Abortion rates higher among sexual minority groups

Abortion rates higher among sexual minority groups | Image Credit: © lazyllama - © lazyllama - stock.adobe.com.

Abortion use is more common among sexual minority groups vs heterosexual individuals, according to a recent study published in JAMA Network Open.¹

Unintended pregnancy and access disparities

Data has indicated increased odds of unintended pregnancy among sexual minority individuals vs their heterosexual counterparts. Additionally, many sexual minority individuals in the United States reside in areas with restricted abortion access, and there is currently little data about abortion use among these populations.

“Accurate data on sexual orientation differences in abortion use are needed to highlight the reproductive health care needs of sexual minority populations,” wrote investigators.

Additionally, data has indicated a disproportionate impact of abortion bans on racial and ethnic minority groups.² A 2024 study reported prevalence ratios of 1.17 and 1.59 for residing in states with abortion bans among American Indian and Black patients, respectively, vs 1.02 for White patients. This highlighted disparities in abortion care.

Sexual identity and abortion data collection

The recent study was conducted to compare abortion use between sexual minority groups.¹ Data was obtained from the Nurses’ Health Study 2 (NHS2), Growing Up Today Study (GUTS), and Nurses’ Health Study 3 (NHS3).

Each cohort provided data about participants’ sexual identity, attractions, and partners. Patient categories included completely heterosexual, heterosexual with same-sex experience, mostly heterosexual, bisexual, and lesbian or gay.

Abortion data was obtained from a 2009 questionnaire in the NHS2 cohort, a 2019 questionnaire in the GUTS cohort, and both an initial and thirteenth survey in the NHS3 cohort. In the NHS3 surveys, participants were asked about pregnancy outcomes, including abortion.

Patient demographics and induced abortion risk

There were 235,948 pregnancies across 85,640 participants included in the final analysis. Of pregnancies, 89.5% were to heterosexual patients and 10.5% to sexual minority patients. Rates of sexual minority patients were 17.7% in the GUTS cohort, 19.7% in NHS3, and 8.4% in NHS2. Participants were aged a mean of 25 to 30 years.

The odds of a pregnancy ending in induced abortion were increased nearly 2-fold among sexual minority populations compared with heterosexual individuals, with an unadjusted risk ratio (RR) of 1.93 across the 3 cohorts. Similarly, a 1.56-fold increase was reported among heterosexual participants with same-sex experience vs completely heterosexual individuals.

Relative risks for induced abortion among mostly heterosexual and lesbian or gay participants were 2.15 and 2.52, respectively, indicating an over 2-fold risk. For bisexual patients, this risk increased nearly 3-fold, with an RR of 2.84.

Adjusted findings and implications

Similar results were reported when adjusting for the year and age at pregnancy. Additionally, tests with bisexual participants as the reference group highlighted this population as having significantly increased odds of abortion use compared to all other sexual orientation groups except for gay or lesbian patients.

Participants from all sexual dimensions displayed increased induced abortion odds across the 3 cohorts, except for lesbian or gay participants in the GUTS study. This highlighted an increased chance of abortion care among sexual minority populations, indicating a disproportionate impact of abortion restrictions among these patients.

“These findings highlight the need to understand the variability in abortion access by sexual orientation and the pathways that contribute to the unique abortion care needs of sexual minority individuals, especially as abortion access has narrowed considerably in the US following the Dobbs ruling,” wrote investigators.

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. Kunzmann K. State abortion bans more frequently affect Black, White, American Indian women. May 3, 2024. Accessed May 8, 2025. https://www.contemporaryobgyn.net/view/state-abortion-bans-affect-black-white-american-indian-women.