Clinically Assisted Reproduction Among Sexual Minority Women: Plans, Pivots, and Partnered-Decisions

Research focused on the efforts to conceive among sexual minority women (SMW) in same-sex couples has expanded in breadth and depth in recent decades. Yet, as consistent evidence of health disparities among SMW, along with sociopolitical and technological transformations that have changed notions of kinship and family formation, the context and forces that shape coupled SMW’s paths to pregnancy require further investigation. Informed by health equity and reproductive justice frameworks, this dissertation qualitatively examines the experiences of 20 coupled SMW (10 same-sex cisfemale couples) actively engaged in trying to conceive with clinically assisted reproduction (CAR), in the United States. Using a three-paper approach, this dissertation addresses three facets of coupled SMW’s experiences: 1) fertility related information needs, seeking, and use; 2) experiences of sexual minority stress in CAR; and 3) an innovative approach to co-created relationship timelines and their use in qualitative analysis. In Chapter II, which focused on information needs, seeking, and use, I found that SMW work hard to build information repositories drawing on multiple sources. Three main themes that reflect the nuances of the results are: contextual factors that shape information navigation; certainty and uncertainty about aspects of CAR; and the cyclical and unpredictable process of information seeking, appraisal, and use. Chapter III, focused on manifestations of sexual minority stress in CAR. I found that stress manifests within hegemonic heteronormativity, with specific structural, clinical, and individual dimensions. Chapter IV, the relationship timeline method, co-construction of timelines yielded graphic and narrative data that offered new insights about SMW couples in a medicalized process. Overall this dissertation provided new insights and generated additional questions about how to achieve more equitable and just paths to pregnancy and family expansion for sexual and gender minorities