Sexual Intercourse, Abuse and Pregnancy Among Adolescent Women: Does Sexual Orientation Make a Difference?
Original article by: Saewyc E.M., Bearinger L.H., Blum R.W., Resnick M.D.
The authors of this study compared the sexual and pregnancy histories of adolescents who identified themselves as bisexual or lesbian, unsure of their sexual orientation, or heterosexual. The researchers were interested in comparing bisexual and lesbian adolescents with unsure and heterosexual adolescents on prevalences of heterosexual intercourse, sexual and physical abuse, pregnancy, contraceptive use, frequent intercourse, and prostitution. For the purposes of this study, the researchers combined lesbian and bisexual adolescents in the analysis.
The researchers conducted a secondary analysis of existing data from the 1987 Minnesota Adolescent Health Survey. This survey was a comprehensive, anonymous survey given to 36,284 students attending randomly selected public schools throughout Minnesota. The sample of the researchers' analysis was a subset of 3,816 young women (ages 12-19), 182 who had identified themselves as bisexual or lesbian, 1,753 as unsure of their sexual orientation, and a comparison group of 1,881 who identified themselves as heterosexual.
When data from all respondents were compared by sexual orientation, unsure respondents reported the lowest prevalence of intercourse (22%), followed by heterosexual (29%) and bisexual/lesbian youth (33%). Bisexual/lesbian youth were also more likely to report a history of physical abuse (19%) versus the unsure (13%) and heterosexual (15%) youth. Additionally, the bisexual and lesbian respondents reported a pregnancy rate (12%) twice that of the heterosexual (5%) or unsure (6%) adolescents. Of all respondents, 6% of youth identifying as bisexual or lesbian reported involvement in prostitution compared with approximately 1% for unsure and heterosexual youth.
Among respondents who reported ever having intercourse (N=990), unsure respondents were significantly more likely to report no use of contraceptives (44%) compared with heterosexual (23%) and lesbian and bisexual (30%) young women. Among sexually experienced respondents who used any contraceptive method, bisexual/lesbian women and heterosexual women were significantly more likely to use less effective methods (e.g., withdrawal or rhythm) compared with unsure women.
Frequency of intercourse was also significantly different with 22% of lesbian/bisexual respondents reporting intercourse occurring daily or several times a week versus 15% for heterosexual youth and 17% for unsure women. Recent engagement in prostitution among sexually experienced respondents is significantly higher for bisexual/lesbian young women (10%) compared with those classified as heterosexual (2%) or unsure (3%).
For those respondents who reported ever being pregnant (N=172), lesbian/bisexual women were more likely to report multiple pregnancies compared with unsure and heterosexual women (24%, 15%, and 10%, respectively). Lesbian and bisexual respondents also reported worse pregnancy outcomes, with 29% reporting miscarriage or infant death as compared to approximately 12% for the unsure group, and 20% for the heterosexual youth. Of respondents who had ever been pregnant, 44% of lesbians/bisexuals reported recent engagement in prostitution, nearly ten times the rate of ever-pregnant unsure or heterosexual youth.
The authors conclude that more research is needed to explore the relationship between sexual identity, its development, and sexual risk-taking behaviors. They also call for interventions targeting gay, bisexual, and unsure youth to help reduce sexual and physical abuse, as well as decrease reliance on prostitution as a means of survival for homeless lesbian or bisexual youth.
The authors also challenge the idea that adolescents who report being bisexual, lesbian, or unsure of their sexual orientation are not in need of family planning counseling. In fact, they urge clinicians and researchers working with these populations to be aware of the increased psychosocial and health risks faced by these youth.