Rachel Epstein

Service Use and Gaps in Services for Lesbian and Bisexual Women During Donor Insemination, Pregnancy, and the Postpartum Period

OBJECTIVE Increasing numbers of lesbian and bisexual women are choosing to have children. This qualitative study investigated the degree to which a sample of Canadian lesbian and bisexual women were satisfied with the health and social services that they received during the process of trying to conceive, during pregnancy, and during the early postpartum weeks and months. METHODS Three focus groups were conducted: (1) women who were themselves, or whose partners were, in the process of trying to conceive (n = 6); (2) biological parents of young children (n = 7); and (3) women who were non-biological parents of young children or whose partners were currently pregnant (n = 10). Participants were asked to discuss their positive and negative experiences with health and social services during their efforts to conceive and through the perinatal period. RESULTS Participants were very satisfied with the care they received from midwives, doulas, and public health nurses. Services directed specifically to lesbian, gay, and bisexual parents were also perceived to be important sources of information and support. Many participants perceived fertility services to be unsupportive or unable to address their different health care needs. CONCLUSION Participants expressed satisfaction with pregnancy-related services provided by non-physicians and dissatisfaction with services provided by physicians and fertility clinics. There is a strong desire for fertility services specific to lesbian and bisexual women, but even minor changes to existing services could improve the satisfaction of lesbian and bisexual patients.

“I Don't Want to Turn Totally Invisible”: Mental Health, Stressors, and Supports among Bisexual Women during the Perinatal Period

Almost no research has examined the parenting experiences of bisexual people. In this mixed-methods study, sexual minority women (N = 64) who were currently trying to conceive, pregnant, or parenting an infant completed standardized questionnaires to assess mental health, social support, and other variables. Fourteen participants identified as bisexual, and 14 reported sexual activity with men in the past 5 years (there was incomplete overlap between these groups). Twenty women (5 bisexual-identified) also completed a qualitative interview. Bisexual women reported poorer scores on assessments of mental health, substance use, social support, and experiences of perceived discrimination, relative to other women in the sample. Differences were particularly pronounced for women who reported sexual activity with men in the past 5 years compared to women who did not. Qualitative analyses highlighted experiences of invisibility and exclusion. It may be particularly challenging for bisexual women to negotiate the invisibility associated with a bisexual identity during the perinatal period, as a result of the implicit assumption that mothers are heterosexual. This invisibility may be linked with a multitude of poor outcomes that could have implications for the mother, baby, and family.

Lesbian and Queer Mothers Navigating the Adoption System: The Impacts on Mental Health

Abstract Increasing numbers of lesbian, gay, bisexual, transgender, transsexual, and queer (LGBTQ) people are choosing to parent through adoption. The minimal research available, focused particularly on lesbian and gay adoptive parents, suggests they face significant barriers to adoption (including being held to a higher standard than heterosexual adoptive parents), homophobia from child welfare professionals, and limited social support post-adoption. These issues have significant implications for the mental health of LGBTQ adoptive parents, but have not been researched to date. Seven interviews were conducted with Canadian lesbian and queer adoptive parents to examine the mental health impact of adoption and identify barriers to accessing health and social services. Adoptive parents described multiple challenges related to the adoption process and becoming a parent. Further research is needed to identify the long-term mental health effects of the stress of the adoption process on lesbian and queer parents, and their need for support services.

Policy, Practice, and Personal Narratives: Experiences of LGBTQ People with Adoption in Ontario, Canada

In 2000, the Ontario Child and Family Services Act was amended to permit same-sex adoption. The goal of our research was to examine whether this legislative change has translated into increased access to adoption for lesbian, gay, bisexual, trans, and queer (LGBTQ) people. Forty-three LGBTQ individuals/couples who had either adopted successfully or were approved for adoption since 2000 completed a narrative interview. In this paper, we will draw from participants’ stories of adoption to illustrate the current strengths and limitations of the adoption system in Ontario, Canada, and to offer recommendations for further improvements to facilitate access for LGBTQ people.

