LGBTQ2S+ childbearing individuals and perinatal mental health: A systematic review
Corresponding Author
Abirami Kirubarajan
University of Toronto Faculty of Medicine, Toronto, ON, Canada
University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada
Correspondence
Abirami Kirubarajan, University of Toronto Faculty of Medicine, Toronto, ON M5S 1A8, Canada.
Email: [email protected]
Search for more papers by this authorLucy C. Barker
University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada
University of Toronto Department of Psychiatry, Toronto, ON, Canada
Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada
Search for more papers by this authorShannon Leung
University of Toronto Faculty of Medicine, Toronto, ON, Canada
Search for more papers by this authorLori E. Ross
University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
Search for more papers by this authorJuveria Zaheer
University of Toronto Department of Psychiatry, Toronto, ON, Canada
Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
Search for more papers by this authorBomi Park
University of Toronto Faculty of Medicine, Toronto, ON, Canada
Search for more papers by this authorAlex Abramovich
University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
Search for more papers by this authorMark H. Yudin
University of Toronto Department of Obstetrics and Gynaecology, Toronto, ON, Canada
Department of Obstetrics and Gynaecology, Unity Health, St Michael's Hospital, Toronto, ON, Canada
Search for more papers by this authorJune Sing Hong Lam
University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada
University of Toronto Department of Psychiatry, Toronto, ON, Canada
Centre for Addiction and Mental Health, Toronto, ON, Canada
Search for more papers by this authorCorresponding Author
Abirami Kirubarajan
University of Toronto Faculty of Medicine, Toronto, ON, Canada
University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada
Correspondence
Abirami Kirubarajan, University of Toronto Faculty of Medicine, Toronto, ON M5S 1A8, Canada.
Email: [email protected]
Search for more papers by this authorLucy C. Barker
University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada
University of Toronto Department of Psychiatry, Toronto, ON, Canada
Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada
Search for more papers by this authorShannon Leung
University of Toronto Faculty of Medicine, Toronto, ON, Canada
Search for more papers by this authorLori E. Ross
University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
Search for more papers by this authorJuveria Zaheer
University of Toronto Department of Psychiatry, Toronto, ON, Canada
Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
Search for more papers by this authorBomi Park
University of Toronto Faculty of Medicine, Toronto, ON, Canada
Search for more papers by this authorAlex Abramovich
University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
Search for more papers by this authorMark H. Yudin
University of Toronto Department of Obstetrics and Gynaecology, Toronto, ON, Canada
Department of Obstetrics and Gynaecology, Unity Health, St Michael's Hospital, Toronto, ON, Canada
Search for more papers by this authorJune Sing Hong Lam
University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada
University of Toronto Department of Psychiatry, Toronto, ON, Canada
Centre for Addiction and Mental Health, Toronto, ON, Canada
Search for more papers by this authorAbstract
Background
The perinatal period may uniquely impact the mental health and wellbeing of lesbian, gay, bisexual, transgender, queer, and Two-Spirit (LGBTQ2S+) childbearing individuals.
Objectives
To characterise and synthesise the experiences of LGBTQ2S+ childbearing individuals regarding perinatal mental health, including symptomatology, access to care and care-seeking.
Search strategy
We conducted and reported a systematic review following PRISMA guidelines of eight databases (EMBASE, MEDLINE-OVID, CINAHL, Scopus, Web of Science: Core Collection, Sociological Abstracts, Social Work Abstract, and PsycINFO) from inception to 1 March 2021.
Selection criteria
Original, peer-reviewed research related to LGBTQ2S+ mental health was eligible for inclusion if the study was specific to the perinatal period (defined as pregnancy planning, conception, pregnancy, childbirth, and first year postpartum; includes miscarriages, fertility treatments and surrogacy).
Data collection and analysis
Findings were synthesised qualitatively via meta-aggregation using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI), and the ConQual approach.
Main results
Our systematic search included 26 eligible studies encompassing 1199 LGBTQ2S+ childbearing participants. Using the JBI SUMARI approach, we reported 65 results, which we synthesised as six key findings. The studies described unique considerations for LGBTQ2S+ individuals’ perinatal mental health, including heteronormativity, cisnormativity, isolation, exclusion from traditional pregnancy care, stigma, and distressing situations from the gendered nature of pregnancy. Many participants described a lack of knowledge from healthcare providers related to care for LGBTQ2S+ individuals. In addition, LGBTQ2S+ individuals described barriers to accessing mental healthcare and gaps in health systems. Strategies to improve care include provider education, avoidance of gendered language, documentation of correct pronouns, trauma-informed practices, cultural humility training and tailored care for LGBTQ2S+ people.
Conclusions
Pregnancy, postpartum, and the perinatal period uniquely impacts the mental health and wellbeing of LGBTQ2S+individuals, largely due to systems-level inequities and exclusion from perinatal care. Healthcare providers should implement the identified strategies to improve perinatal care and address inequities.
CONFLICT OF INTEREST
None. Completed disclosure of interests form available to view online as supporting information.
Open Research
DATA AVAILABILITY STATEMENT
Data sharing not applicable - no new data generated, or the article describes entirely theoretical research.
Supporting Information
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Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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