, Volume 54, Issue 3, pp 887–909 | Cite as

Non-Heterosexuality, Relationships, and Young Women’s Contraceptive Behavior



Non-heterosexual young women have a higher rate of unintended pregnancy than their heterosexual peers, but their fertility behaviors are understudied. We use longitudinal data from the Relationship Dynamics and Social Life study to investigate mechanisms contributing to non-heterosexual women’s higher pregnancy risk. These data include weekly reports of relationships, sex, and contraceptive use over 30 months. We compare the relationships and fertility behaviors of three groups: exclusively heterosexual (consistent heterosexual behavior, identity, and attraction); mostly heterosexual (heterosexual identity with same-sex behavior and/or same-sex attraction); and LGBTQ (any non-heterosexual identity). We find that mostly heterosexual and LGBTQ women behave differently from exclusively heterosexual women in ways likely to elevate their risk of unintended pregnancy: more distinct partners during the study period, more sexual intercourse with men, less frequent contraceptive use, less use of a dual method (condom plus hormonal method), and more gaps in contraceptive coverage. Mostly heterosexual women resemble LGBTQ women in their contraceptive behavior but have significantly more intercourse with men, which may increase their pregnancy risk relative to both LGBTQ and exclusively heterosexual women. We conclude by considering implications for LGBTQ health and the measurement of sexual minority populations.


Relationships Contraception Sexuality Non-heterosexual young women 



We are grateful to Jennifer Barber, Yasamin Kusunoki, Heather Gatny, and the RDSL working group for their support and feedback on earlier drafts. We gratefully acknowledge grants from National Institute of Child Health and Human Development (R01 HD050329, R01 HD050329-S1; PI Barber, R24 HD041028, T32 HD007339) and the National Institute on Drug Abuse (R21 DA024186; PI Axinn). Earlier versions were presented at the annual meetings of the American Sociological Association (San Francisco, August, 2014) and the Population Association of America (San Diego, May, 2015).


