Study Outlines Challenges Sexual Minorities Face in Seeking Abortion Care
September 1, 2025 5 minutes read
By Melinda Young
Accessing abortion care is more challenging for sexual minorities than heterosexuals, according to new research that uses a survey taken by nearly 2,000 people.1 Sexual minorities included people who identified as something other than heterosexual, including bisexual, lesbian, queer, etc.1 Every challenge to obtaining an abortion was greater for people who identified as a sexual minority, according to their answers to a survey.1
“What surprised me the most is just how clear the findings were,” says Marta Bornstein, PhD, MPH, an assistant professor in the department of health promotion, education, and behavior at the Arnold School of Public Health of the University of South Carolina in Columbia.
“When we did the analysis and looked at it in different ways, it was very clear that sexual minority individuals were facing more challenges,” she adds. “The one that surprised me was that sexual minorities were more likely to delay paying rent, paying other bills, and buying food — these basic necessities that everyone needs.”
Investigators found that sexual minority participants in almost all sociodemographic groups cited having more challenges and were more likely than heterosexual participants to delay an expense to afford an abortion.1 “We found, overall, 90% of people — regardless of their sexual identity — encountered at least one challenge in getting an abortion,” Bornstein notes. “Sexual minorities encountered more than one challenge.”
Researchers asked about a dozen different challenges, including cost, transportation, scheduling, making the decision, emotional health, keeping the pregnancy and/or abortion a secret, work/school, childcare, multiple clinic trips, getting correct information, not knowing the area where the abortion clinic is located, and protesters outside the clinic.1
When researchers saw that every challenge was cited more often by sexual minority individuals, they thought it might be the result of sexual minority people being younger and having fewer resources, Bornstein explains. “In our analysis, we controlled for those things, and still — even controlling for resources, education, and age — we still found that sexual minority individuals were more likely to delay an expense and encounter more challenges,” she says. “One theory is there are structural sexism and biases against queer people that could make getting an abortion more challenging.”
The study’s data came from the Ohio Policy and Evaluation Network, collected from April 2020 to February 2023. These included 1,953 completed patient surveys. After someone has an abortion, they have the option to respond to the survey, and about 20% of the people who filled out the surveys identified as something other than heterosexual, including bisexual, lesbian, queer, etc.,1 Bornstein says.
“We weren’t shocked by 20% [identifying as a sexual minority] because other studies have found, in general, that especially Gen Z — 15% to 20% of people are identifying as something other than heterosexual,” she explains. “It meant we had a big enough sample size to make comparisons, and our findings were extremely clear.”
Sexual minority individuals were encountering more challenges, Bornstein says.For example, 21% of sexual minorities delayed buying food, compared with 11% of heterosexual individuals who delayed buying food, she says. “That was a significant difference and one of the findings that struck all of us,” Bornstein adds.
The surveys were offered to people at abortion clinics in five states. “We were at 25 clinics in Ohio, West Virginia, Kentucky, Illinois, and Pennsylvania,” she adds. “We had clinic staff let patients know about this survey.” Stand-alone abortion facilities were invited to participate, and all of the clinics in West Virginia and Kentucky participated.1
Each survey took about 20 minutes to complete, and it included questions about sociodemographic characteristics, pregnancy characteristics, and the person’s experiences in seeking abortion care, including any challenges and delayed expenses because of the abortion.1 The expenses people could say were delayed because of the abortion expense were rent, food, childcare, and other bills. They could write in another delayed expense as well.
See Table 1 for participant demographics.1 Sexual minorities were more likely to be white and in the 18- to 24-year-old age group. They also were more likely to have a household income of less than $36,000 per year.1
Table 1. Participant Demographics |
Race
Age
Education
Household Income $19,999 or less: 44.7% $20,000 to $35,999: 27.3% $35,000 to $49,999: 13% $50,000 or more: 15% |
Source: Bornstein M, Turner AN, Rivlin K, et al. Challenges faced by sexual minority and heterosexual people seeking abortion care. LGBT Health. 2025;10.1089/lgbt.2024.0304. [Online ahead of print]. |
The survey did not ask people about their support networks, such as family, friends, and outside nonprofit organizations. “We don’t know exactly the kind of support they receive,” Bornstein says. “We know a lot of people receive support from abortion funds that have been really strained, especially since Dobbs.” The people surveyed may be receiving help with logistics and/or psychosocial support, but that data was not captured.
“The one thing we found in our discussion is that a lot of people in reproductive justice and abortion clinics are changing their language to be more inclusive,” Bornstein says. “It’s hard to signal acceptance to sexual minorities.” Clinics could change their language to say, “pregnant people” instead of “pregnant women.” But it is challenging to make other changes that send a message that the place is accepting of sexual minorities, she explains. “Even if they’re very open and accepting, it’s hard to signal that — at least outwardly,” she adds. “I think we can do a better job.”
Most of the sexual minorities in the study identified as bisexual, which is an understudied population, Bornstein notes. “We know from other studies that bisexual individuals face a lot of health disparities in sexual and reproductive health; they have higher rates of unintended pregnancy, for one, and they have higher rates of sexual assault and violence.”2
There are other ways clinicians can show acceptance of sexual minorities, including changing their website language to be more inclusive when it comes to gender. Their waiting rooms could be gender neutral, and they can use the pronouns and names patients request.
The take-away of the study is that sexual minority patients are part of a population that needs reproductive healthcare services and sometimes encounters challenges in obtaining abortion care, Bornstein says. “Recognize they have encountered more challenges to get there and have sensitivity around that,” she says.
For instance, sexual minorities seeking an abortion were more likely to say they faced a challenge of keeping their abortion and pregnancy a secret, and they had an emotional burden in making the decision, she adds.
“One bias of our survey is we’re surveying abortion patients who made it to the clinic to get an abortion,” Bornstein says. “We don’t know the challenges of people who never made it to a clinic, and those challenges are likely even bigger.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Bornstein M, Turner AN, Rivlin K, et al. Challenges faced by sexual minority and heterosexual people seeking abortion care. LGBT Health. 2025;10.1089/lgbt.2024.0304. [Online ahead of print].
2. Flanders CE, Wright M, Khandpur S, et al. A quantitative intersectional exploration of sexual violence and mental health among bi+ people: Looking within and across race and gender.J Bisex. 2022;22(4):485-512.
Accessing abortion care is more challenging for sexual minorities than heterosexuals, according to new research that uses a survey taken by nearly 2,000 people.
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