- Saewyc EM, Bearinger LH, Blum RW, Resnick MD. Sexual intercourse, abuse and pregnancy among adolescent women: does sexual orientation make a difference? Fam Plann Perspect. 1999 May-Jun;31(3):127-31. CONTEXT: Although a limited amount of research has retrospectively explored the childhood and adolescent heterosexual experiences of lesbians, little is known about the prevalence of heterosexual behavior and related risk factors or about pregnancy histories among lesbian and bisexual teenagers. METHODS: A secondary analysis was conducted using responses from a subsample of 3,816 students who completed the 1987 Minnesota Adolescent Health Survey. Behaviors, risk factors and pregnancy histories were compared among adolescents who identified themselves as lesbian or bisexual, as unsure of their sexual orientation and as heterosexual. RESULTS: Overall, bisexual or lesbian respondents were about as likely as heterosexual women ever to have had intercourse (33% and 29%, respectively), but they had a significantly higher prevalence of pregnancy (12%) and physical or sexual abuse (19-22%) than heterosexual or unsure adolescents. Among sexually experienced respondents, bisexual or lesbian and heterosexual women reported greater use of ineffective contraceptives (12-15% of those who used a method) than unsure adolescents (9%); bisexual or lesbian respondents were the most likely to have frequent intercourse (22%, compared with 15-17% of the other groups). In the sample overall, among those who were sexually experienced and among those who had ever been pregnant, bisexual or lesbian women were the most likely to have engaged in prostitution during the previous year. CONCLUSIONS: Providers of reproductive health care and family planning services should not assume that pregnant teenagers are heterosexual or that adolescents who say they are bisexual, lesbian or unsure of their sexual orientation are not in need of family planning counseling. Further research should explore the interactions between adolescent sexual identity development and sexual risk behaviors. PIP: The influence of sexual orientation on adolescents' sexual behaviors and pregnancy histories was investigated in a subsample of 3816 female adolescents, 12-19 years old, who completed the 1987 Minnesota (US) Adolescent Health Survey. 182 identified themselves as bisexual or lesbian, 1753 were unsure of their sexual orientation, and 1881 were heterosexual. Bisexual/lesbian respondents were about as likely as heterosexual respondents ever to have had intercourse (33.0% and 29.3%, respectively), but they had a significantly higher prevalence of childhood physical abuse (19.3% vs. 11.9%) and sexual abuse (22.1% vs. 15.3%) than their heterosexual counterparts. Among sexually experienced respondents, 29.8% of bisexual/lesbian adolescents, 43.5% of those unsure about their identity, and 23.1% of heterosexuals used no contraception and 12.3%, 8.5%, and 14.5%, respectively, of those who used contraception used an ineffective method. 12.3% of bisexual/lesbian women, 6.1% of those unsure about their sexual orientation, and 5.3% of heterosexual adolescents had experienced a pregnancy; 2 or more pregnancies were reported by 23.5%, 15.1%, and 9.8%, respectively, of ever-pregnant teens. Finally, 9.7% of bisexual/lesbian women had engaged in prostitution in the year preceding the survey, compared with 1.9% of heterosexuals and 3.4% of those unsure about their orientation. These findings suggest that adolescents who identify themselves as lesbian or bisexual are at high risk of pregnancy and poor contraceptive practices. Providers of reproductive health care and family planning services should not assume that their pregnant adolescent patients are heterosexual or that lesbian clients or those unsure of their sexual orientation are not in need of contraception.
- Saewyc EM, Skay CL, Bearinger LH, Blum RW, Resnick MD. Sexual orientation, sexual behaviors, and pregnancy among American Indian adolescents. J Adolesc Health. 1998 Oct;23(4):238-47. PURPOSE: A recent study found a disproportionate number of pregnancies among Euro-American lesbian and bisexual adolescents compared to heterosexual peers. American Indian adolescents have reported higher prevalence of gay/lesbian/bisexual orientations than Euro-Americans; do they also report higher prevalence of pregnancy? METHODS: The study assessed prevalence of teen pregnancy and related factors by sexual orientation among sexually experienced, reservation-based American Indian adolescent males (n = 2056) and females (n = 1693) who participated in a national school-based survey in 1991. Self-reported orientation was classified as heterosexual, gay/lesbian/bisexual, and "unsure" of orientation. RESULTS: Gay/bisexual males were more likely than other males to report early heterosexual intercourse (<14 years), more consistent contraception, and a higher prevalence of abuse and running away (p < 0.05 to p < 0.0001). Likewise, lesbian/bisexual females were more likely to report early onset of heterosexual intercourse, more frequent intercourse, and running away. Sexual or physical abuse did not vary by orientation for females. Prevalence of pregnancy also did not vary by orientation (males, 18.6% gay/bisexual vs. 10.4% "unsure" vs. 11.8% heterosexual; females, 25.0% lesbian/bisexual vs. 22.1% "unsure" vs. 21.9% heterosexual). For lesbian/bisexual females, no variables were significantly associated with pregnancy history; for "unsure" females, pregnancy was associated with contraceptive frequency and early onset of heterosexual activity. For heterosexual females, age, intercourse frequency, and physical abuse were associated. For gay/bisexual males, intercourse frequency, ineffective contraception, and physical abuse were associated with involvement in a pregnancy; for "unsure" and heterosexual males, most items except ineffective
contraception were related to pregnancy involvement history. CONCLUSIONS: Although prevalence of pregnancy is similar, findings show group differences in associated risk factors by sexual orientation. Interventions to reduce pregnancy among American Indian adolescents should include assessment of sexual orientation and behavioral risk factors.