Queering SRHR: Lesbian women, Bisexual women and SRHR: the conversation we need to have.
Editor’s note: to mark pride month, Inspire has launched a series of articles called “Queering SRHR” with the goal to dive a little deeper into the various specific ways that SRHR relates to LGBTIQ people.
On the occasion of Pride Month, the Inspire Team has launched a series called “Queering SRHR” in the hope of raising awareness on current sexual and reproductive health and rights’ struggles, goals and achievements related to intersex, queer, gay, lesbian, bi and trans people. With this series, the goal is also to challenge the binary and heteronormative narratives around sexual and reproductive health and rights, and to encourage colleagues, partners and others to make SRHR discussions all-inclusive.
This is the fifth article of the “Queering SRHR” series. Here, you can read our previous articles:
“Queering SRHR: LGBTIQ Families” click here
“Queering SRHR: Homo-Bi-Trans-Phobia No More” click here
“Queering SRHR: De-pathologizing Trans-people: WHO removes transgender as mental disorder from the ICD” click here
“Queering SRHR: Queering SRHR: The need for a trans-specific focus within SRHR” click here
Queering SRHR: Lesbian women, Bisexual women and SRHR: the conversation we need
The right to sexual and reproductive health is a fundamental part of human rights and essential to living a dignified life. However, persistent myths and stereotypes might have adverse consequences when it comes to the sexual and reproductive health of lesbian and bisexual women. In this article, our goal is to debunk some of these perceptions, or at least to highlight them.
One striking fact when researching data for this article is the gap in available information on lesbian and bisexual women’s access to / experiences regarding sexual and reproductive health. Research gaps on women’ SRH are further emphasised in the case of Lesbians and bisexual women, because of a generally heteronormative health care environment. Currently, LGBTIQ comprehensive sex education programmes on LBQ women are hardly available. Whether it concerns school curricula, NGO programmes or public healthcare, there is a general lack of information and education on LBQ women’s sexual and reproductive health.
Myths & Realities of Lesbian and Bisexual women’s sexual and reproductive health
One of the primary concerns related to the sexual health of lesbian and bisexual women is caused by their lack of attendance of gynaecological check-ups. Because mainstream reproductive rights discourse and policies are usually framed as heteronormative, many lesbians and bisexual women avoid gynaecological check-ups. Additionally, several studies have suggested that lesbians and bisexual women seem to avoid going to the gynaecologist due to fear of lesbophobic reactions and insensitivity or because of negative past experiences (Alencar Albuquerque et al, 2016; Blosnich et al, 2014,LGB&T Partnership, 2016; Quinn et al, 2015; Zeeman et al., 2017a, 2017b, 2017c ). Those who did visit health care providers have at times met providers who either assumed they were heterosexual, were uncomfortable with their sexual orientation or provided them with incomplete and incorrect information (LGB&T Partnership, 2016, Quinn et al, 2015, Zeeman et al., 2017a, 2017b, 2017c ). The general lack of information on where to find LGBTIQ friendly health-care provider further limits LB women’s access to gynaecological care (this is especially the case for those living in rural settings). In addition, LGBTIQ friendly gynaecologists that are available, are usually based at private clinics. This is problematic for LB women who, both as women and “sexual minorities” may face increased economic exclusion or poverty (Jann, Edmiston & Ehrenfeld, 2015; Khalili, Leung & Diamant, 2015).
Myth 1: Lesbian and Bisexual Women do not need cervical screening
In 2008 Ruth Hunt and Julie Fish conducted a survey on LB&Q women in Great Britain, where 6178 LB&Q women from an age range between 14-84 years responded to questions on their sexual health experiences. The survey revealed that half of those women had never been tested for an STI and three fourths of them believed they were not at risk. More than half of those who were tested throughout the study were then diagnosed with an STI.
In some contexts, the misbelief that bisexual and especially lesbians do not need regular visits with a gynaecologist is prevalent within the medical field itself: lesbians are screened less often. Hunt and Fish’s survey revealed that health providers had been telling lesbians and bisexual women that they do not need cervical screening because they have sex with women. This was later re-confirmed by an LGB&T partnership research in 2016, conducted in England.
