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Sexual Orientation and Exposure to Violence Among U.S. Patients Undergoing Abortion

Jones, Rachel K., PhD; Jerman, Jenna, MPH; Charlton, Brittany M., ScD

doi: 10.1097/AOG.0000000000002732
Contents: Original Research

OBJECTIVE: To assess the characteristics of patients undergoing abortion in the United States according to sexual orientation and exposure to sexual and physical violence.

METHODS: Data for this observational study come from the Guttmacher Institute's 2014 Abortion Patient Survey, which obtained information from 8,380 individuals obtaining abortions at nonhospital facilities in the United States; 7,656 of those (91%) provided information on sexual orientation identity. We used simple logistic regression to assess differences between heterosexuals and three sexual minority groups—bisexual, lesbian, and something else—according to demographic characteristics and exposure to sexual and physical violence. Multivariate logistic regression was used to assess associations between sexual orientation and exposure to violence.

RESULTS: Among patients undergoing abortion in 2014, 4.1% identified as bisexual (n=316), 1.1% as something else (n=81), and 0.4% as lesbian (n=28); 94.4% identified as heterosexual (n=7,231). Similar proportions of lesbian and heterosexual respondents reported a prior birth (53.6% and 58.2%, P=.62), whereas respondents who identified as something else were more likely to report having had a prior abortion (58.0% vs 43.9%, P=.01). Exposure to sexual violence was substantially and significantly higher among all three sexual minority groups compared with heterosexuals, and lesbian and bisexual respondents were also more likely than their heterosexual peers to report exposure to physical violence by the man involved in the pregnancy (33.3% and 8.7% vs 3.6%, P<.001).

CONCLUSION: No patient should be presumed to be heterosexual. Understanding the disproportionate role of sexual violence in unintended pregnancies among sexual minorities may aid in the design of interventions and clinical guidelines that address the needs of sexual minority patients.

A nonnegligible proportion of patients undergoing abortion do not identify as heterosexual, and these individuals may be at particular risk of physical and sexual violence.

Guttmacher Institute, New York, New York; and Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston Children's Hospital, Boston, Massachusetts.

Corresponding author: Rachel K. Jones, PhD, Guttmacher Institute, 125 Maiden Lane, New York, NY 10038; email:

Supported by the Susan Thompson Buffett Foundation. Additional support was provided by the Guttmacher Center for Population Research Innovation and Dissemination (National Institutes of Health grant 5 R24 HD074034).

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Heather Boonstra, Lawrence B. Finer, and Rebecca Wind for providing feedback on earlier drafts of the manuscript.

Each author has indicated that she has met the journal's requirements for authorship.

Received February 28, 2018

Received in revised form April 17, 2018

Accepted May 03, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.