How and Why Reproductive Care Is Still Failing LGBTQ+ Families

As a midwife who specializes in supporting the LGBTQ+ community, I see us getting left in the margins all too often. Whether that involves being misgendered by our doctors, seeing providers who make assumptions about who we sleep with or not seeing ourselves reflected in brochures around the office, the experience of getting medical care as an LGBTQ+ person is often daunting—if not downright traumatic.

Reproductive care is no exception. The worlds of fertility care, pregnancy, birth, postpartum and lactation are intensely gendered and full of normative societal expectations—and providers too often don’t know how to appropriately care for LGBTQ+ people who are growing our families.

Ahead, read about five ways that reproductive care is still failing LGBTQ+ families, and three things providers can do to address these disparities.

How Reproductive Care Is Failing LGBTQ+ Families

There’s a lot missing when it comes to reproductive care for LGBTQ+ families. Here’s where things could stand to improve, from a practitioner’s perspective.

Making too many assumptions

Fertility care has historically been geared toward heterosexual, married couples, and many fertility clinics and providers are still caught in these assumptions about their patients. Whether it’s having “husband” instead of “partner” on intake forms or care protocols that assume you’ve been trying to get pregnant at home on your own before accessing fertility care, the generalizations are rampant and contribute to inadequate counseling and a lack of personalized, culturally appropriate care for LGBTQ+ folks accessing fertility services.

Lack of research and protocols for LGBTQ+ people

Most clinical trials and reproductive health studies have historically centered around heterosexual, cisgender populations, leaving gaps in understanding about how various technologies and treatments affect LGBTQ+ individuals. While research focusing on the experiences of LGBTQ+ people in fertility and pregnancy care exists, all too often, doctors and clinics aren’t incorporating this knowledge into their practice.

Without evidence-based protocols, healthcare providers lack the proper guidelines for caring for LGBTQ+ families, leading to inconsistent practices and potential disparities.

Providers and staff lack adequate training and institutional support

Healthcare providers often lack the specific training necessary to address the reproductive needs of LGBTQ+ individuals and families. Much of medical education remains rooted in traditional models that prioritize heterosexual, cisgender patients and providers, other medical staff and front-desk personnel often don’t receive training around supporting LGBTQ+ patients. Without proper training on protocols and support for trans individuals who are stopping gender-affirming hormone therapy to begin their conception process, and without comfort using they/them pronouns or providing documentation that reflects a person’s identity, providers and staff lack the essential tools to serve this population effectively. As a result, the care they provide is often subpar.

Fertility, birth and lactation are profoundly gendered

We live in a heavily gendered society, and the worlds of fertility care, birth and lactation are especially laden with gendered norms in the medical world. I work with many nonbinary and transmasculine people going through the process of trying to conceive or gestating a pregnancy. It’s hard for people who don’t experience the world as cisgender women to get appropriate care in general, but it’s especially difficult when it comes to fertility, birth and feeding our babies. A pregnant trans man may feel alienated in the “Mom and baby” ward, or put off by the pink decorations in labor and delivery. The gendered framing of reproductive care fails to accommodate the realities of LGBTQ+ individuals and families, often leading to trans and nonbinary people seeking care outside of the Western medical systems whenever possible.

There’s a lack of respect around the non-gestational parent’s role

Too often, non-gestational parents in LGBTQ+ families are overlooked throughout their experiences of fertility, pregnancy and birth care. Whether that involves being assumed to be the patient’s sister or not having their pronouns or chosen parent name respected, non-gestational parents too often leave medical settings feeling unseen and unprioritized.

How Providers Can Improve Reproductive Care for LGBTQ+ Families

All people and families deserve dignity and respect when accessing medical care. The reproductive care system has a long way to go to improve care for LGBTQ+ folks, but there are some simple changes that would go a long way. Here, a few ways to start.

Institute staff training around providing culturally sensitive care

Training all staff members, including providers of all levels, front desk and administration staff, to understand the unique challenges that LGBTQ+ people face will help promote safety and inclusion within reproductive care systems. Trainings around understanding diverse gender identities and experiences, the unique dynamics of LGBTQ+ relationships, trans health care and unlearning biases will help create safety for each person who walks through the clinic doors.

Incorporate evidence-based protocols into clinics

The body of research specific to LGBTQ+ fertility and family building is growing—and clinics and providers must incorporate this evidence into how they treat patients. It’s not medically sound to treat a 30-year-old lesbian woman with the same medications used for a 42-year-old who’s been trying to get pregnant at home with her husband for two years without success. Incorporating evidence-based protocols into reproductive care will allow providers to accurately and safely treat each of their patients.

Cultivate representation of all different types of families

The emotional and psychological impact of not seeing your own family represented in reproductive healthcare systems is deep. When institutions can include representation of all types of families in their educational and promotional materials as well as within their walls, it’ll go a long way in fostering a sense of inclusion and safety for everyone involved.

*Marea Goodman, LM, CPM, is a midwife who specializes in supporting the LGBTQ+ community throughout pregnancy, birth and postpartum. They’re also the co-author of *Baby Making for Everybody—Fertility and Family Building for LGBTQ+ and Solo Parents_, and the founder of PregnantTogether, a virtual community supporting queer folks and solo parents from preconception through parenting._