  1. Allison, R., & Risman, B. J. (2014). It goes hand in hand with the parties: Race, class, and residence in college student negotiations of hooking up. Sociological Perspectives, 57, 102–123.CrossRefGoogle Scholar
  2. Badgett, M. V. L. (2009). Best practices for asking questions about sexual orientation on surveys. Los Angeles, CA: Williams Institute. Retrieved from
  3. Barber, J. S., Axinn, W. G., & Thornton, A. (1999). Unwanted childbearing, health, and mother-child relationships. Journal of Health and Social Behavior, 40, 231–257.Google Scholar
  4. Barber, J. S., & East, P. L. (2009). Home and parenting resources available to siblings depending on their birth intention status. Child Development, 80, 921–939.Google Scholar
  5. Barber, J. S., & East, P. L. (2011). Children’s experiences after the unintended birth of a sibling. Demography, 48, 101–125.CrossRefGoogle Scholar
  6. Barber, J. S., Kusunoki, Y., & Gatny, H. (2011). Design and implementation of an online weekly journal to study unintended pregnancies. Vienna Yearbook of Population Research, 9, 327–334.CrossRefGoogle Scholar
  7. Bauermeister, J. A., Meanley, S., Hickok, A., Pingel, E., VanHemert, W., & Loveluck, J. (2013). Sexuality-related work discrimination and its association with the health of sexual minority emerging and young adult men in the Detroit metro area. Sexuality Research and Social Policy, 11, 1–10.CrossRefGoogle Scholar
  8. Baumle, A. K. (Ed.). (2013). International handbook on the demography of sexuality (Vol. 5). Dordrecht, The Netherlands: Springer.Google Scholar
  9. Black, D., Gates, G., Sanders, S., & Taylor, L. (2000). Demographics of the gay and lesbian population in the United States: Evidence from available systematic data sources. Demography, 37, 139–154.CrossRefGoogle Scholar
  10. Bongaarts, J. (1978). A framework for analyzing the proximate determinants of fertility. Population and Development Review, 4, 105–132.CrossRefGoogle Scholar
  11. Bradford, J. B., Cahill, S., Grasso, C., & Makadon, H. J. (2012). Policy focus: How to gather data on sexual orientation and gender identity in clinical settings. Los Angeles, CA: Fenway Institute. Retrieved from
  12. Budnick, J. (2016). “Straight girls kissing”? Understanding same-gender sexuality beyond the elite college campus. Gender & Society, 30, 745–768.Google Scholar
  13. Cahill, S. R., Baker, K., Deutsch, M. B., Keatley, J., & Makadon, H. J. (2015). Inclusion of sexual orientation and gender identity in Stage 3 Meaningful Use guidelines: A huge step forward for LGBT health. LGBT Health, 3, 100–102.CrossRefGoogle Scholar
  14. Chandra, A., Copen, C., & Mosher, W. (2013). Sexual behavior, sexual attraction, and sexual identity in the United States: Data from the 2006-2010 National Survey of Family Growth. In International Handbook on the Demography of Sexuality (pp. 45–66). Dordrecht: Springer.Google Scholar
  15. Chandra, A., Mosher, W., Copen, C., & Sionean, C. (2011). Sexual behavior, sexual attraction, and sexual identity in the United States: Data from the 2006–2008 National Survey of Family Growth (National Health Statistics Reports No. 36). Hyattsville, MD: National Center for Health Statistics.Google Scholar
  16. Charlton, B. M., Corliss, H. L., Missmer, S. A., Rosario, M., Spiegelman, D., & Austin, S. B. (2013). Sexual orientation differences in teen pregnancy and hormonal contraceptive use: An examination across 2 generations. American Journal of Obstetrics and Gynecology, 209, 204.e1–204.e8. doi:10.1016/j.ajog.2013.06.036
  17. Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71, 53–61.CrossRefGoogle Scholar
  18. Coker, T. R., Austin, S. B., & Schuster, M. A. (2010). The health and health care of lesbian, gay, and bisexual adolescents. Annual Review of Public Health, 31, 457–477.CrossRefGoogle Scholar
  19. Coleman-Fountain, E. (2014). Lesbian and gay youth and the question of labels. Sexualities, 17, 802–817.CrossRefGoogle Scholar
  20. Conron, K., Mimiaga, M., & Landers, S. (2010). A population-based study of sexual orientation identity and gender differences in adult health. American Journal of Public Health, 100, 1953–1960.CrossRefGoogle Scholar
  21. Copen, C. A., Chandra, A., & Fabo-Vezquez, I. (2016). Sexual behavior, sexual attraction, and sexual orientation among adults aged 18–44 in the United States: Data from the 2011–2013 National Survey of Family Growth (National Health Statistics Reports No. 88). Hyattsville, MD: National Center for Health Statistics.Google Scholar
  22. Corliss, H. L., Goodenow, C. S., Nichols, L., & Austin, S. B. (2011). High burden of homelessness among sexual-minority adolescents: Findings from a representative Massachusetts high school sample. American Journal of Public Health, 101, 1683–1689.CrossRefGoogle Scholar
  23. Diamant, A. L., Schuster, M. A., & Lever, J. (2000). Receipt of preventive health care services by lesbians. American Journal of Preventive Medicine, 19, 141–148.CrossRefGoogle Scholar
