"I Don't See Birthing As Essential to Having a Family": Exploring Pregnancy and Parenting Choices for Queer Women and Non-Binary Individuals Assigned Female at Birth

Background and Purpose: Queer women and non-binary individuals assigned female at birth (AFAB), are at an increased risk of experiencing an unintended pregnancy, while also facing barriers to achieving intended pregnancies. Research on family planning and pregnancy does not always reflect queer identity. Further, the relationship between the decision to parent and the decision to get pregnant remains under-explored. Pregnancy is only one path to parenthood and should be understood in the context of other ways of becoming a parent. This qualitative study is a first step in centering the voices of queer individuals in an exploration of pregnancy and family formation focused on the concerns and factors most salient to queer AFAB individuals.

Methods: This study is part of a larger project using a modified grounded theory approach to understand the role of queer identity in pregnancy decisions and desires. Investigators conducted in-depth interviews with 25 queer AFAB individuals, ages 20-40, who had been pregnant or were considering pregnancy. Participants were recruited via social media. Interviews were recorded and transcribed verbatim. Two researchers independently coded transcripts using inductive coding. For the current study, investigators conducted selective analysis focusing on sub-themes around pregnancy desires parenting preferences.

Findings: Participants conceptualized pregnancy and parenting decisions differently and saw the decision to become pregnant as related, but distinct from, the decision to parent. Participants described first a desire to parent and second, which path to parenthood was most feasible (pregnancy, adoption, fostering etc.). Notably, the decision how to become a parent was an iterative decision and constantly re-examined. Participants named four key considerations that informed their decision.

First, participants considered the importance of genetic ties. While some participants felt biological connections to be imperative for family formation, others valued this less so. Second, participants considered the acceptability of pregnancy. Some participants were excited by the idea of pregnancy, while others voiced concern about the impact of pregnancy on their queer identity (e.g. being seen as less queer, triggering gender dysphoria). Several participants saw pregnancy as unacceptable but viewed adoption as an acceptable path to parenthood. Third, participants considered their partner(s)’ ability to get pregnant and get them pregnant, as well as their partner(s)’ preferences around parenting. Fourth, participants named the barriers informing their choices. Barriers included accessibility and cost of reproductive health services, including abortion and artificial reproductive technologies (ARTs), lack of social support, and stigma and discrimination in the health system.

Conclusion and Implications: Findings highlight the need to conceptualize pregnancy and parenting as distinct decisions in both social work practice and research to reflect individuals' own understandings of these phenomena. Further, social workers must advocate for removing structural barriers to reproductive health services, including abortion and ART, so that queer individuals can become pregnant under the circumstances that they deem ideal. Simultaneously, social workers must advocate for alternative paths to parenthood and queer family formation. The field’s definition of family must be explicitly queer inclusive and family policies and programs must be supportive of queer families.