What is important to know is that attending regular gynaecological check-ups is essential for all women as these can help detect and treat breast cancer, cervical cancer and sexually transmitted infections. This is especially important for lesbians and bisexual women who do not have children. Scientific studies have indeed demonstrated that both breast and uterine cancer are associated with not having children. Moreover, lesbians and bisexual women who have never used an oral contraceptive pill face a 50 percent greater risk of contracting ovarian cancer (American Cancer Society, 2019). However, in order to understand the correlation between the risks, more medical research is needed.
Cervical cancer is one of the most frequent types of cancer affecting women. Between 85 and 90 % of cervical cancers develop following a chronic infection by HPV (Human Papillomavirus), which is one of the most prevalent STIs on the planet. HPV is very contagious and can be transmitted through sexual contact with or without penetration. Any woman having had same-sex or heterosexual relations can be a carrier of HPV and prevention, screening and vaccination are essential.
Myth 2: Lesbian and Bisexual women cannot contract HIV
Another prevalent myth about lesbians and bisexual women’s sexual health is that they do not risk being infected with the human immunodeficiency virus (HIV). Both HIV and STIs can be transmitted through blood, including menstrual blood, vaginal discharge, sperm, wounds on skin or drugs sharing through syringes. Several cases of HIV between women have been identified. Although the risk seems to be weak, there is a general lack of knowledge regarding HIV transmission between women caused by the limited and rare research that exists on the subject.
Myth 3: Lesbian and Bisexual Women do not need contraception/protection
Because STIs can pass through sexual fluids or through blood, the risk of transmission can be caused by the lack of protection used by women during sex. Women are at heightened risks of contamination by STIs and HIV when: they practice cunnilingus & anilingus during menstrual periods, rub vagina against vagina, or when exchanging sex toys and using them for vaginal or anal penetration.
The STIs that lesbians and bisexual women are particularly subjected to are yeast infection, genital herpes, genital and anogenital warts, trichomoniasis, syphilis, chlamydia and gonorrhoea, bacterial vaginosis and hepatitis B and C. In order to avoid being infected, women need to use protections such as dental dams, condoms and precautions such as hygiene (washing hands before and after sex) and avoiding unprotected oral sex if they have any cuts or sores on their mouth or lips.
Lesbian & Bisexual women’s experience of parenthood
Currently, there are many sociolegal challenges that stand in the way of lesbian and bisexual women seeking access to Assisted Reproductive Technology (ART). The reason why ART is difficult to access in the majority of countries is because ART is considered as a means to deal with infertility, thus the laws related to ART were established to help heterosexual couples with difficulties in conceiving. That’s in part because health authorities such as the Centers for Disease Control and Prevention, the World Health Organization, and the American Society for Reproductive Medicine define infertility as the inability to get pregnant after one year of unprotected sex. This interpretation, of course, does not apply to women in a same-sex relationships — or, for that matter, to any woman who is interested in fertility benefits but not in unprotected penile-vaginal sex. Therefore, lesbian and bisexual women’s inability to prove their infertility hinders their access to ART.
Lesbian and Bisexual women’s difficulties in accessing ART can be seen both in the case of interauterine insemination (IUI), where lesbian and bisexual women use donor sperm from an anonymous or known donor and in the case of in Vitro Fertilisation (IVF), which involves the fertilisation of the egg by the sperm donor in an incubator outside the body. At the moment, only fourteen countries in Europe (Austria, Belgium, Denmark, Finland, Iceland, Ireland, Luxembourg Malta, Netherlands, Portugal, Norway, Spain, Sweden and the UK) currently allow medically assisted insemination for same-sex couples (Rainbow Europe, 2019).
In both Switzerland and Germany only heterosexual couples can use donated sperm cells. The current restrictions on reproductive rights in the countries has forced same-sex couples to travel abroad in countries such as Spain, Denmark or Austria in order to seek fertility treatments.
At the same time, after years of legal battles, the French Government has now claimed that from the end of September it would examine a new legislation that would lift the ban that prevents single women and lesbian couples accessing medically assisted procreation. Although some steps seem to be taken to eliminate restrictions on access to IVF, even in countries where IVF is legalised, there are still major social obstacles that LB women have to face. In 2017, for example, a UK lesbian couple Laura Hineson and Rachel Morgan have reported being denied access to funded IVF treatment by their local NHS Clinical Commissioning Group because of their sexual orientation (The Telegraph, 2017).