  24. Diamond, L. M. (2008a). Sexual fluidity: Understanding women’s love and desire. Cambridge, MA: Harvard University Press.Google Scholar
  25. Diamond, L. M. (2008b). Female bisexuality from adolescence to adulthood: Results from a 10-year longitudinal study. Developmental Psychology, 44, 5–14.CrossRefGoogle Scholar
  26. Durso, L. E., & Meyer, I. H. (2013). Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sexuality Research & Social Policy, 10, 35–42.CrossRefGoogle Scholar
  27. Finer, L. B., & Henshaw, S. K. (2006). Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual and Reproductive Health, 38, 90–96.CrossRefGoogle Scholar
  28. Finer, L. B., & Zolna, M. R. (2013). Shifts in intended and unintended pregnancies in the United States, 2001–2008. American Journal of Public Health, 104(Suppl. 1), S43–S48.Google Scholar
  29. Flores, A. (2014). National trends in public opinion on LGBT rights in the United States. Los Angeles, CA: Williams Institute. Retrieved from
  30. Ford, J., & England, P. (2015). Women’s queer sexuality in college. Contexts. Retrieved from
  31. Fredriksen-Goldsen, K. I., Kim, H.-J., Barkan, S. E., Balsam, K. F., & Mincer, S. L. (2010). Disparities in health-related quality of life: A comparison of lesbians and bisexual women. American Journal of Public Health, 100, 2255–2261.CrossRefGoogle Scholar
  32. Frost, J. J., Singh, S., & Finer, L. B. (2007). Factors associated with contraceptive use and nonuse, United States, 2004. Perspectives on Sexual and Reproductive Health, 39, 90–99.CrossRefGoogle Scholar
  33. Gates, G. J. (2011). LGBT identity: A demographer’s perspective. Loyola Law Review, 45, 693–714.Google Scholar
  34. Gatny, H., Couper, M., Axinn, W. G., & Barber, J. (2009). Using debit cards for incentive payments: Experiences of a weekly survey study. Survey Practice, 2(7), 1–5.Google Scholar
  35. Gipson, J. D., Koenig, M. A., & Hindin, M. J. (2008). The effects of unintended pregnancy on infant, child, and parental health: A review of the literature. Studies in Family Planning, 39, 18–38.CrossRefGoogle Scholar
  36. GLSEN (Gay, Lesbian and Straight Education Network). (2014). School Climate in Michigan (2013 State Snapshot). New York, NY: GLSEN. Retrieved from
  37. Goodenow, C., Szalacha, L. A., Robin, L. E., & Westheimer, K. (2008). Dimensions of sexual orientation and HIV-related risk among adolescent females: Evidence from a statewide survey. American Journal of Public Health, 98, 1051–1058.CrossRefGoogle Scholar
  38. Hamilton, L. (2007). Trading on heterosexuality: College women’s gender strategies and homophobia. Gender & Society, 21, 145–172.CrossRefGoogle Scholar
  39. Hiestand, K., Horne, S., & Levitt, H. (2007). Effects of gender identity on experiences of healthcare for sexual minority women. Journal of LGBT Health Research, 3(4), 15–27.CrossRefGoogle Scholar
  40. Institute of Medicine (IOM). (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding (Report). Retrieved from
  41. Jones, J., Mosher, W., & Daniels, K. (2012). Current contraceptive use in the United States, 2006–2010, and changes in patterns of use since 1995 (National Health Statistics Reports No. 60). Hyattsville, MD: National Center for Health Statistics. Retrieved from
  42. Kapadia, F., & Landers, S. (2013). The health of sexual minorities: A new frontier. American Journal of Public Health, 103, 1735.Google Scholar
  43. Kravdal, Ø., & Rindfuss, R. R. (2008). Changing relationships between education and fertility: A study of women and men born 1940 to 1964. American Sociological Review, 73, 854–873.CrossRefGoogle Scholar
  44. Kusunoki, Y., Barber, J. S., Ela, E. J., & Bucek, A. (2016). Race and other sociodemographic differences in sex and contraceptive use among young women. Demography, 53, 1399–1428.CrossRefGoogle Scholar
  45. Laumann, E., Gagnon, J., Michael, R., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago, IL: University of Chicago Press.Google Scholar
  46. Lesthaeghe, R. J., & Neidert, L. (2006). The second demographic transition in the United States: Exception or textbook example? Population and Development Review, 32, 669–698.CrossRefGoogle Scholar
  47. Li, G., Katz-Wise, S. L., & Calzo, J. P. (2014). The unjustified doubt of Add Health studies on the health disparities of non-heterosexual adolescents: Comment on Savin-Williams and Joyner (2014). Archives of Sexual Behavior, 43, 1023–1026.CrossRefGoogle Scholar
  48. Makadon, H. (2011). Ending LGBT invisibility in health care: The first step in ensuring equitable care. Cleveland Clinic Journal of Medicine, 78, 220–224.CrossRefGoogle Scholar
  49. Manlove, J., Ryan, S., & Franzetta, K. (2007). Contraceptive use patterns across teens’ sexual relationships: The role of relationships, partners, and sexual histories. Demography, 44, 603–621.CrossRefGoogle Scholar
  50. Morgan, E. M. (2014). Outcomes of sexual behaviors among sexual minority youth: Outcomes of sexual behaviors among sexual minority youth. New Directions for Child and Adolescent Development, 2014(144), 21–36.CrossRefGoogle Scholar
