Focus on Lesbian Health
By Kathleen DeBold
A young woman goes to a Florida doctor seeking treatment for a bad cough. She leaves with a prescription for Bible scriptures to free her from homosexuality.1
A New Hampshire dentist refuses treat to a woman because she listed her female partner as her spouse on the office’s “get-acquainted card.”2
The director of clinical rehabilitative services at health care center in Utica, New York, calls two lesbian senior citizens “faggots” and throws them out of the facility.3
Homophobic horror stories from the 1950s? Unfortunately, not. These are all recent accounts of lesbians who tried to access health care services in their home towns.
Knowing this, it should come as no surprise that stigma and the potential for discrimination in a health care setting have a major impact on lesbian health.
A national survey conducted in 2005 by Harris Interactive® and the Mautner Project, The National Lesbian Health Organization, found that lesbians (used throughout this article to mean women who partner with women) are much more likely than heterosexual women to delay obtaining health care (75% versus 54%).4
Sixteen percent of lesbians report that they delayed obtaining health care because they were concerned they would be discriminated against. Their fears are justified: lesbians are more likely than heterosexual women to say that bad experiences with health care providers in the past have caused them to delay obtaining health care (27% vs. 12%).
Three quarters of lesbians (74%) who have experienced discrimination at a doctor’s office believe they were discriminated against because of their sexual orientation, and 5% said it was because of their gender identity or expression.
Lesbians are found among all subpopulations of women, and are represented in all racial and ethnic groups, all socio-economic strata, and all ages. The health and well-being of lesbians is, therefore, compromised by all of the factors that affect all women’s health, plus:
Individual and institutionalized homophobia, heterosexism, and gender stereotyping in all aspects of the health care systems;
Lack of cultural competence on the part of health care providers, health educators, and health policy makers;
Lack of civil rights (e.g., spousal insurance benefits, hospital visitation, Family Medical Leave), which limits lesbian access to quality health care;
The added stress of being part of a stigmatized group and its potential consequences, including familial rejection, employment discrimination, harassment, and hate crimes; and
Lifestyle factors that can increase risk for certain conditions and negative health outcomes (e.g., obesity, substance abuse, and smoking-related illnesses).
One of the greatest advances in women’s health was breaking free – at least intellectually – of the male-centered care model that viewed women as aberrant or unnatural versions of men.
Thanks to the efforts of advocates like the National Women’s Health Network, women’s unique health needs and concerns are less likely to go unnoticed, discounted, or ignored.
Sadly, 34 years after the American Psychiatric Association deleted homosexuality from its compendium of psychiatric disorders, we still live in a society where homosexuals are often seen as aberrant, unnatural versions of heterosexuals – and the unique health needs and concerns of lesbians are still largely unnoticed, discounted, or ignored.
That’s the bad news. The good news is that as feminists committed to health justice, we can improve lesbian health the same way we are improving all women’s health – through advocacy, research, education, and the establishment and support of culturally appropriate health services.
Because of discrimination and marginalization as women and as homosexuals, lesbians have had a limited role in public policy and resource allocation decisions within the political, economic, and social systems and institutions directly affecting their own health.
Consumers and health activists who care about lesbian health can make a huge difference by supporting and partnering with organizations whose advocacy efforts:
Increase lesbian access to and voices in the decision-making of institutions relevant to health;
Educate policy makers, politicians, and the general public about lesbian health; and
Build individual and institutional support for health care justice for everyone.
Such organizations include national leaders like the National Women’s Health Network and the Mautner Project; members of the National Lesbian Feminist Health Coalition; and local and national lesbian, gay, bisexual, and transgender (LGBT) and women’s health organizations and agencies with a strong lesbian-feminist focus.
Successful advocacy strategies for getting lesbian health on the agendas of relevant organizations and agencies include lobbying, coalition work, service on boards and committees, presentations at conferences, educational meetings with policymakers, letter and email campaigns, media outreach, voter education, and good old street activism.
Another important area for lesbian health activism is research. Research-based information influences the health care decisions of politicians, policymakers, and the general public.
Research-based information directs the practices of health care providers by giving them the knowledge and skills necessary to best serve their clients. Research-based information forms the foundation for conducting – and receiving funding for – additional research.
Because little research is done specifically on lesbians and because lesbians are not identified as such in most research studies, there is very little hard scientific data on lesbian health.
(This has become a real Catch 22 for lesbian health: funders want to see evidence-based information showing that research or intervention is needed but, without funding, there is no science-based research.) Priorities for individuals and groups that care about lesbian health must therefore include:
Educating researchers and policymakers about the need to include, identify, and track lesbian, gay, bisexual, and transgender people in all their studies;
Initiating, conducting, and collaborating on lesbian-focused research; and
Increasing funding for lesbian health research.
Culturally competent health education is yet another area where we can make a real difference in lesbian health. The transmission of health information, like all communications, is most effective when the intervention is specifically designed with the target audience in mind.
The more the recipient relates to the message, the messenger, and medium, the more likely she is to absorb and act on the information. Unfortunately, most health education initiatives are created (intentionally or not) by and for heterosexuals. The lack of lesbian sensibility and content makes them much less likely to have the intended impact on lesbian audiences.
Lesbian-appropriate educational materials and interventions are especially needed to address those conditions for which lesbians may have increased risk factors, such as smoking-related illnesses, breast cancer, substance abuse, and obesity. The more lesbians know about their own health and their rights as health care consumers, the more empowered they will be to act in their own interest.
