QUICK FACTS
• LBQ cisgender women are stascally as likely to have had aborons in their lifeme as
straight cisgender women (22.8% vs 17.3%).
1
• Nearly half of LBQ cisgender women who have been pregnant became pregnant in their teen
years.
2
• For bisexually idened women ages 15-44, the odds of an unwanted pregnancy are 1.75
mes greater than their heterosexual peers.
3
• Sexually acve, self-idened bisexual girls are 1.72 mes more likely to become pregnant
than their sexually acve straight high school-aged peers.
4
• LBQ cisgender women, as well as transgender people whose sex assigned at birth is female,
are less likely than their straight cisgender peers to have had cancer screenings, such as Pap
smears or mammograms.
5
1
Bianca D.M. Wilson et al., Health and Socioeconomic Well-Being of LBQ Women in the US, Mar. 2021),
2
Id.
3
Sexual Orientaon Disparies in Mismed and Unwanted Pregnancy
Among Adult Women
Sexual Orientaon Disparies in Pregnancy Risk Behaviors and Pregnancy Among Sexually Acve Teenage
Girls: Updates from the Youth Risk Behavior Survey, Oct. 2019),
Mapping the Scienc Literature on Reproducve Health Among
Transgender and Gender Diverse People: A Scoping Review, 29
Pap Test Use is Lower Among Female-to-Male
Cathren Cohen, Bianca D.M. Wilson, Kerith J. Conron
Center on Reproductive Health,
Law, and Policy
The Implicaons of Dobbs on
Reproducve Health Care Access
for LGBTQ People Who Can Get
Pregnant
Dobbs
On June 24, 2022, the United States Supreme Court struck down Roe v. Wade and Planned Parenthood v.
Casey by issuing the Dobbs v. Jackson Women’s Health Organizaon decision, which found that there is no
right to aboron protected by the federal Constuon. As a result, aboron access is currently determined
by individual states, and 26 states have already or are likely to ban or severely restrict aboron.
6
Policies
that restrict aboron care are oen accompanied by decreased access to other reproducve health
services, including contracepon, and worsened health outcomes for both women and children.
7
Most conversaons and media aenon about the impact of Dobbs have focused on harms to the
health and well-being of cisgender heterosexual women. However, restricng aboron access will
also impact members of the LGBTQ community. It is essenal to consider the unique and signicant
impacts on LGBTQ people who can get pregnant (including LBQ cisgender women and transgender
people who can become pregnant) in discussions about the harm caused by the rollback of aboron
and sexual and reproducve health care access across the country.
LBQ cisgender women are more likely to lack health insurance coverage compared to straight women;
14.3% (nearly 1 in 6) reported having no health insurance compared with 10.1% of straight women.
8
Slightly more LBQ cisgender women relied on Medicaid for health insurance coverage than their
straight counterparts (13.3% vs 10.7%).
9
In addion, LBQ cisgender women were more likely than
straight women to report not having a regular health care provider (29.3% versus 15.7%).
10
Within
this group, bisexual women were signicantly more likely to report not having a regular health care
Paents Than Non-Transgender WomenThe Report of the 2015
U.S. Transgender Survey,
.
26 States Are Certain or Likely to Ban Aboron Without Roe: Here’s Which Ones and Why,
.
See, e.g.How Liming Access to Aboron Limits Access to Birth Control,
Evaluang Priories: Measuring Women’s and Children’s Health and Well-being against Aboron Restricons in the States,
Liming Aboron Access Contributes to Poor Maternal
Health Outcomes,
.
supra note 1, , Behavioral Risk Factor Surveillance
System Survey Data).
9
Id.
10
Id.
Dobbs
provider compared to lesbian women (31% versus 25%).
11
In general, transgender people experience discriminaon, mistreatment, or denials of care when seeking
health care and oen have diculty nding providers who are knowledgeable and able to provide trans-
competent health care.
12
In parcular, transgender men and nonbinary people who can get pregnant
can face dicules nding inclusive and arming reproducve health care, including providers who use
gendered language or incorrectly assume that all of their paents idenfy as female.
13
However, more
research is needed on the specic reproducve health care experiences of transgender people.
Research indicates that LGBTQ people assigned female at birth are less likely to receive cancer screenings
such as Pap tests and mammograms. An analysis of the Centers for Disease Control and Prevenon’s
Behavioral Risk Factor Surveillance System (BRFSS) found that LBQ women are less likely to have received
a Pap test in the last ve years; 69% of LBQ women had received this screening, compared to 80% of
straight women.
14
LBQ women overall were less likely to have received a mammogram: only 42.8% of
LBQ women had ever had a mammogram, compared with 70.8% of straight women.
15
Transgender men
are less likely to obtain regular Pap tests compared to cisgender women, and the 2015 U.S. Transgender
Survey found that 13% of transgender respondents had been denied coverage by a health insurance
company for supposedly gender-specic services such as Pap smears and mammograms.
16
Unplanned pregnancies are more common among cisgender bisexual girls and women than their
heterosexual peers.
17
Sexually acve, self-idened bisexual girls are 1.72 mes more likely to become
11
Id.
