Stigma, debt and legal battles: the barriers to parenthood for LGBTQ+ individuals

It is time the system evolves to advance a more equitable path to parenthood

parent holds the hand of a small child. mother holding baby's hand. rainbow lgbt bracelet on parents hand
(Photo: Adobe Stock)

While the composition of one’s family might look different for each of us, its meaning remains universal. Indeed, the concept of family is central to us as Americans: a recent Pew Research survey revealed that 87% of parents feel that being a parent is either “one of” or “the [single] most” important facet of their identity. 

Perhaps so much so that the meaning of family has become inseparable from our idea of success. When respondents were asked to define their view of the American dream, an interesting theme emerged. Rather than center on traditional goals, such as wealth or prosperity, the answers were overwhelmingly about community and quality of life: 83% feel that “a good family life” was an essential component of their dream.

For some of us, this dream is farther out of reach. While marriage equality became federal law in 2015, social stigma persists — and outdated policies, loopholes and state-level legislation complicate the path to parenthood for many LGBTQ+ individuals. For all families to thrive, we must prioritize equal access to a path to parenthood. In the sections that follow, I’ll outline actions we can take to begin thoughtfully eliminating barriers to parenthood.

An uncertain path to parenthood

While family planning can be complicated for just about anyone, LGBTQ+ individuals face undeniable social, legal, financial, and policy challenges that can make starting a family challenging at best. For instance, one popular route to family life begins with adoption; however, 13 states allow faith-based agencies to deny adoption placement to same-sex couples if doing so would conflict with their religious beliefs. 

Even through conception, the path to parenthood can be arduous for lesbian, gay, bisexual, transgender, queer and questioning individuals. Overt discrimination persists, which limits their ability to access the care they need. Not only does this make individuals less likely to seek out care, but, as the Center for American Progress writes: “it endangers LGBTQ+ people’s lives through delays or denials of medically necessary care.” Nearly a third (29%) of transgender people reported that a health care professional had refused to see them; and about a quarter (23%) said that a clinician intentionally misgendered them or used the wrong name. 

Nearly every avenue to parenthood for LGBTQ+ individuals requires a hefty financial investment. Surrogacy, in vitro fertilization, adoption or egg/sperm freezing are all expensive family planning options — many of which are accompanied by exorbitant legal fees, such as those required to establish parental rights through surrogacy. Standard insurance policies are often written to exclude coverage for the types of reproductive assistance often necessary for LGBTQ+ people, which means steep out-of-pocket costs.

Even once a parent, legal and social recognition may remain out of reach. For some LGBTQ+ individuals, it is a challenge to even be legally recognized as a parent to one’s own child. A majority of states nationwide do not recognize the parental rights of a non-gestational parent if the couple is not married — five of these states do not recognize a “de facto” parent, or one who has actively participated in the raising of a child. For same-sex couples, who are more likely to be unmarried than opposite-sex couples, this is often a time-consuming and additional final hurdle to parenthood.

Paving an equitable path to parenthood 

Today, LGBTQ+ individuals must overcome myriad hurdles to realize their dream of parenthood. This should not be the case. Luckily, there are proactive actions that stakeholders across the health care ecosystem can take to help make the path to parenthood easier for LGBTQ+ people. 

  • Providers should consider offering allied family planning services
    While one in six LGBTQ+ individuals avoid seeking care for fear of discrimination, practices and organizations alike can promote LGBTQ+-affirming family planning services that project a sense of invitation and support to individuals regardless of sexual orientation, gender identity or expression. These organizations would make it standard practice to continually update their knowledge of breakthroughs in reproductive technology trends, transgender healthcare, and medical transition best practices, while also adopting culturally competent care protocols that work to eliminate heteronormative or stigmatizing interactions. 
  • Employers should reevaluate their paid leave and insurance policies
    For LGBTQ+ employees that are family planning, the level of insurance coverage can make or break even the best laid plan. Employers can consider offering supplemental insurance policies that help cover costs involved in adoption, surrogacy, IVF, or egg/sperm freezing. Ensuring that employee handbook policies specifically outline that policies are available to all employees goes a long way in helping LGBTQ+ individuals feel included, supported and covered by their benefits policies — and their employers. 
  • Health plans can consider additional use cases for reproductive assistance
    Health care has traditionally oriented itself around a heteronormative gender binary, which means that required conception periods, fertility preservation assistance, and even medical record categorization practices are all too limited for LGBTQ+ individuals and their needs. Perhaps most importantly, plans can begin by waiving the required period of attempted conception before reproductive assistance kicks in — for those without the anatomical ability to conceive, this outdated policy eliminates their access to the coverage necessary to support their family planning efforts. 

Toward equal parenthood for all 

Enthusiasm for family life in all its forms shows no sign of slowing: in a recent survey, 63% of LGBTQ+ millennials reported considering becoming parents for the first time or expanding their families. For these individuals, and anyone motivated to expand their family, the barriers to parenthood should never be too steep to overcome. 

That’s why, for families of all shapes and sizes, access to high-quality, inclusive care must be made available. It is time that stakeholders across the industry looked inward and began actively re-evaluating their practices, policies and coverage options to ensure they are modernized, up-to-date and equally available to all.

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