Brittany M. Charlton
Teenagers who are of a sexual minority are at increased risk of teen pregnancy, with those who identify as bisexual having a nearly fivefold increased risk of becoming pregnant, according to research published in Pediatrics.
According to Brittany M. Charlton, ScD, assistant professor at Harvard Medical School at the T.H. Chan School of Public Health, and colleagues, teenagers who identify as mostly heterosexual or lesbian have approximately a doubled risk of teen pregnancy. This disparity could be partially explained by childhood maltreatment and bullying.
“We know that sexual minorities have more established risk factors for teen pregnancy than their heterosexual peers,” Charlton told Infectious Diseases in Children. “These established risk factors include things like initiating sex at a younger age. Being sexually abused and homeless are two other strong risk factors for teen pregnancy — both of which are more common among sexual minority teens.”
To examine whether different sexual orientation groups had different risk factors for teen pregnancy, and if adolescents of a sexual minority have other unique risk factors, the researchers applied multivariable log-binomial models collected from teenage females who participated in the Growing Up Today Study. Charlton and colleagues assessed childhood maltreatment, bullying victimization and perpetration and gender nonconformity — all of which are potential risk factors for teen pregnancy.
The researchers also observed sexual minority developmental milestones, sexual orientation-related stress, sexual minority outness and involvement in lesbian, gay and bisexual social activities for teenagers who identify as a sexual minority.
Of the 7,120 adolescents who were included in the sample, a majority of females identified as completely heterosexual and reported no same-sex partners (84%). The remaining females identified as completely heterosexual with same-sex partners (2%), mostly heterosexual (11%), bisexual (2%) and lesbian (1%).
Those who were of a sexual minority experienced a greater amount of childhood maltreatment, bullying victimization and perpetration and gender nonconformity than those who identified as completely heterosexual with no same-sex partners.
According to the researchers, lesbian teenagers were more likely to reach sexual minority developmental milestones earlier than other sexual minorities, and the most sexual orientation-related stress was experienced by bisexual and mostly heterosexual teenagers. The researchers note that these groups were the least out about their orientation and were least likely to participate in lesbian, gay and bisexual social activities.
Of the entire cohort, 2% were pregnant in adolescence. The researchers observed no significant elevated risk of pregnancy between teens who were completely heterosexual with same-sex partners and those who were completely heterosexual with no same-sex partners (RR = 1.51; 95% CI, 0.58-4.03); however, mostly heterosexual (RR = 1.78; 95% CI, 1.18-2.69) and lesbian adolescents (RR = 2.37; 95% CI, 0.76-7.37) were nearly two times more likely to become pregnant, and bisexual teenagers were nearly five times more likely to become pregnant (RR = 4.67; 95% CI, 2.74-7.97).
Charlton and colleagues also observed that teen pregnancy was related to childhood maltreatment, as well as bullying victimization and perpetration. These risk factors contributed to a significant portion of pregnancy in adolescence, with 38% of the disparity attributed to physical or emotional abuse, or both, and 32% of the disparity explained by childhood sexual abuse. Bullying alone was not considered significant. When combined, childhood maltreatment and bullying accounted for 45% of the disparity related to sexual orientation and pregnancy.
For teenagers of a sexual minority, an increased risk of teen pregnancy was observed if the adolescent reached sexual minority developmental milestones at an earlier age.
“Documenting these disparities is the first step toward reaching health equity,” Charlton said. “Every one of us can help to lessen this burden. For example, health care providers can become better trained to meet the needs of their sexual minority patients. Public health practitioners can design inclusive teen pregnancy interventions targeted at socially marginalized populations.”
“Furthermore, teachers can ensure that all their students, especially sexual minority teens, are properly equipped with comprehensive sex education and the knowledge necessary to make healthy decisions,” she continued. “Parents can also ensure that their children are supported and have access to requisite reproductive health care.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.