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.
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By “non-heterosexual,” we mean people who are attracted to or have had experience with same-sex partners, or people who identify as lesbian, gay, bisexual, or not straight.
See Table 5 in the appendix for a comparison of our analytic sample, the full RDSL sample, and women aged 18/19 in the nationally representative National Survey of Family Growth sample. We discuss differences between these samples and the potential effect of selection bias on our results in greater detail in the Discussion section.
Some notable differences between NSFG and RDSL question wording produce different prevalences of non-heterosexuality. (NSFG prevalences describe women ages 18–24; see Copen et al. 2016). The NSFG behavior measure specifies sex (19.4 % report a lifetime history of any sex with a female partner), and the RDSL measure captures a broader range of romantic and sexual behavior. The NSFG identity question limits response options to heterosexual/straight, homosexual/gay, or bisexual (10.5 % report anything other than straight). The NSFG attraction question includes response options for “only” men/women, “mostly” men/women, and “equally” men/women (24.1 % report anything other than “only the opposite sex”), while the RDSL measure includes a more open-ended response option. RDSL measurement choices are informed by sexualities research (Diamond 2008a, b) and community-specific recommendations for language choice (Badgett 2009) and are designed to capture a broad range of non-heterosexual people and practices.
As a sensitivity check, we conduct a version of analyses excluding respondents who answered, “I don’t label myself in this way.” These results are comparable with those presented here.
The diversity of terms used in research on sexual minorities reflects the inherent complexity of sexuality as well as the foci and priorities of different research traditions. We have used terms that clearly and consistently identify our three analytic groups, reflect meaningful distinctions among our respondents, and are common in research on sexuality and popular discourse (Coleman-Fountain 2014; Diamond 2008a, b; Savin-Williams and Vrangalova 2013).
The prevalence of non-heterosexual identity in the RDSL sample is comparable with the prevalence of non-heterosexual identity in the Add Health sample (15 %) (Savin-Williams and Ream 2007).
These associations could result from sociodemographic differences in behavior, identity, and attraction but could also result from differences in young women’s willingness to disclose non-heterosexuality to a researcher.
Hispanic ethnicity is assessed in a separate question. Our sample includes 19 Hispanic black women and 28 Hispanic white women whom we categorize as black and nonblack, respectively. The “Other” groups are combined with white respondents as part of the nonblack category because they more closely resemble white women.
Results do not change appreciably when these three variables are included as separate predictors.
A respondent in a long-term relationship at baseline who stayed with that partner for much or all of the journal study could have a very high value on average relationship duration. Results do not change when long relationship outliers (n = 6) are excluded.
This is consistent with an analysis of sexual behavior among college women that found that some lesbian and bisexual women reported having “penetrative sex” with women (Ford and England 2015). The authors hypothesized that this could be sex with fingers or toys, and called for researchers to include unambiguous definitions of sex in survey language.
Women were already pregnant in 1,923 journal weeks (4.1 % of weeks in the analytic sample). Women reported strong pregnancy desire in 738 journal weeks (1.5 % of weeks in the analytic sample). When these weeks are excluded, the analytic sample decreases from 579 to 578 women because one woman reported strong pregnancy desire in all journals. These 578 women contributed 47,068 eligible weeks.
We categorize each use week as LARC (long-acting reversible contraception: includes IUD, implant, and Depo-Provera), pill/patch/ring, condoms, or withdrawal. Categories are mutually exclusive and give priority to the most effective method used in a given week.
OLS regression may yield illogical estimates when the outcome is a proportion. Thus, we conducted a version of analyses using generalized linear models (GLM) with a binomial error distribution, which is appropriate when the outcome is bounded from [0,1] and both endpoints are valid values (Papke and Wooldridge 1996). This method produced nearly identical results and the same substantive conclusions, so we present the OLS models for ease of interpretation. (GLM results are not shown; available upon request.)
We ran all models with and without controls. We present only the version with controls because the sexuality coefficients do not change appreciably when controls are added.
Weighted proportions among women aged 18/19 in the 2006–2010 NSFG (authors’ tabulations).
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.
