When the Trump administration attempted to defund Planned Parenthood in May 2018, it shed light on how stigma dictates women’s healthcare policy. The proposal, retooled from the Reagan administration, required family planning facilities receiving federal funds to be physically separated from facilities that perform abortion, eliminated family counseling for women facing unintentional pregnancies, and banned abortion referrals—even though Planned Parenthood doesn’t use federal funds to provide abortions. Conservatives have been attempting to strip Planned Parenthood of its funding and impose gag rules on family planning centers since the 1980s, and the Trump administration’s latest proposal is part of a long line of threats to women’s healthcare clinics.
These proposed cuts threatened the health and well-being of the estimated 2.5 million people who receive medical services and educational resources from Planned Parenthood, including STI and HIV testing, contraception, screening for reproductive cancers, Pap tests, prenatal care, and trans-inclusive healthcare services like hormone replacement therapy (HRT). For the 80 percent of this population who rely on Planned Parenthood to prevent unintended pregnancies, losing access would have life-altering consequences. A 2016 study published in the Journal of Obstetrics and Gynecology found that pregnancy-related deaths in Texas nearly doubled when the state stopped reimbursing clinics in 2016, though women’s healthcare clinics have been under attack for years in states with large rural populations.
Unfortunately, sexual health taboos are also keeping lesbian, bisexual, queer, nonbinary, and trans people from getting adequate reproductive healthcare. Not all of Planned Parenthood’s patients are heterosexual, cisgender, woman-identifying, or require pregnancy prevention or abortion services, but rely on the organization to provide gender-affirming healthcare. In her 2006 book, Heterosexism in Health and Social Care, Julie Fish, a social work and health inequalities professor, wrote that homophobia, stigma, and stereotypes about queer women keeps many LGBTQ women from seeking quality medical care. “Lesbians are reluctant to place themselves in situations where they may be obliged to disclose their sexual identity [if] they anticipate a heterosexist reaction from health professionals,” wrote Fish. As a result, she added, “cervical screening has emerged as a key area of health inequality.”
Some lesbian women aren’t receiving Pap smears because their doctors have told them they don’t need them because lesbian sex “doesn’t count” as real sex. A 2011 study from the University of Salford found that 37 percent of the queer women surveyed were told by their doctors that they didn’t need a cervical screening test. According to researchers Jennifer Kates, Usha Ranji, Adara Beamesderfer, Alina Salganicoff, and Lindsey Dawson, queer women’s healthcare is also stigmatized within the medical community. Their 2018 study, “Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender (LGBT) Individuals in the U.S.,” published by the Henry J. Kaiser Family Foundation, notes that discrimination, violence, workplace inequality, and family rejection can create barriers to quality healthcare for LGBTQ populations, with some individuals reporting “outright denial of care” because of their sexual orientation or gender identity.
Part of the problem, one study indicated, is that many doctors assume their queer, bi, and lesbian patients are straight, or believe the “urban myth” that lesbian women don’t need to be tested for STIs or reproductive cancers because they don’t have heterosexual sex with cisgender men. These kinds of assumptions reinforce the misguided notion that queer women are militantly monogamous, and therefore don’t need to worry about STDs. The idea that queer sex between women isn’t “real” sex suggests that queer relationships are somehow less valuable or meaningful than heterosexual relationships—a belief that is both alienating and dangerous. Lesbian women are screened for HPV, STIs, and cervical cancer less frequently, and may not be offered the same amount of information about preventative measures like dental dams or the HPV vaccine as heterosexual patients, leading to a greater risk for cervical cancers and other reproductive health issues.
Young queer women are particularly vulnerable to contracting HPV and STIs, and according to one 2015 study, may be more likely to opt out of receiving the HPV vaccine without sufficient information from their healthcare providers. Fish’s research focused primarily on lesbian women, but bisexual women, trans women and men, and gender nonbinary individuals regularly report experiencing anxiety about disclosing their gender identity and sexual orientation. They have good reason to: Trans individuals surveyed in “Transgender Patient Perceptions of Stigma in Health Care Contexts,” a 2013 study published in the journal Medical Care, reported being denied healthcare, or experiencing “substandard care, forced care, [and] verbal abuse.”
Misinformed or homophobic healthcare providers are one of many barriers to adequate, compassionate, judgement-free care for queer women. “Not all healthcare providers have knowledge or understanding of diverse sexualities and gender identities. This can alienate queer and transgender people, put them in harm’s way, or prevent them from seeking care,” says Dr. Gillian Dean, Planned Parenthood’s Senior Director of Medical Services. “We don’t make assumptions about people’s sexual partners, bodies, or identities. Planned Parenthood strives to provide an environment where people’s gender identity and sexual orientation are acknowledged, respected, and understood.”
The wage inequality and financial instability that are often byproducts of homophobia, transphobia, and related discrimination can also make quality healthcare inaccessible. Without affordable options like Planned Parenthood, where visitors in 28 states can access hormone therapy and PrEP, some queer and trans women might go without potentially life-saving care or comprehensive educational resources. “One result of homophobia and transphobia is that LGBTQ people in the United States are more likely to rely on federally funded programs, like Title X or Medicaid, to access care,” Dean explains. “When politicians try to block people who are struggling to make ends meet from coming to Planned Planned through these programs, they’re denying them the chance to see an expert provider that they can trust.”
The Trump administration’s plan to reinstate a Reagan-era domestic gag rule would make it illegal for healthcare providers receiving funding from Title X to refer patients to outside clinics or abortion providers. “Planned Parenthood serves 41 percent of the 4 million people who rely on the Title X program. If Planned Parenthood were pushed out of the program, the ability for those people to access free or low-cost birth control, cancer screenings, STD screenings, and other reproductive health care would be at risk,” Dean says. With growing numbers of young people identifying as queer, access to safe spaces and resources for appropriate and accurate sex education is more important than ever. Until the mainstream medical community learns to recognize queer women’s right to affordable, queer-inclusive care, Planned Parenthood will remain an essential, valuable resource.
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