Harvard Med School Associate Professor Discusses Health Disparities in Sexual and Gender Minority Females

Harvard Medical School associate professor Brittany M. Charlton discussed reproductive health care disparities experienced by sexual and gender minority women at a Harvard School of Public Health seminar Wednesday.

Sexual and gender minority populations encompass LGBTQ+ people or others who are nonbinary or do not self-identify as specific sexual orientations or gender identities.

Charlton is affiliated with the Center for Population and Development Studies and serves as the co-director of Harvard Sexual Orientation and Gender Identity and Expression Health Equity Research Collaborative. This event is the fourth installment of HSPH’s Center for Population and Development Studies’ population research exchange series, which aims to present population science topics through seminars, workshops, and information sessions.

Charlton began the lecture by explaining the research challenges relating to the reproductive health of LGBTQ+ patients. These difficulties include limitations in sampling — such as small or “convenient” samples — exclusion of children and adolescents, and a lack of specialized researchers in the field.

Charlton said she and her team overcame these barriers by using large national prospective cohort studies, such as the Nurses’ Health Study — which investigates chronic diseases in women — and the Growing Up Today Study — a longitudinal cohort super-study on a wide range of health issues. Charlton helped lead both of these initiatives.

Presenting her research findings, Charlton said “structural stigma” has led to reproductive health disparities in sexual minority women.

“It can include things like discriminatory laws, same-sex marriage bans. Those really adversely impact the reproductive health of sexual minorities above and beyond that of their heterosexual peers,” Charlton said.

As a result of these causal factors, she said, sexual minority women are “twice as likely to have had a sexually transmitted infection” and are “more likely to have an unintended pregnancy.”

Charlton’s research shows that for every one cisgender and heterosexual woman who becomes pregnant as a result of sexual assault and rape, about 10 LGBTQ+ people experience the same.

Charlton said she and her colleagues at Harvard SOGIE have aimed to educate others on these disparities in order to mitigate them.

Charlton’s team develops and implements programs in the medical education field. One such program is a training that teaches faculty to cultivate a more inclusive and safe learning environment.

Harvard SOGIE also created a model to help faculty mentor sexual and gender minority people.

“We know that quality mentorship needs a whole host of things, whether that’s an increased sense of belonging or activity. Unfortunately most of us learn how to mentor by trial and error,” Charlton said.

Charlton added that there were no mentor training programs for LGBTQ+ health professionals at the time the model was constructed; however, she said a pilot of her team’s mentoring program last spring was a success.

Despite the ongoing work of LGBTQ+ health researchers, Charlton still believes there is much work to be done to reduce disparities. She concluded her talk with a call to action for health care professionals, researchers, and legislators, citing the current political climate and persistent violence toward LGBTQ+ people and allies.

“We are seeing a completely unprecedented and coordinated attack primarily on our pediatricians who are providing gender affirming care,” Charlton said, referencing a September 2022 protest against the nation’s first pediatric and adolescent transgender health program at Boston Children’s Hospital.

“We’ve really got to puff up our chests and really just not back down from this work,” Charlton added.