See LGBTQ People in the US: Select Findings from the Generaons and TransPop
Studies,
Discriminaon in America: Experiences and Views of LGBTQ Americans
Discriminaon Prevents LGBTQ People From Accessing Health Care,
13
See, e.g., Beyond the Binary: Sexual and Reproducve Health Consideraons for Transgender and Gender
Expansive Adolescents, 3 .
supra
Id.
supra supra supra
See Kerith Conron et al., Reproducve Health Care and LBT Adults,
supra Sexual
Orientaon and Risk of Pregnancy Among New York City High-School Students
supra note 3).
Dobbs
pregnant than their sexually acve straight high school-aged peers.
18
For bisexually idened women
ages 15-44, the odds of an unwanted pregnancy are 1.75 mes greater than their heterosexual
peers.
19
In fact, a signicant number of LBQ women—nearly half of those who have been pregnant—
become pregnant in their teen years.
20
In addion, LBQ cisgender women are stascally similarly likely to have had aborons in their lifeme
compared to straight cisgender women (22.8% vs 17.3%).
21
It is possible that the Hyde Amendment’s
prohibion on payment for aboron care through federal Medicaid funds has limited access to
aboron for LBQ cisgender women; 13.3% of LBQ cisgender women are insured through Medicaid
(compared to 10.7% of straight cisgender women).
22
Although 16 states currently use state funds to
pay for aborons in their state Medicaid programs,
23
LBQ women enrolled in Medicaid in the majority
of states cannot rely on their insurance and instead must pay out-of-pocket for aboron care.
Contracepve use, aboron, and birth rates for transgender people are understudied.
24
However,
transgender people assigned female at birth do experience pregnancy and may face dicules
obtaining contracepon and other reproducve health services.
25
LBQ cisgender women are less likely to have a doctor ask about their interest in geng pregnant than
their straight cisgender counterparts, despite considerable interest in expanding and starng families.
26
An analysis of the Naonal Survey of Family Growth shows that 24.9% of LBQ cisgender women have had
supra
19
supra note 3.
20
supra
21
Id
22
supra note 1,
23
See KFF, State Funding of
Aborons Under Medicaid
.
supra but see Transgender Aboron Paents and the
Provision of Transgender-Specic Care at Non-Hospital Facilies that Provide Aborons, 2
supra see Not Up for Debate: LGBTQ People Need and Deserve Tailored
Sexual and Reproducve Health Care,
.
supra see also LGBTQ Family Building Survey,
Dobbs
a doctor ask them if they wanted to get pregnant, compared to 32.8% of straight cisgender women.
27
Some (14.6%) LBQ cisgender women have used inseminaon services intended to achieve pregnancy
(compared to 19.1% of straight cisgender women).
28
In general, more LGB cisgender women than
straight women reported wanng but not being able to have children (15.3% vs 8%, respecvely).
29
Transgender people who can get pregnant also face dicules with services related to pregnancy,
childbearing, and parenng, including limited access to ferlity preservaon and assisted
reproducve services.
30
While the overturning of Roe v. Wade will allow states to restrict access to aboron and other sexual
and reproducve health care, some states are using the Dobbs decision as an opportunity to preserve
and expand access to care.
31
Given exisng barriers to sexual and reproducve health care access for
LGBTQ people, these eorts in promong health equity should include all LGBTQ people who can get
pregnant. Providers should follow the CDC’s Sexual Health Assessment recommendaons to idenfy
paent needs and provide appropriate services and informaon about contracepon, aboron,
safer sex counseling, STI screening and treatment, and resources to facilitate family formaon such
as assisted reproducve technologies.
32
Health service organizaons that focus on the provision of
reproducve health care, as well as those that specialize in the care of LGBTQ communies, should
oer a range of LGBTQ-competent reproducve and sexual health care services. Eorts to track the
eects of the Dobbs decision on women in the general populaon should include tracking the unique
impact on LGBTQ people who can get pregnant. Beer data collecon and research into LGBTQ access
to sexual and reproducve care generally is also needed, parcularly for transgender people.
supra
Id.
29
Id.
30
supra
31
See
2022 State Legislave Sessions: Aboron Bans and Restricons on Medicaon Aboron Dominate,
see alsoStates Want to Ban Aborons Beyond Their
Borders. Here’s What Pro-Choice States Can Do,
.
32
See CDC, Discussing Sexual Health with Your Paents
.
Dobbs
Cathren Cohen, J.D., is a Sta Aorney at the Center on Reproducve Health, Law, and Policy and the
Williams Instute.
Bianca D.M. Wilson, Ph.D., is the Rabbi Zacky Senior Scholar of Public Policy at the Williams Instute
and Associate Researcher at the UCLA School of Law.
is the Blachford-Cooper Disnguished Scholar and Research Director at
the Williams Instute.
The authors thank Mia Humphreys Pozo for her review.
SUGGESTED CITATION
Cohen, C., Wilson, B.D.M., Conron, K.J. (2022). The Implicaons of Dobbs on Reproducve Health Care
Access for LGBTQ People Who Can Get Pregnant. The Center on Reproducve Health, Law, and Policy,
UCLA School of Law
Founded in 2021 through a budget allocaon from the state of California, CRHLP is an interdisciplinary,
naonal academic research center dedicated to training the next generaon of reproducve health
and rights leaders, while producing research-informed strategies to transform current debates.
CRHLP amplies UCLA Law’s current work on reproducve health, law, and policy and builds capacity
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