Understanding LGBTQ+ Peoples' Experiences of Stigma and Resilience in the Context of Pregnancy Loss: Implications for Social Work Practice

Background and Purpose: Pregnancy loss is a common experience, affecting one-in-four recognized pregnancies in the US. Emerging evidence suggests that bisexual and lesbian women are more likely to experience pregnancy loss than heterosexual women. However, scant literature has focused on pregnancy loss and notably absent is consideration of those with diverse sexual orientations and gender identities, inclusive of lesbian, gay, bisexual, trans, queer, and other sexual and gender minority (LGBTQ+) persons. Moreover, a thorough exploration of how LGBTQ+ persons exhibit resilience in relation to stigmatizing experiences throughout the pregnancy process and in relation to pregnancy loss is a substantial gap in the literature. Thus, the objective of this qualitative study was to explore the experiences of stigma and resilience among LGBTQ+ people in the context of pregnancy and pregnancy loss.

Methods: During April 2019 we conducted 25-70-minute semi-structured individual interviews with 17 persons self-identified LGBTQ+ who had experienced pregnancy loss or been in an intimate partnership in which a pregnancy was lost in the last two years. Participants were recruited via social media networks (e.g., Facebook) and word-of-mouth. Interested participants were purposively selected based on diverse identities (e.g., gender identity, race/ethnicity) and interviewed virtually. Transcribed interviews were analyzed using a thematic approach, facilitated by Dedoose. Four team members (ALD, NA, LR, KW) independently open-coded three transcripts and met together four times to generate a code list. Then, KW continued open coding the remainder of the transcripts, meeting bi-weekly with NA to discuss and refine codes Finally, ALD, NA, and LR reviewed the coding and further conceptualized broader themes.

Results: Two overarching themes included: (1) LGBTQ+-specific experiences of stigma throughout conception, pregnancy, and loss. This theme encapsulated how cisnormativity and heteronormativity contributed to challenges throughout the pregnancy process for LGBTQ+ persons, including financial (e.g., lack of insurance coverage for assisted reproductive technologies), medical (e.g., complex decision-making about methods of conception), and social challenges (e.g., lack of social support). Interpersonal stigma was pervasive (e.g., physician’s judgment of a couple’s donor choice). (2) Resilience among LGBTQ+ people throughout conception, pregnancy, and loss. Resilience manifested as individual resilience (e.g., avoiding health care providers and support spaces known to be heteronormative and/or discriminatory) and collective resilience (e.g., LGBTQ+ persons creating LGBTQ+-specific online spaces for social support). Both stigma and resilience were influenced by intersecting identities across gender identity, gender expression, race, socioeconomic status, disability, and geography. For example, in the absence of trans-inclusive LGBTQ+ online parenting groups, one trans participant sought out trans-specific spaces.

Conclusions and Implications: This study draws attention to a severely overlooked area of LGBTQ+ health. Findings suggest that LGBTQ+ people experience stigmatization throughout the pregnancy process, which also limits their access to social support after experiencing pregnancy loss. However, findings also elucidate both individual and collective resilience strategies among LGBTQ+ people in response to stigmatization. Social workers can learn from these resilience strategies to promote strengths-based and affirming approaches to reproductive health care for LGBTQ+ persons alongside this group.