Why are some LGBTQ girls at higher risk of becoming pregnant?

In the new young-adult novel “Girls Like Me,” author Nina Packebush tells the story of a pregnant 16-year-old who identifies as queer. In a scene where Banjo, the main character, visits her obstetrician for the first time, a women's clinic waiting room is a gauntlet of disapproval and judgment where she feels "too queer, too poor, too much in the middle of the gender binary, and too young."

In one particularly deflating moment, she overhears a nearby child ask, "Mommy, is that boy gonna have a baby?"

Teenage pregnancy in the United States is not typically thought of as a problem for sexual and gender minorities. But it is: In several large-scale, longitudinal studies of American and Canadian adolescents, bisexual and, in some cases, lesbian adolescent women were at higher risk than their heterosexual counterparts of having a pregnancy, and transgender youth were as likely as other youth to be involved in a pregnancy.

It’s difficult to tease out the reasons why young women who aren’t exclusively heterosexual have a higher risk of pregnancy. There are well-established risk factors for teen pregnancy in general populations. For instance, both childhood abuse and early sexual activity are known to increase the risk of teen pregnancy more generally. Some data suggest sexual minorities are exposed to these risk factors more often — although the reasons why aren’t always clear.

In a recent study, Brittany Charlton, a Harvard epidemiologist, and her co-investigators found that girls identifying as "completely heterosexual" had the lowest teen pregnancy risk, while the risk of "mostly heterosexual" girls and lesbians was doubled, and bisexual girls' risk was nearly five-fold in comparison.

In the study, sexual minorities reported suffering higher levels of abuse, mistreatment, and bullying compared with heterosexual girls — and those experiences were important contributors to adolescent pregnancy risk, explaining about half the disparity between heterosexual girls and sexual minorities. It's unknown what explains the other half of the disparity, although it's likely some combination of risk factors unique to LGBTQ teens.

In a previous study, Charlton found that sexual minorities start having sex at younger ages than heterosexual kids do. But it’s not clear yet why sexual minorities are more vulnerable to such risk factors for pregnancy, says Charlton. But we can make some educated hypotheses: A bisexual girl may experience more bullying because she doesn’t dress or look like other girls, or she may be targeted by an abuse perpetrator because she appears more vulnerable. A girl questioning her sexuality might have more and earlier sex with boys in an effort to prove or hide something.

One finding in Charlton’s latest study hints that internalized stigma might play a role: the earlier that girls in her study sample were aware of same-sex attraction and had sexual contact with girls, the more likely they were to have a pregnancy in adolescence.

But fundamentally, we can't yet connect the dots: "We would need more data to really understand what's leading to those risk factors being more common among sexual minorities," Charlton said.

She hopes that a better understanding of these issues will lead to better strategies for preventing pregnancies among adolescents of all sexual orientations. Evidence has shown that sex education — especially when it’s designed to include sexual minority students — can prevent risky sexual behavior in LGBTQ teens, and students in schools with positive representations of LGBTQ topics in the curriculum report hearing stigmatizing remarks less often and feeling safer than do students in schools without such curricula.

Educators and clinicians can take the next steps by including LGBTQ students when they plan sex education curricula and counseling about birth control, says Charlton. As awareness spreads about these downstream effects of abuse and bullying, particularly for bisexual girls, Charlton is hopeful that “parents and other community members can really support their children and [get them] all the access they need, whether it's to reproductive health care or anything else, to really ensure people are able to live their best lives.”

[Photo by Janine via Flickr.]