Lesbians are not the only ones who need health education. Providers and their staffs need to understand why lesbians might be reluctant to seek medical care, and the impact of homophobia and heterosexism on the provision of services to lesbians. Heterosexism – the assumption that everyone is heterosexual and that heterosexuality is the expected norm – is evident in intake forms that ask questions such as: “Are you Single/Married/ Widowed or Divorced?”, which leave no options for lesbian couples (or unmarried straight couples!).
Heterosexism is evident when forms assess health risks by asking: “Are you sexually active?” followed by questions about what birth control methods the patient uses; or “Do you experience discomfort during intercourse?” rather than “Do you experience discomfort during vaginal penetration?”
Informed and open discussions regarding all aspects of a patient’s life promote health, prevent disease, and improve access to and the quality of health care.
According to the American Medical Association, “unrecognized homosexuality by the physician or the patient’s reluctance to report his or her sexual orientation can lead to failure to screen, diagnose, or treat important medical problems.” But if lesbians don’t feel comfortable coming out to their providers, and providers lack sufficient information on lesbian health issues and are unable to communicate their expertise and acceptance to lesbian patients, informed and open discussion cannot occur.
Health care providers need training to understand the specific needs and concerns of their lesbian patients and to identify and counter their own internalized homophobia/ heterosexism and the institutionalized homophobia/heterosexism in their practices, organizations, and agencies. Such training allows providers to remove barriers to care for lesbians in their own practices, increases the number of culturally competent health care sites for lesbians to access important health services, and creates systemic change in the healthcare system.
A good example of a successful provider training program is the Mautner Project’s Removing the Barriers® curriculum, which was developed in cooperation with the U.S. Centers for Disease Control and Prevention (CDC) and is used by medical practices and agencies around the country, including the nation’s Breast and Cervical Cancer Early Detection Programs.
Through an exploration of cultural competence and the clinical concerns specific to women who partner with women, Removing the Barriers® helps providers understand the obstacles to quality care within their own practices and aids them in minimizing or removing these obstacles. Removing the Barriers® is accredited for CMEs and CEUs and is available onsite through arrangement with the Mautner Project or online .
Until all mainstream health programs are fully accessible to and accepting of lesbian clients, there remains a tremendous need for lesbian-specific health services, including support groups, affinity screening days, referral services, health fairs, etc.
As consumer activists, we can increase lesbian access to quality healthcare by starting and supporting these local efforts – and by fighting for universal health care, which is essential for improving the health and well-being of everyone.
Thanks to the tireless efforts of empowered consumers and health justice advocates like you, lesbian health is beginning to receive more attention. But it is up to each of us to ensure that the attention is turned into action. By improving the health of our lesbian sisters, we are moving one step closer to the National Women’s Health Networks’ vision of a health care system that is guided by social justice and reflects the needs of diverse women.
Kathleen DeBold is Executive Director of the Mautner Project, the National Lesbian Health Organization. A long-time social justice activist and former Deputy Director of the Gay and Lesbian Victory Fund, she was recently chosen by Women’s Enews© as one of their “21 Leaders for the 21st Century.”
1. National Center for Lesbian Rights (NCLR). "Lesbian Files Complaint against Doctor for Prescribing Unwanted Anti-Gay 'Treatment'." San Francisco: NCLR. Feb 2, 2006. Online http://www.nclrights.org/releases/pr-doctor020206.htm
2. Gfn. "Dentist Suspended for Refusing to Treat Lesbian." New York: Gfn. July 21, 2006. Online: http://www.gfn.com/storyArticle.cfm?storyRecordID=11243
3. American Civil Liberties Union (ACLU). Bizzari & Hackett v. Sitrin Health Center - Case Profile. New York:ACLU. February 24, 2005. Online: http://www.aclu.org/lgbt/discrim/12132res20050224.html
4. Harris Interactive Poll. "New National Survey Shows Top Causes for Delay by Lesbians in Obtaining Health Care." Rochester, NY: Harris, March 11, 2005. Online:http://www.mautnerproject.org/programs_and_services/research/305.cfm
The Handbook of Lesbian, Gay, Bisexual and Transgender Public Health, Michael D. Shankle, Editor, Harrington Park Press, 2006
Hope and Healing: A Technical Manual for Creating Safe Spaces for Lesbian Cancer Survivors, Mautner Project, 2006
Removing the Barriers to Quality Care for Lesbians (Participants Handbook and Trainers Guide), Mautner Project, 2005 revision
Special Issues in Women’s Health: Improving Access to Quality Care for Women, The American College of Obstetricians and Gynecologists, 2004
Primary Care for Lesbians and Bisexual Women, Sally A. Mravcak, M.D., American Family Physician, 2006; 74:279–88
[Report from the Institute of Medicine] Lesbian Health: Current Assessments and Directions for the Future, Andrea Solarz, editor, National Academy Press, 1999
Healthy People 2010 Companion Document for Lesbian, Gay, Bisexual and Transgender (LGBT) Health, Gay and Lesbian Medical Association, 2002
Mental Health Correlates of Perceived Discrimination Among Lesbian, Gay and Bisexual Adults in the United States, Vickie M. Mays, PhD, MSPH, and Susan D. Cochran, PhD, MS, American Journal of Public Health, 2001; 91:1869–1876
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