Queer Cisgender Women and Gender-Expansive Individuals' Use of "Complicated Strategies" to Navigate Reproductive Health Care

Background and Purpose: The LGBTQ health disparities literature outlines numerous barriers to comprehensive and queer-inclusive care. Queer cisgender women and gender-expansive individuals assigned female at birth (AFAB) experience myriad health disparities related to reproductive health, in part due to the healthcare system. However, few studies have examined how queer individuals cope with and overcome barriers to queer-competent reproductive health care. This study aims to understand the strategies queer cisgender women and gender-expansive individuals use to meet their reproductive health needs.

Methods: Using a modified grounded theory approach, investigators conducted interviews with 22 queer cisgender women and gender-expansive individuals AFAB about their experiences seeking reproductive health care services. We used inductive coding to identify themes related to meeting reproductive health and healthcare needs.

Results: Findings highlighted the prevalence of negative and harmful experiences while seeking reproductive health care. In response to these negative experiences, individuals developed active strategies to meet their health needs: 1) seeking information and community to assist them in becoming better advocates for their health needs and to combat feelings of isolation; 2) seeking alternative models of care to increase the likelihood of access to queer-informed providers and to gain control over their care; and 3) managing identity disclosure to providers, motivated by a fear of discrimination or bias, emotional self-protection, and the desire to get the healthcare they need. Importantly, these strategies varied in effectiveness, depending on participants' social and economic advantage, as participants with more privilege and resources were better able to meet their health needs through the use of these strategies.

Conclusions and Implications: Queer individuals face numerous barriers to queer-competent reproductive health care when seeking reproductive healthcare. While queer patients are often resilient and creative, developing strategies to get their needs met, the presence of such strategies highlights the need for structural changes in the health system to better serve queer patients. Social workers can play an important role both in educating providers, reforming health systems, and advocating for structural changes to address health disparities. Findings from this study also underscore the urgent need to address queerphobia and systematic barriers to LGBTQ equality, both in and out of the health system, to truly address the persistent barriers in queer cisgender women and gender-expansive individuals' reproductive health care outcomes.