Koori Maternity Service, Northern Health, Australia.
Department of Social Work, Griffith University, Australia; Women's Health in the North (WHIN), Australia.
Midwifery. 2023 Aug;123:103712. doi: 10.1016/j.midw.2023.103712. Epub 2023 May 5.
The widespread availability of reproductive technology and family planning services has led to an increase in the number of available pathways to parenthood for LGBTIQA+ people. However, emerging research indicates that significant healthcare inequities have been documented among LGBTIQA+ people and attributed to the pervasiveness of structural and systemic discrimination that extends to preconception and pregnancy care.
The aim of this systematic review was to synthesise qualitative research that has explored the experiences of LGBTIQA+ people in navigating preconception and pregnancy care services to inform healthcare quality improvement.
Six databases were searched for relevant research published between 2012 and 2023. The findings of all included studies underwent a secondary thematic synthesis, and methodological quality was assessed using the Joanna Briggs Institute Checklist for Qualitative Research.
A total of 37 studies were eligible for inclusion. Four major themes were constructed through thematic synthesis: (1) unavailability of information, services, and support; (2) clinical competencies of healthcare staff; (3) hetero- and cis-sexist care experiences; and (4) discrimination and traumatisation.
The findings of this review indicate that LGBTIQA+ people experience significant challenges during the journey towards parenthood, marked predominantly by the pervasiveness of inequity, and defined by discriminatory healthcare processes. This review has led to several recommendations for future healthcare quality improvement through an investment in policies, procedures, and interactions that are sensitive to the needs of LGBTIQA+ people. Importantly, future research must be co-designed and led by LGBTIQA+ community input.
生殖技术和计划生育服务的广泛普及，使得 LGBTIQA+人群获得了更多的生育途径。然而，新出现的研究表明，LGBTIQA+人群存在显著的医疗保健不平等问题，这归因于普遍存在的结构和系统性歧视，这种歧视延伸到了孕前和妊娠护理。
本系统综述旨在综合探索 LGBTIQA+人群在寻求孕前和妊娠护理服务时的经验的定性研究，以为改善医疗保健质量提供信息。
在 2012 年至 2023 年期间，从六个数据库中搜索了相关研究。对所有纳入研究的结果进行了二次主题综合分析，并使用 Joanna Briggs 研究所定性研究检查表评估了方法学质量。
共有 37 项研究符合纳入标准。通过主题综合分析构建了四个主要主题：（1）信息、服务和支持的不可用；（2）医疗保健人员的临床能力；（3）异性恋和顺性别化的护理体验；（4）歧视和创伤。
本综述的结果表明，LGBTIQA+人群在生育之旅中面临重大挑战，主要表现为不平等现象的普遍存在，并以歧视性的医疗保健过程为特征。本综述提出了一些建议，以通过对政策、程序和互动的投资来改善未来的医疗保健质量，这些投资应敏感地满足 LGBTIQA+人群的需求。重要的是，未来的研究必须由 LGBTIQA+社区的投入共同设计和主导。
