Transitions: Working with GLBTQ Youth
Volume 14, No. 4, June 2002

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By Tamarah Moss, Program Manager, Emergency Contraception Initiative, Advocates for Youth

Many young women who have sex with women (YWSW) also have sexual intercourse with men. In a survey of lesbians, 77.3 percent reported sexual intercourse with one or more males in their lifetime.²⁷ Sexual intercourse with men places YWSW at risk for unintended pregnancy. Indeed, one study showed that lesbian and bisexual teens have twice the rate of pregnancy as their heterosexual and questioning peers.²⁸ Compared to their female peers, lesbian and bisexual teens reported a higher incidence of sexual abuse, incest, and rape; heterosexual relationships before they identified as lesbian; internalizing the stigma associated with lesbian identity and using pregnancy to ensure being perceived as heterosexual; and engaging in heterosexual activity as a means to deal with their fear of discrimination and rejection.²⁸

Therefore, health providers and educators should make special efforts to educate YWSW about emergency contraception as an option to prevent teen pregnancy. Emergency contraception (EC) is a method of preventing pregnancy after contraceptive failure, sexual assault, and/or unprotected sexual intercourse. Emergency contraceptive pills (ECPs) can be used any time up to 120 hours (five days) after sexual intercourse.

As such, ECP is an option that could annually avert as many as 50 percent of pregnancies and consequent abortions among American teens.²⁹ ECPs are available as Plan B®, and/or as repackaged birth control pills that are taken in a particular dosage and manner. ECPs do not cause abortion because the pills have no effect after pregnancy is established. (The American College of Obstetricians and Gynecologists defines pregnancy as beginning with implantation.³⁰)

Lesbian and bisexual teens, like their heterosexual peers, face barriers to obtaining ECPs. Barriers include providers' lack of knowledge about ECPs, cost, time constraints, lack of insurance and transportation problems, and limited clinic hours. Teens often fear that their confidence will be violated. They also often fear procedures such as blood tests, pelvic exams, and the reputed side effects of ECPs. However, lesbian and bisexual teens face additional challenges from providers, including homophobia, heterosexual assumptions, and lack of understanding of lesbian health care issues.

Youth-serving professionals can help overcome barriers and ensure lesbian and bisexual young women's access to health care. Access means timely use of personal health services to achieve the optimal health outcomes. Health care providers and educators need to ensure that lesbian and bisexual teens receive respect and comprehensive information:

• Inform young women who have sex with women of the risks associated with unprotected vaginal, anal, and oral sexual intercourse.
• Develop and distribute ECP educational materials that address the needs of all teenage women, including lesbian and bisexual teens.
• Develop formal referral systems among health providers, educators, and GLBTQ youth serving organizations.
• Provide ECPs in clinical and non-clinical settings.
• Ensure that teens are able to get hold of ECP within the 72-hour time period. Better yet, provide ECPs or prescriptions for ECP in advance of need and without pelvic exams.
• Create both teen-friendly and GLBTQ-friendly office policies and/or procedures.
• Provide training to staff on the needs of lesbian and bisexual teens.

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Transitions (ISSN 1097-1254) © 2002, is a quarterly publication of Advocates for Youth—Helping young people make safe and responsible decisions about sex. For permission to reprint, contact Transitions' editor at 202.419.3420.

Editor: Sue Alford