Badgett, M. V. L. (2009). Best practices for asking questions about sexual orientation on surveys. Los Angeles, CA: Williams Institute. Retrieved from http://williamsinstitute.law.ucla.edu/wp-content/uploads/SMART-FINAL-Nov-2009.pdf
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.
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.
Barber, J. S., & East, P. L. (2011). Children’s experiences after the unintended birth of a sibling. Demography, 48, 101–125.
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.
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.
Baumle, A. K. (Ed.). (2013). International handbook on the demography of sexuality (Vol. 5). Dordrecht, The Netherlands: Springer.
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.
Bongaarts, J. (1978). A framework for analyzing the proximate determinants of fertility. Population and Development Review, 4, 105–132.
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 http://fenwayhealth.org/documents/the-fenway-institute/policy-briefs/Policy_Brief_WhyGather..._v6_01.09.12.pdf
Budnick, J. (2016). “Straight girls kissing”? Understanding same-gender sexuality beyond the elite college campus. Gender & Society, 30, 745–768.
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.
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.
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.
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
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.
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.
Coleman-Fountain, E. (2014). Lesbian and gay youth and the question of labels. Sexualities, 17, 802–817.
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.
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.
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.
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.
Diamond, L. M. (2008a). Sexual fluidity: Understanding women’s love and desire. Cambridge, MA: Harvard University Press.
Diamond, L. M. (2008b). Female bisexuality from adolescence to adulthood: Results from a 10-year longitudinal study. Developmental Psychology, 44, 5–14.
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.
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.
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.
Flores, A. (2014). National trends in public opinion on LGBT rights in the United States. Los Angeles, CA: Williams Institute. Retrieved from http://williamsinstitute.law.ucla.edu/wp-content/uploads/POP-natl-trends-nov-2014.pdf
Ford, J., & England, P. (2015). Women’s queer sexuality in college. Contexts. Retrieved from http://contexts.org/blog/womens-queer-sexuality-in-college/
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.
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.
Gates, G. J. (2011). LGBT identity: A demographer’s perspective. Loyola Law Review, 45, 693–714.
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.
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.
GLSEN (Gay, Lesbian and Straight Education Network). (2014). School Climate in Michigan (2013 State Snapshot). New York, NY: GLSEN. Retrieved from http://www.glsen.org/content/michigan-snapshot-2013
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.
Hamilton, L. (2007). Trading on heterosexuality: College women’s gender strategies and homophobia. Gender & Society, 21, 145–172.
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.
Institute of Medicine (IOM). (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding (Report). Retrieved from http://iom.nationalacademies.org/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx
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 http://www.cdc.gov/nchs/data/nhsr/nhsr060.pdf
Kapadia, F., & Landers, S. (2013). The health of sexual minorities: A new frontier. American Journal of Public Health, 103, 1735.
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.
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.
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.
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.
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.
Makadon, H. (2011). Ending LGBT invisibility in health care: The first step in ensuring equitable care. Cleveland Clinic Journal of Medicine, 78, 220–224.
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.
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.
Musick, K., England, P., Edgington, S., & Kangas, N. (2009). Education differences in intended and unintended fertility. Social Forces, 88, 543–572.
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).
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 http://www.nimhd.nih.gov/about/directors-corner/message.html
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.
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.
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.
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.
Rupp, L. J., & Taylor, V. (2010). Straight girls kissing. Contexts, 9(3), 28–32.
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.
Rust, P. R. (2000). Bisexuality in the United States: A social science reader. New York, NY: Columbia University Press.
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.
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.
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.
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.
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.
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.
Sell, R. L. (1997). Defining and measuring sexual orientation: A review. Archives of Sexual Behavior, 26, 643–658.
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.
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.
Tabatabai, A. (2015). Lesbian, queer, and bisexual women in heterosexual relationships: Narratives of sexual identity. Lanham, MD: Lexington Books.
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.
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 http://www.healthypeople.gov/2020/topics-objectives/topic/family-planning
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 http://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health
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).
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Ela, E.J., Budnick, J. Non-Heterosexuality, Relationships, and Young Women’s Contraceptive Behavior. Demography 54, 887–909 (2017). https://doi.org/10.1007/s13524-017-0578-y
- Non-heterosexual young women