  51. Musick, K., England, P., Edgington, S., & Kangas, N. (2009). Education differences in intended and unintended fertility. Social Forces, 88, 543–572.CrossRefGoogle Scholar
  52. National Campaign to Prevent Teen and Unplanned Pregnancy. (2015). Teen childbearing in the United States, 2014 birth data—National campaign. Hyattsville, MD: National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC).Google Scholar
  53. National Institute on Minority Health and Health Disparities (NIMHHD). (2016). Sexual and gender minorities formally designated as a health disparity population for research purposes (Director's message). Retrieved from
  54. Papke, L. E., & Wooldridge, J. M. (1996). Econometric methods for fractional response variables with an application to 401(k) plan participation rates. Journal of Applied Econometrics, 11, 619–632.Google Scholar
  55. Pearson, J., & Wilkinson, L. (2013). Adolescent sexual experiences. In A. K. Baumle (Ed.), International handbook on the demography of sexuality (pp. 167–194). Dordrecth, The Netherlands: Springer.Google Scholar
  56. Powell, B., Blozendahl, C., Geist, C., & Steelman, L. C. (2012). Counted out: Same-sex relations and Americans’ definitions of family. New York, NY: Russell Sage Foundation.Google Scholar
  57. Roberts, A. L., Rosario, M., Corliss, H. L., Koenen, K. C., & Austin, S. B. (2012). Elevated risk of posttraumatic stress in sexual minority youths: Mediation by childhood abuse and gender nonconformity. American Journal of Public Health, 102, 1587–1593.CrossRefGoogle Scholar
  58. Rupp, L. J., & Taylor, V. (2010). Straight girls kissing. Contexts, 9(3), 28–32.Google Scholar
  59. Rupp, L. J., Taylor, V., Regev-Messalem, S., Fogarty, A., & England, P. (2014). Queer women in the hookup scene: Beyond the closet? Gender & Society, 28, 212–235.CrossRefGoogle Scholar
  60. Rust, P. R. (2000). Bisexuality in the United States: A social science reader. New York, NY: Columbia University Press.Google Scholar
  61. Saewyc, E. M. (2011). Research on adolescent sexual orientation: Development, health disparities, stigma, and resilience: Sexual orientation decade in review. Journal of Research on Adolescence, 21, 256–272.CrossRefGoogle Scholar
  62. Saewyc, E., Pettingell, S., & Skay, C. (2004). Teen pregnancy among sexual minority youth during the 1990s: Countertrends in a population at risk. Journal of Adolescent Health, 34, 125–126.Google Scholar
  63. Saewyc, E. M., Bearinger, L. H., Blum, R. W., & Resnick, M. D. (1999). Sexual intercourse, abuse and pregnancy among adolescent women: Does sexual orientation make a difference? Family Planning Perspectives, 31, 127–131.Google Scholar
  64. Savin-Williams, R. C., & Ream, G. L. (2007). Prevalence and stability of sexual orientation components during adolescence and young adulthood. Archives of Sexual Behavior, 36, 385–394.CrossRefGoogle Scholar
  65. Savin-Williams, R. C., & Vrangalova, Z. (2013). Mostly heterosexual as a distinct sexual orientation group: A systematic review of the empirical evidence. Developmental Review, 33, 58–88.CrossRefGoogle Scholar
  66. Schwartz, P., Serafini, B. J., & Cantor, R. (2013). Sex in committed relationships. In A. K. Baumle (Ed.), International Handbook on the Demography of Sexuality (pp. 131–166). Dordrecht, The Netherlands: Springer.Google Scholar
  67. Sell, R. L. (1997). Defining and measuring sexual orientation: A review. Archives of Sexual Behavior, 26, 643–658.CrossRefGoogle Scholar
  68. Sonfield, A., Kost, K., Gold, R. B., & Finer, L. B. (2011). The public costs of births resulting from unintended pregnancies: National and state-level estimates. Perspectives on Sexual and Reproductive Health, 43, 94–102.CrossRefGoogle Scholar
  69. St. Pierre, M. (2012). Under what conditions do lesbians disclose their sexual orientation to primary healthcare providers? A review of the literature. Journal of Lesbian Studies, 16, 199–219.CrossRefGoogle Scholar
  70. Tabatabai, A. (2015). Lesbian, queer, and bisexual women in heterosexual relationships: Narratives of sexual identity. Lanham, MD: Lexington Books.Google Scholar
  71. Tornello, S. L., Riskind, R. G., & Patterson, C. J. (2014). Sexual orientation and sexual and reproductive health among adolescent young women in the United States. Journal of Adolescent Health, 54, 160–168.CrossRefGoogle Scholar
  72. U.S. Department of Health and Human Services (USDHHS). (2014a). Healthy People 2020: Goals for family planning. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved from
  73. U.S. Department of Health and Human Services (USDHHS). (2014b). Healthy People 2020: Goals for lesbian, gay, bisexual, and transgender health. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved from

Copyright information

© Population Association of America 2017

Authors and Affiliations

  1. 1.Population Studies Center, Institute for Social ResearchUniversity of MichiganAnn ArborUSA

Personalised recommendations