Understanding the Experiences and Needs of LGBTIQA+ Individuals when Accessing Abortion Care and Pregnancy Options Counselling: A scoping review

AbstractBackgroundSafe, accessible, and inclusive abortion care and pregnancy options counselling are essential components of sexual and reproductive health and rights. Recent research has documented LGBTIQA+ people are as or more likely than the general population of women to experience an abortion in their lifetime yet face significant barriers to accessing abortion and related care which undermine wellbeing.AimsThe present study undertakes a scoping review of research on the needs and experiences of the LGBTIQA+ population when accessing abortion care, pregnancy options, and post-abortion counselling, to support improved understanding of pregnant people’s preferences, needs, and experiences.Materials and MethodsOnline academic databases were searched using terms relating to gender identity and sexuality, abortion, pregnancy-options, and post-abortion counselling to identify peer reviewed papers published in English, from which we selected six publications from the United States, and one from Colombia that described experiences of LGBTIQA+ people accessing abortion-related care.ResultsFour of the seven studies reported in-depth or semi-structured interview studies while the remaining three examined cross-sectional surveys. Thematic analysis of all studies highlighted frequent discrimination and exclusion experienced by participants, healthcare avoidance, unsafe abortion, non-disclosure to providers, provision of poor quality of care, and poor health outcomes for LGBTIQA+ people.ConclusionsGender-inclusive services and training for health providers are key to the provision of safe and accessible abortion care, and imperative to overcome generations of mistrust held by the LGBTIQA+ community. Research into the needs of LGBTIQA+ people when accessing pregnancy options counselling is critically needed.Key messagesLGBTIQA+ people experience exclusion, isolation, misgendering, and denial of care when accessing abortion, and barriers faced are compounded by socioeconomic status and race.Poor provision of abortion care and negative experiences for this population result in deep mistrust of providers, non-disclosure of gender/sexuality, healthcare avoidance, and self-induced abortion.Appropriate, inclusive, and accessible care requires gender affirming and inclusive services, educational materials, and intake forms, community consultation, and improved healthcare provider training and knowledge.