A third major obstacle for lesbian and bisexual women’s experience of motherhood has to do with the social and legal recognition of the second non-biological parent. Currently in Europe, automatic co-parents are recognised only in Austria, Belgium, Denmark, Ireland, Malta, Netherlands, Norway, Portugal, Spain and the United Kingdom. When living in countries that prohibit same-sex adoption, parents have to face the difficult choice of deciding who will be the legal parent and adopt as a single parent (Appel, 2003; Messina and D’Amore,2018). This procedure can cause distress for the non-legal parent because of their invisibility, isolation, and lack of legal tie with their child (Goldberg, 2012). Social parents experience a sense of loneliness throughout the adoption process. The idea of not having a legal bond with the adopted child provokes insecurity together with a feeling of being a “second-class parent” (Messina & D’Amore, 2018). Moreover, there are almost no programs present to help non-biological mothers to deal with their new status.
Sexual Abuse, Same-Sex Domestic Violence and Mental Health
According to a 2012 survey conducted by the European Union Agency for Fundamental Rights (FRA), within the EU, 23% of lesbians were physically/sexually attack or threatened with violence. Of those women, 54% said it happened because they were perceived to be part of the LGBTIQ community. Out of the women attacked, only 21% ever reported their most serious incident to the police.
Lesbians and bisexual women are subjected to discrimination and violence on a dual basis: their sex and their sexual orientation. For black women or women of colour, the experience might be additionally influenced by varying levels of racism or xenophobia.
GAMS Belgium has asserted that throughout research conducted with FGM survivors based in Belgium, they have encountered some who identified as either lesbian or bisexual. However, data on lesbian and bisexual women subjected to FGM is hardly available and this is perhaps one of the biggest gaps in lesbian/bisexual SRHR-related research.
This is a good moment to recall the Yogyakarta Principle 17 which asserts that States shall: “take all necessary measures to eliminate all forms of sexual and reproductive violence on the basis of sexual orientation, gender identity, gender expression and sex characteristics, including forced marriage, rape and forced pregnancy.”
In some specific contexts lesbians and bisexual women have also been targeted with ‘corrective rape’ or otherwise called ‘homophobic rape’ (Human Rights Watch, 2003). Accoridng to the United Nations Office of the High Commissioner for Human Rights (OHCHR), ‘homophobic rape’ is a hate crime that was first introduced via the term, ‘corrective rape’ by South African feminist activist Bernadette Muthien in 2001, during an interview conducted by Human Rights Watch:
“Lesbians are particularly targeted for gang rape. African lesbians are more likely to be raped as lesbians in the townships. To what extent are coloured lesbians also targeted for rape because of their sexual orientation? There are no statistics for this, and I don't know what percent of coloured lesbians are targeted for corrective rape action. Growing up, I never heard that lesbians were targeted in this way and so I want to know when that started happening. Gangsterism has always existed in the townships, so you can't attribute it to that. I don't know why black lesbians are targeted more, either. I'd like to know how many women are being raped by brothers, fathers, etc., in coloured townships. Why is no one studying this? Has it just been under-reported, not studied, or what?”
Homophobic/corrective rape often goes un-recognized by authorities, especially in countries without laws prohibiting LGBTIQ discrimination and violence or where same-sex relations are criminalised. Lesbians and bisexual women who endure these traumatic experiences may be faced with unwanted pregnancies or are infected with HIV or STIs. These horrible acts occur especially where the LGBTIQ community is severely marginalised and criminalised. Moreover, because these hate crimes are often carried out by family members or acquaintances, they very often go unreported.
Domestic violence in same-sex relations
In other instances, lesbian and bisexual women in same-sex relationships are also victims of physical, psychological, emotional, sexual and/or financial domestic abuse by their partners. Yet, the mainstream perception is that domestic violence only occurs within heterosexual relationships and that women are only ever abused by men and also rarely perceived as abusers. This assumption and lack of awareness generates a lot of denial and guilt within lesbian and bisexual women victims of domestic violence who feel excluded from domestic abuse support and avoid reporting the abuse.
In addition to this, there is generally no training done for police officers and social workers who encounter lesbian or bisexual women who have suffered from domestic violence from their partners. And domestic violence legislation usually excludes same-sex partners from its scope. Thus, in order to avoid additional marginalisation from their community, LB women fail to report their abuse.
The violence, exclusion and double discrimination that lesbians and bisexual women endure throughout their lives has a negative impact on their mental health. Lesbians and bisexual women are in fact at a heightened risk of depression, self-harming behaviour and suicidal thoughts.
