Date of Award

Spring 2024

Project Type

Dissertation

Program or Major

Sociology

Degree Name

Doctor of Philosophy

First Advisor

Rebecca Glauber

Second Advisor

Cliff Brown

Third Advisor

Thomas Safford

Abstract

Throughout modern Western history, access to fully affirming and supportive sexual and reproductive health care (SRH) has been denied to most women and sexual and gender minorities. Also, as demonstrated by the ubiquity of the term “women’s health,” SRH often reflects a cisgender heterosexual (cishet) women-centered approach, alienating transgender, non-binary, gender nonconforming, and sexual minority individuals who are not cishet women but are in equal need of the same life-saving screenings, treatments, and counseling services. Due to the operationalization and reproduction of gendered ideologies and unequal social hierarchies within SRH, inadequate access to quality sexual health education for youth, and the proliferation of harmful legislation, LGBTQ+ groups are particularly at risk for disparities in SRH access and health outcomes. However, there is a paucity of research that addresses these concerns.

This dissertation employed three distinct empirical papers to robustly address the nuances and stratification of LGBTQ+ inclusion in SRH in New Hampshire (NH). The first paper utilized qualitative focus groups with LGBTQ+ adults throughout NH to gain a better understanding of how the meaning of authentic inclusion, and therefore higher quality care, manifests in SRH clinic settings. Transcripts revealed 248 distinct comments grouped into 11 themes. In addition to describing how they gained access to SRH services, participants identified the presence of LGBTQ+ inclusion (or exclusion) through a variety of environmental, administrative, and interpersonal mechanisms.

The second paper used the LGBT-DOCSS survey tool to measure attitudes toward, knowledge of, and clinical preparedness for LGBTQ+ patients across SRH health professional job types and organizational structures. Only administrative managers and providers reported high overall inclusion, with clinical managers, and administrative and clinical support staff reporting moderate inclusion. Health professionals in OB/GYN clinics scored the lowest in attitudes and knowledge, but they scored the highest in self-reported clinical preparedness.

The third paper also used the LGBT-DOCSS survey tool in addition to an environmental assessment tool informed by earlier focus group findings to uncover disparities in inclusion by metropolitan status, county, and regional public health network in NH. Taken together, these three papers provide a holistic understanding of the nature of LGBTQ+ inclusion and disparities in the delivery of affirming care individually, organizationally, and geographically. They also offer actionable policy and practice recommendations to give health professionals, legislators, and community members the tools to establish enduring supportive spaces.

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