Lesbian, gay, and bisexual people may have more abortions than their heterosexual counterparts, according to a peer-reviewed Harvard study published in JAMA Network Open, a Journal of the American Medical Association publication, last week.

Researchers looked at more than 235,000 pregnancies in nurses, their offspring, and nursing students over a 65-year period. Nursing datasets were used because they provided national and longitudinal data, and offered detailed information about participants’ sexual orientation and pregnancy history, Dr. Payal Chakraborty, the paper’s primary author, said.

They found that people who self-identified as a sexual minority—which the paper defined as bisexual, gay, or lesbian, as well as heterosexual study participants with some same-sex attraction or experience—were nearly twice as likely to have a pregnancy that ended in abortion than their strictly heterosexual peers. Because data on gender wasn’t available for all participants, the research only evaluated sexual orientation, Chakraborty said.

Chakraborty is an epidemiologist and postdoctoral research fellow at Harvard Medical School and the Harvard T.H. Chan School of Public Health, and a fellow of the university’s LGBTQ Health Center of Excellence. She explained her team’s findings—and their high-stakes, real-world consequences—in an interview with Rewire News Group.

The following conversation has been edited for length and clarity.

What’s the top takeaway of this study?

Our research found that participants of all [sexual minority] groups were more likely to use abortion compared to their heterosexual peers. This finding is really striking for multiple reasons, but one of them is that almost no data are really available on abortion care needs of LGBTQ+ people, because data on sexual orientation and gender are often not available in a lot of reproductive health data sets. So what we show in this paper is that abortion is an LGBTQ+ issue, as these populations can and do seek abortions, and that restricting and banning abortion disproportionately harms LGBTQ+ populations.

What do you think explains that finding?

We know that sexual minority people are more likely to experience discrimination in employment, in housing. They’re more likely to experience poverty, and thus they generally have less access to health care and reproductive health care, including contraception. Sexual minority people are also more likely to experience sexual assault. We also know that [sexual minority groups] have less access to sex education because existing curricula are often not LGBTQ+ inclusive. Providers often fail to take a comprehensive sexual history and conflate identity with sexual encounters, making heteronormative assumptions about their patients’ pregnancy risks, so sexual minority people who do have access to contraceptive care may not get high-quality care. All of these reasons could contribute to higher rates of unintended pregnancies among sexual minority folks, which may then contribute to a higher reliance on abortion care for achieving reproductive autonomy. For wanted pregnancies, there’s a growing literature showing that sexual minority folks experience disparities in adverse pregnancy outcomes, so they may be more likely to need life-saving abortion care in the event of a pregnancy complication.

What are the real-world consequences of your findings?

There’s a lot of research showing that being denied a wanted abortion has really profound negative, financial, social, and health-related consequences for the pregnant person, such as being more likely to experience financial insecurity, being less able to care for existing children, having higher exposure to intimate partner violence, and having poor mental and physical health. And these are really highlighted by the Turnaway Study [a landmark study that measured the impact of unwanted pregnancies on pregnant people]. So given that sexual minority people already experience barriers across the reproductive health spectrum, they’re even more likely to be disproportionately impacted by growing abortion restrictions in this post-Dobbs [v. Jackson Women’s Health Organization] climate. And these restrictions are really likely to exacerbate, entrench, and compound the social and reproductive health inequities that sexual minority populations already face.

What’s a question that went unanswered that you think would be a fruitful area for further research?

We need to know the pathways that contribute to the unique abortion care needs of sexual minority folks, so that we can really understand how policies and programs can provide adequate support to this population. Specifically, health care—and especially reproductive health care—can be very stigmatizing for [sexual minority] folks. And so figuring out how we can make reproductive health-care less stigmatizing, to ensure that these folks get high quality care, is really essential. But we really need to know more about unmet abortion care need [to do that.] So this study is sort of like the tip of the iceberg, in that sense.

Why is this research important, especially now?

Across the whole country, anti-abortion legislators have been passing laws that restrict abortion or ban it completely. These restrictions create a web of barriers that interfere with people’s reproductive autonomy and their ability to access reproductive health care. We also know that when abortion care is unavailable, the harm falls hardest on those who already face significant social barriers and barriers to health care, and this includes LGBTQ+ people. LGBTQ+ rights are also currently under attack, so this, in combination with abortion restrictions and bans, are likely to have really compounding negative effects on the health of LGBTQ+ people and communities, and particularly people in this population who can get pregnant.