Examining Perinatal Mental Health in LGBTQ2S+ People

Quality perinatal care is crucially important for the health of the birthing parent and the baby. But for many LGBTQ2S+ individuals, the perinatal period is filled with challenges and complexities.

A recently-published systematic review by Temerty Medicine researchers found that stigma, discrimination and systemic barriers contribute to mental health risks for LGBTQ2S+ individuals during the perinatal period, and points to a need for improvements in the delivery of health care for these groups.

Three of the study authors  – Dr. Lucy Barker, Dr. Abi Kirubarajan and Shannon Leung  – spoke to Julia Soudat about this research, why it’s important and what it means for LGBTQ2S+ health care.

Tell me a bit about this research.

Lucy: We conducted a qualitative systematic review to describe the experiences of LGBTQ2S+ childbearing individuals regarding perinatal mental health.

What we found was that LGBTQ2S+ childbearing individuals can face many complex challenges during the perinatal period. LGBTQ2S+ patients can face stigma, discrimination, and exclusion in both social spheres and healthcare settings. The use of gendered language or incorrect pronouns, as well as the gendered treatment of pregnancy and childbirth were noted as sources of distress.

LGBTQ2S+ childbearing individuals also experienced a lack of knowledge from healthcare providers regarding both their perinatal care and mental health. Stigma and systemic barriers such as inadequate discussion of mental health by healthcare providers were identified as barriers to seeking mental healthcare during the perinatal period.

The implications of these findings are that LGBTQ2S+ childbearing individuals face unique risks for mental health during the perinatal period. Improvements are needed at multiple levels to ensure that care is inclusive of LGBTQ2S+ individuals. 

Were any of the findings particularly surprising for your team? 

Abi: Although we were expecting there to be gaps in care, it was still staggering how little healthcare providers knew about LGBTQ2S+ health. It was very unfair how LGBTQ2S+ patients felt pressured to educate their own doctors. It should not be that way.

What needs to be done to improve perinatal mental health care for LGBTQ2S+ individuals? 

Shannon: The studies included in our review provided suggestions for improving perinatal mental health of LGBTQ2S+ childbearing individuals. Implementable changes to improve care identified by studies in our review include ensuring the consistent use of correct pronouns and names, gender-neutral terminology (e.g., “pelvic examination”), tenets of trauma-informed care, improving privacy, and de-stigmatizing mental health concerns. Additional training regarding care for LGBTQ2S+ patients was frequently cited as a needed intervention to improve inclusive perinatal mental health care.

Why is this research important? 

Abi: LGBTQ2S+ individuals are often underserved by the current mental health systems and thus may be particularly likely to experience poor outcomes associated with undertreated mental health challenges. Given that the perinatal period poses unique stressors for mental health, we believed it was imperative to study this population.

Lucy: Up to one in five childbearing individuals experiences mental illness during the perinatal period, and existing research suggests that this risk may be even higher among LGBTQ2S+ individuals. It is critical that we understand the perinatal mental health experiences of  LGBTQ2S+ individuals so that we can deliver high-quality, inclusive care.

What got you interested in this research? 

Lucy: As a perinatal psychiatrist, it is a priority to deliver inclusive mental health care to all childbearing individuals. Understanding the experiences of LGBTQ2S+ individuals is critical to be able to meet patients’ needs.  

Shannon: As a future physician, I think it is incredibly important that LGBTQ2S+ individuals have access to safe and inclusive care. This research will be helpful for myself and other healthcare providers in thinking about how we can improve care for LGBTQ2S+ patients.

Abi: I feel very privileged to deliver babies and take care of pregnant people. I strongly believe that perinatal care needs to be equitable and inclusive of all people, regardless of gender identity or sexual orientation.

Dr. Lucy Barker (she/her) is psychiatrist in the Reproductive Life Stages Program at Women’s College Hospital, a PhD candidate in the Institute of Health Policy, Research and Management (U of T), and a research fellow at Women’s College Research Institute and in the Department of Psychiatry at the University of Toronto. 

Dr. Abi Kirubarajan (she/her) is a first-year Obstetrics & Gynecology resident at McMaster University.  She recently graduated from the University of Toronto Faculty of Medicine's MD-MSc program in Health Policy, Management, and Evaluation with a specialization in Systems Leadership and Innovation.

Shannon Leung (she/her) is a second-year MD student at the University of Toronto Faculty of Medicine.