Sexual Orientation-Specific Policies Are Associated With Prenatal Care Use in the First Trimester Among Sexual Minority Women: Results From a Prospective Cohort Study

Background 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.Purpose 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.Methods 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).Results 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.Conclusions 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. Previous studies have found that sexual minority women (SMW) are more likely to report adverse infant outcomes, particularly for women who do not live in states with anti-discrimination policies against lesiban, gay, bisexual, transgnder, or queer (LGBTQ) populations. This is the first to examine sexual orientation disparities in prenatal care use using a nationally representative, prospective data set. Additionally, we examined whether prenatal care use varied by the number of state-level policies that protect against discrimination based on sexual orientation. Our results show high rates of prenatal care use in the first trimester across all sexual orientations, however, in states with states with two or more policies that prevent discrimination by sexual orientation, sexual minority women were more likely to access prenatal care in the first trimester than heterosexual women. These findings suggest that more inclusive state-level environments promote healthcare-seeking behaviors during pregnancy for sexual minority women.