide what happens to their embryos, but this right may end (The Editors, 2022). Selective reduction, used to lower risks for people pregnant with multiple fetuses, may no longer be an option, which may put the pregnant person’s life at risk, not to mention the lives of the remaining fetuses. All of these changes not only increase the risks to the health of the gestational parent and fetus, but also may additionally make IVF financially unfeasible to many LGBTQIA+ families as only one embryo may be implanted at a time.
Other impacts of overturning Roe
There are many other ways the laws may impact pregnant people who are LGBTQIA+. Although these may not have disproportionate impacts on LGBTQIA+ people, they are being under-discussed in the media and are worth raising here. For example, if a pregnancy results in threat to the pregnant person’s life, such as an ectopic pregnancy, then time is of the essence; traveling to a state where abortion is legal may not be an option, thereby putting the life of the pregnant person at risk. In many jurisdictions, abortions are illegal even when the fetus is not viable which forces the pregnant person to carry the pregnancy to term and labor through delivery, which can be traumatic. In some states, terminations in the instance of rape or incest are no longer an option, even for adolescents who are not even old enough to drive—much less parent. This will disproportionately impact LGBTQIA+ people with the capacity for pregnancy. Abortion restrictions further impact the training of medical students, residents, and fellows who wish to be trained in the full array of reproductive health options. So, even if a pregnant person’s life is in danger due to hemorrhage or other life-threatening pregnancy adverse events, there may not even be a healthcare provider trained in abortion who can provide lifesaving care.
Without access to the full array of reproductive healthcare, LGBTQIA+ people who have the capacity for pregnancy are in grave danger. Those living in jurisdictions without LGBTQIA+ protections like state-level anti-discrimination laws are especially at risk (Charlton, Hatzenbuehler, et al., 2019; Everett, Limburg, et al., 2022). We may likely also see increases in depression, suicidal thoughts and feelings, and completed suicides among trans and nonbinary people (due to gender dysphoria related to pregnancy; a Charlton et al., 2021) and LGBQ cisgender women in the absence of the full array of reproductive health options (Biggs et al., 2017, 2018).
Overturning Roe even further marginalizes queer cisgender women, transgender men, and nonbinary, two-spirit, and intersex people and makes us second-class citizens because it indicates that we cannot be trusted to make decisions about our own bodies and futures. Not being able to control our fertility has significant implications for the ability to work, get an education, and our autonomy. History has repeatedly taught us that when we cannot make decisions about if, when, and how we have children, we are at the mercy of our reproduction which severely limits our opportunities.
Overturning Roe affects the LGBTQIA+ community now—not just because of the potential impacts on marriage equality through Obergefell, but because it immediately restricts the rights of a large proportion of the LGBTQIA+ community immediately. This should concern every single member of the LGBTQIA+ community.
Authors
Cindy Veldhuis is a research psychologist, an Associate Research Scientist at Columbia University, and incoming Assistant Professor at Northwestern University.
Brittany Charlton is an Associate Professor at Harvard Medical School and Co-Director of the Harvard SOGIE Health Equity Research Collaborative.
Bethany Everett is Associate Professor of Sociology and Adjunct Associate Professor of Obstetrics and Gynecology at the University of Utah.
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