Department of Sociology, University of Utah, Salt Lake City, UT, USA.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Cambridge, MA, USA.
Ann Behav Med. 2024 Aug 7;58(9):594-602. doi: 10.1093/abm/kaae037.
Previous research has shown sexual minority women (SMW) are more likely to report multiple maternal and infant health outcomes compared to heterosexual women and that these outcomes are moderated by the policy environment. Little is known, however, about prenatal care use disparities or the social determinants of prenatal care use for SMW.
To examine the relationship between sexual orientation-specific policies that confer legal protections (e.g., hate crime protections, housing discrimination, same-sex marriage) and prenatal care use among women using a prospective, population-based data set.
Using the National Longitudinal Study of Adolescent to Adult Health and logistic regression, we link measures of state policies to the use of prenatal care in the first trimester among women who had live births. The use of prospective data allows us to adjust for covariates associated with preconception care use prior to pregnancy (n = 586 singleton births to SMW; n = 4,539 singleton births to heterosexual women).
Sexual orientation-specific policies that conferred protections were associated with increased use of prenatal care among pregnancies reported by SMW (OR = 1.86, 95% CI 1.16, 2.96). In fact, in states with zero protections, we found no differences in prenatal care use by sexual minority status; however, in states with two or more protective policies, SMW were more likely to access prenatal care in the first trimester than heterosexual women. There was no relationship between sexual orientation-specific policy environments and prenatal care use among pregnancies reported by heterosexual women.
Recent research has documented that SMW are more likely to have adverse perinatal and obstetrical outcomes than their heterosexual peers. These findings suggest that Lesbian/Gay/Bisexual-specific policy protections may facilitate the use of prenatal care among SMW, a potentially important pathway to improve reproductive health among this population.
先前的研究表明，与异性恋女性相比，性少数群体女性（SMW）更有可能报告多种母婴健康结果，而这些结果受到政策环境的调节。然而，对于性少数群体女性的产前护理使用差异或产前护理使用的社会决定因素知之甚少。
使用前瞻性、基于人群的数据集，研究赋予法律保护的特定性取向政策（例如仇恨犯罪保护、住房歧视、同性婚姻）与女性使用产前护理之间的关系。
我们使用全国青少年至成人健康纵向研究和逻辑回归，将州政策措施与有活产的女性在第一孕期使用产前护理联系起来。前瞻性数据的使用使我们能够调整与怀孕前 preconception 护理使用相关的协变量（n = 586 例性少数群体女性的单胎出生；n = 4539 例异性恋女性的单胎出生）。
赋予保护的特定性取向政策与性少数群体女性报告的妊娠中产前护理使用率的增加相关（OR = 1.86，95% CI 1.16，2.96）。事实上，在没有任何保护政策的州，我们没有发现性少数群体身份对产前护理使用的差异；然而，在有两个或更多保护政策的州，SMW 比异性恋女性更有可能在第一孕期接受产前护理。在异性恋女性报告的妊娠中，性取向特定的政策环境与产前护理使用之间没有关系。
最近的研究表明，SMW 比他们的异性恋同龄人更有可能出现不良围产期和产科结局。这些发现表明，女同性恋/男同性恋/双性恋特定政策保护可能促进 SMW 使用产前护理，这是改善该人群生殖健康的一个潜在重要途径。
