TY - JOUR
T1 - Experiences in the delivery of preconception and pregnancy care for LGBTIQA+ people
T2 - A systematic review and thematic synthesis of patient and healthcare provider perspectives
AU - Permezel, Jess
AU - Arnold, Amelia St Clair
AU - Thomas, Jacob
AU - Maepioh, Anita Lorelle
AU - Brown, Rhonda
AU - Hafford-Letchfield, Trish
AU - Skouteris, Helen
AU - Hatzikiriakidis, Kostas
AU - McNair, Ruth P.
N1 - Funding Information:
Amelia St Clair Arnold, Jess Permezel, Jacob Thomas, Rhonda Brown, Ruth P. McNair, and Helen Skouteris are all members of the Growing Queer Families Alliance, established under the Centre for Research Excellence in Health in Preconception & Pregnancy (CRE-HiPP), funded by the National Health and Medical Research Council (NHMRC) and directed by Professor Helen Skouteris.
Funding Information:
The authors would like to acknowledge their positionality as academics and practising clinicians who have expertise working with, and conducting research and delivering education related to, people of diverse sexuality and gender. A number of the authors also identify as sexuality and gender diverse, queer, and/or LGBTIQA+ themselves. Amelia St Clair Arnold, Jess Permezel, Jacob Thomas, Rhonda Brown, Ruth P. McNair, and Helen Skouteris are all members of the Growing Queer Families Alliance, established under the Centre for Research Excellence in Health in Preconception & Pregnancy (CRE-HiPP), funded by the National Health and Medical Research Council (NHMRC) and directed by Professor Helen Skouteris. The authors also recognise the voices and bravery of those who participated in the research included in this review. The authors acknowledge the contributions they have made in sharing their stories and bringing attention to the disparities in health equity that have been experienced during the transition to parenthood. The authors would like to thank Dr Emma Galvin from Monash University's Health and Social Care Unit for supporting the methodological quality assessment as an external reviewer. The authors would also like to thank the peer-reviewers for the time they provided to offer their thoughtful and insightful feedback on this manuscript.
Publisher Copyright:
© 2023
PY - 2023/8
Y1 - 2023/8
N2 - Background: The widespread availability of reproductive technology and family planning services has led to an increase in the number of available pathways to parenthood for LGBTIQA+ people. However, emerging research indicates that significant healthcare inequities have been documented among LGBTIQA+ people and attributed to the pervasiveness of structural and systemic discrimination that extends to preconception and pregnancy care. Aim: The aim of this systematic review was to synthesise qualitative research that has explored the experiences of LGBTIQA+ people in navigating preconception and pregnancy care services to inform healthcare quality improvement. Method: Six databases were searched for relevant research published between 2012 and 2023. The findings of all included studies underwent a secondary thematic synthesis, and methodological quality was assessed using the Joanna Briggs Institute Checklist for Qualitative Research. Findings: A total of 37 studies were eligible for inclusion. Four major themes were constructed through thematic synthesis: (1) unavailability of information, services, and support; (2) clinical competencies of healthcare staff; (3) hetero- and cis-sexist care experiences; and (4) discrimination and traumatisation. Conclusions and implications for practice: The findings of this review indicate that LGBTIQA+ people experience significant challenges during the journey towards parenthood, marked predominantly by the pervasiveness of inequity, and defined by discriminatory healthcare processes. This review has led to several recommendations for future healthcare quality improvement through an investment in policies, procedures, and interactions that are sensitive to the needs of LGBTIQA+ people. Importantly, future research must be co-designed and led by LGBTIQA+ community input.
AB - Background: The widespread availability of reproductive technology and family planning services has led to an increase in the number of available pathways to parenthood for LGBTIQA+ people. However, emerging research indicates that significant healthcare inequities have been documented among LGBTIQA+ people and attributed to the pervasiveness of structural and systemic discrimination that extends to preconception and pregnancy care. Aim: The aim of this systematic review was to synthesise qualitative research that has explored the experiences of LGBTIQA+ people in navigating preconception and pregnancy care services to inform healthcare quality improvement. Method: Six databases were searched for relevant research published between 2012 and 2023. The findings of all included studies underwent a secondary thematic synthesis, and methodological quality was assessed using the Joanna Briggs Institute Checklist for Qualitative Research. Findings: A total of 37 studies were eligible for inclusion. Four major themes were constructed through thematic synthesis: (1) unavailability of information, services, and support; (2) clinical competencies of healthcare staff; (3) hetero- and cis-sexist care experiences; and (4) discrimination and traumatisation. Conclusions and implications for practice: The findings of this review indicate that LGBTIQA+ people experience significant challenges during the journey towards parenthood, marked predominantly by the pervasiveness of inequity, and defined by discriminatory healthcare processes. This review has led to several recommendations for future healthcare quality improvement through an investment in policies, procedures, and interactions that are sensitive to the needs of LGBTIQA+ people. Importantly, future research must be co-designed and led by LGBTIQA+ community input.
KW - Health equity
KW - LGBTIQA+
KW - Preconception
KW - Pregnancy
KW - Queer
KW - Systematic review
UR - https://www.scopus.com/pages/publications/85159146049
U2 - 10.1016/j.midw.2023.103712
DO - 10.1016/j.midw.2023.103712
M3 - Article
AN - SCOPUS:85159146049
SN - 0266-6138
VL - 123
JO - Midwifery
JF - Midwifery
M1 - 103712
ER -