Bisexual women are also confronted with an extra layer of discrimination due to a recurrent hyper-sexualisation of their sexual orientation. Their bisexuality often leads them to be excluded or erased from narratives both within same-sex and opposite-sex relationships. In addition to this, a common dualistic belief that one can either be homosexual or heterosexual puts double pressure on bisexual women who are often asked to pick a side. The lack of understanding and acceptance of their sexuality negatively impacts their mental health. Because of it, there is an essential need to create a safe and welcoming environment for bisexual women within the SRHR field.
In order to reduce and hopefully eliminate any forms of discrimination and stigma associated with lesbians and bisexual women, it is essential for the next generations to be taught about different sexualities and genders in an open and transparent way. Education is essential for the wellbeing of communities both on a mental health and SRHR level.
The Right to Health and the Right to Education as cornerstones
In November 2006, 29 distinguished human rights experts met in Yogyakarta, Indonesia, to draft, develop, and redefine what are now called the ‘Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Sexual Identity’ (‘YPs’).
The YPs were issued to reflect the existing international human rights laws in relation to sexual orientation and gender identity considering the principles of universality and non-discrimination.
According to Yogyakarta Principle 17, the Right to the Highest Attainable Standard of Health “Everyone has the right to the highest attainable standard of physical and mental health, without discrimination on the basis of sexual orientation or gender identity.” YP 17 also stresses that: “Sexual and reproductive health is a fundamental aspect of this right.”
Because lesbian and bisexual women face the risks of contracting STIs or getting cancer just like heterosexual women, as YP 17 stresses, States need to “ensure that all persons are informed and empowered to make their own decisions regarding medical treatment and care” and to “ensure access to a range of safe, affordable and effective contraceptives, including emergency contraception, and to information and education on family planning and sexual and reproductive health.”
To take proper care of their sexual and reproductive health and for healthcare providers to offer a safe and welcoming space for lesbians and bisexual women there is a need for radical change within the field of sexual education. Yogyakarta Principle 16 on “The Right to Education” sets forth that states need to: “ensure inclusion of comprehensive affirmative and accurate material on sexual, biological, physical and psychological diversity and the human rights of people of diverse sexual orientations, gender identities, gender expression and sex characteristics in curricula taking into consideration the evolving capacity of a child.” To be properly aware of their sexual and reproductive health, just like gay and bisexual men and heterosexual men and women, lesbian and bisexual young women and girls need to be properly taught about lesbian sex and risks of infections.
Properly diagnosing cancers and STIs, and addressing the issue of sexual and domestic violence are only a few of the SRHR issues that concern the wellbeing of lesbian and bisexual women. The goal of this article was to shed light on some of the experiences lesbians and bisexual women face that are not properly addressed on a mainstream level. The lack of funding for both lesbian/bisexual women SRHR-related research and organising leads to a general lack of knowledge and data on SRHR health issues and injustices. Over the past few years, organisations such as the EL*C, the EuroCentralAsian Lesbian* Community, Crips Ile-De-France in France or Rainbow House in Belgium (and many more) have been working on raising awareness and trying to reduce the gaps in knowledge on LB women’s SRHR. For instance, the EL*C has produced a Brief Report on discrimination and health on Lesbian* Lives in (parts of) Europe, Crips has produced a wide range of informative media resources on LB women’s SRH and Rainbow house has been hosting a “Let’s Talk about sex” project, a meeting place for respectful debates on SRH. We hope this article will serve as an inspiration for many SRHR and LGBTIQ organisations to focus further research on lesbian and bisexual women.
It is high time to recognise that restrictive sexual and reproductive rights policies are just as harmful in practice to lesbians and bisexual women, if not even more so, since their access to these rights are a challenge to start with. Moreover, ommitting lesbians and bisexual women from the SRHR discourse erases the enormous contributions they have made as advocates fighting simultaneously against all forms (or many at least) of heteropatriarchal oppression. For example, ‘Many campaign leaders, activists and organizers in Ireland’s abortion rights movement were queer women or queer people capable of getting pregnant.’
We would like partners and allies in the SRHR community to take these issues on board, and to fight for all, let’s work together on queering SRHR, to make it as inclusive as possible and to go beyond the binaries.
Together let’s work on Queering SRHR!
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