Sexual and Gender Minority Peoples' Recommendations for Assisted Human Reproduction Services

OBJECTIVE To determine what recommendations lesbian, gay, bisexual, trans, and queer (LGBTQ) people have for provision of assisted human reproduction (AHR) services to their communities. METHODS Using a semi-structured guide, we interviewed a purposeful sample of 66 LGBTQ-identified individuals from across the province of Ontario who had used or had considered using AHR services since 2007. RESULTS Participants were predominantly cisgender (non-trans), white, same-sex partnered, urban women with relatively high levels of education and income. Participants made recommendations for changes to the following aspects of AHR service provision: (1) access to LGBTQ-relevant information, (2) adoption of patient-centred practices by AHR service providers, (3) training and education of service providers regarding LGBTQ issues and needs, (4) increased visibility of LGBTQ people in clinic environments, and (5) attention to service gaps of particular concern to LGBTQ people. CONCLUSION Many of the recommendations made by study participants show how patient-centred models may address inequities in service delivery for LGBTQ people and for other patients who may have particular AHR service needs. Our results suggest that service providers need education to enact these patient-centred practices and to deliver equitable care to LGBTQ patients.

Correlates of Mental Health Service Use Among Lesbian, Gay, and Bisexual Mothers and Prospective Mothers

ABSTRACT Lesbian, gay, and bisexual women undertake parenting in a social context that may be associated with unique risk factors for perinatal depression. This cross-sectional study aimed to describe the mental health services used by women in the perinatal period and to identify potential correlates of mental health service use. Sixty-four women who were currently trying to conceive, pregnant, or the parent of a child less than one year of age were included. One-third of women reported some mental health service use within the past year; 30.6% of women reported a perceived unmet need for mental health services in the past year, with 40% of these women citing financial barriers as the reason for their unmet need. Women who were trying to get pregnant or who were less “out” were most likely to have had recent mental health service use. Women who had conceived by having sex with a man or who reported more than three episodes of discrimination were most likely to report unmet needs for mental health services. Providers may benefit from additional knowledge about the LBG social context that is relevant to perinatal health, and from identifying a strong referral network of skilled and affordable counsellors.

Using interactive theatre to help fertility providers better understand sexual and gender minority patients

Objective To determine the effectiveness of interactive theatre as a knowledge translation and exchange (KTE) method to educate assisted human reproduction (AHR) service providers about lesbian, gay, bisexual, trans and queer (LGBTQ) patients. Design We transformed data from the ‘Creating Our Families’ study, a qualitative, community-based study of LGBTQ peoples’ experiences accessing AHR services, into a script for an interactive theatre workshop for AHR service providers. Based on forum theatre principles, our workshop included five scenes illustrating LGBTQ people interacting with service providers, followed by audience interventions to these scenes. Before and after the workshop, service providers completed surveys to assess their knowledge and comfort concerning LGBTQ patients, as well as the modality of the interactive theatre workshop as a KTE strategy. Wilcoxon signed-rank tests were used to determine changes in preworkshop and postworkshop knowledge and comfort scores. Results Thirty AHR service providers attended the workshop. Twenty-three service providers (76.7%) fully completed the preworkshop and postworkshop evaluation forms. Service providers’ knowledge scores significantly improved after the workshop, while their comfort scores minimally decreased. Most agreed that the interactive workshop was an effective KTE method. Conclusions In comparison with traditional forms of KTE, interactive theatre may be particularly effective in engaging service providers and addressing their attitudes towards marginalised patient populations. Although the evaluation results of our interactive workshop were mostly positive, the long-term impact of the workshop is unknown. Long-term evaluations are needed to determine the effectiveness of arts-based KTE efforts. Other considerations for developing effective arts-based KTE strategies include adequate funding, institutional support, attention to power dynamics and thoughtful collaboration with forum theatre experts.

Policy and Practice Regarding Adoption by Sexual and Gender Minority People in Ontario

En 2000, l’Ontario a modifié la Loi sur les services à l’enfance et à la famille, permettant ainsi à deux gais ou à deux lesbiennes formant un couple d’adopter conjointement un enfant. Dans cet article, nous posons la question suivante : dans quelle mesure les agences d’adoption et les intervenants agréés dans ce domaine soutiennent-ils et appliquent-ils ces mesures qui rendent l’adoption possible parmi les gens membres de minorités sexuelles ? Nos observations indiquent que, dans l’ensemble, la réponse est oui. Toutefois, on observe des disparités en fonction des types d’agences (agences publiques / agences privées / agences internationales ; agences liées à une confession religieuse) et du lieu où elles sont situées (grands centres urbains / petites collectivités), de même que selon la catégorie des personnes qui font une demande d’adoption (lesbiennes et gais / autres minorités sexuelles). En conclusion, nous abordons les implications de ces résultats en termes de politiques publiques et de mesures pratiques.