Study Finds Higher Abortion Rates Among Sexual Minority Individuals

Sexual minority individuals are almost twice as likely to have abortions than their heterosexual peers, underscoring heightened vulnerabilities as abortion access narrows across the US post-Dobbs.1

These new findings were published in JAMA Network Open and based on data from more than 235,000 pregnancies across 3 large longitudinal cohorts between 1959 and 2024: Nurses’ Health Study II (NHS2), Growing Up Today Study (GUTS), and Nurses’ Health Study 3 (NHS3).

Researchers found that pregnancies among sexual minority participants—who made up only 10.5% of analyzed pregnancies—were 93% more likely to end in abortion compared with pregnancies among those identifying as completely heterosexual. Bisexual individuals were the most affected subgroup, with a nearly threefold increased risk (RR, 2.84), followed by lesbian or gay individuals (RR, 2.52), and those identifying as mostly heterosexual (RR, 2.15).

Among sexual minority subgroups, bisexual individuals were most likely to undergo abortions, highlighting the need for inclusive obstetric care. | Image credit: Parilov – stock.adobe.com

“Increased abortion use among sexual minority participants may reflect gaps in access to preventive care, including contraception, and sex education that is sexual minority–inclusive, the researchers said. “Addressing causes behind these differences, as well as understanding the unique needs of sexual minority abortion seekers, is more critical now, because the narrowing of abortion access in the US after the Dobbs ruling.”

Why Are Sexual Minority Individuals at Higher Risk?

There are several factors that could be attributed to this abortion gap. As demonstrated in prior research, sexual minority individuals tend to become sexually active earlier in life, are more likely to experience sexual assault, and may become pregnant out of pressure to conform to heterosexuality, putting them at a higher risk for an unintended pregnancy.2-4

Beyond higher rates of poverty, they also face structural barriers like access to health care, insurance, and sex education, with researchers noting that the “existing sex education programs in the US are often not LGBTQ+ inclusive.”5,1 These stressors may also impact a person’s mental or physical health before or during pregnancy, potentially leading to higher rates of adverse pregnancy outcomes and specific complications that can vary by sexual minority subgroup, and therefore increasing the likelihood of needing life-saving abortion care.

However, according to the study authors, these increased risks may be the reason these patients have had to become more familiar with navigating the health care system and fertility treatments. Additionally, gay and lesbian individuals use assisted reproductive technologies at a higher rate than other sexual minority subgroups, contributing to the higher abortion rates. Regardless of sexual orientation, a pregnancy could become unviable for any reason, such as new health information, a change in relationship status, financial hardship, or other factors.

“Abortion is necessary reproductive health care, regardless of the reason for seeking it,” the researchers emphasized. “However, sexual minority people may need abortion care more than heterosexual individuals because of factors rooted in structural-, interpersonal-, and individual-level manifestations of heterosexist stigma and discrimination.”

Limitations of the study include that sexual orientation and pregnancy outcome data were self-reported, and changes in abortion access over time may influence reporting behavior. As state-level abortion policy landscapes continue to shift, it becomes increasingly important for providers to ensure their vulnerable patients can still obtain the care they need.

References

1. Chakraborty P, McKetta S, Reynolds CA, et al. Differences in abortion use by sexual orientation in 3 national cohorts. JAMA Netw Open. 2025;8(5):e258644. doi:10.1001/jamanetworkopen.2025.8644
2. Xu F, Sternberg MR, Markowitz LE. Women who have sex with women in the United States: prevalence, sexual behavior and prevalence of herpes simplex virus type 2 infection-results from national health and nutrition examination survey 2001-2006. Sex Transm Dis. 2010;37(7):407-413. doi:10.1097/OLQ.0b013e3181db2e18
3. Everett BG, McCabe KF, Hughes TL. Sexual orientation disparities in mistimed and unwanted pregnancy among adult women. Perspect Sex Reprod Health. 2017;49(3):157-165. doi:10.1363/psrh.12032
4. Rosario M, Goodenow C, Ybarra M, Saewyc E, Prescott T. Reasons lesbian and bisexual adolescent girls have or might have sex with females or males: implications for discordance between sexual identity and behaviors and for prevention of pregnancy and STIs. J Sex Res. 2020;57(8):966-978. doi:10.1080/00224499.2020.1753638
5. Charlton BM, Gordon AR, Reisner SL, Sarda V, Samnaliev M, Austin SB. Sexual orientation-related disparities in employment, health insurance, healthcare access and health-related quality of life: a cohort study of US male and female adolescents and young adults. BMJ Open. 2018;8(6):e020418. doi:10.1136/bmjopen-2017-020418