Some LGBTQ+ people and their allies have seized the moment of societal change by trying to change systems from within, finding private sector corporations to be much more open and agile in response to their needs than public institutions. To not lose customers or employees because of anti-LGBTQ+ sentiment, many corporations are opting to strengthen LGBTQ+ workplace policies and affinity groups.[47] Such policies include equal spousal and partner health care benefits, affirmative transgender health care benefits, gender-neutral bathrooms, and nondiscrimination policies that provide protections for sexual orientation, gender identity, and gender expression (figure 8.10). To capture the progress being made in the private sector, the Human Rights Campaign rates corporations in their annual Corporate Equality Index. Described as a “benchmarking tool on corporate policies and practices pertinent to lesbian, gay, bisexual, transgender, and queer employees,” these ratings are often used by corporations to demonstrate openness and inclusion.[48]
These corporate workplace gains haven’t come without criticism, however. Some have voiced concerns that private sector openness to LGBTQ+ communities is really just a way of manipulating workers into complacency by “keeping employees happy” and exploiting their need to “seek meaning through their job.” These policies can mask labor violations and exploitative practices, thereby creating the perfect marriage of capitalism and personal identity.[49] These corporate policies and practices are often described as assimilationist—that is, a strategy “that strives for access to those in power [and] is rooted in an interest-group and legislative-lobbying approach to political change.”[50]
Figure 8.10. A 2018 rally in support of protecting access to health care for the transgender community. (CC-BY-SA Ted Eytan.)
Other institutional change from within has occurred in health care and human services agencies. The National Association of Social Workers expressed its support in 2002 for allowing same-sex couples to foster and adopt and has repeatedly issued professional support for same-sex marriage—for example, in 2013 and 2015 in relation to Supreme Court rulings.[51]In 2004, the American Medical Association issued a similar statement supporting adoption, and in 2012, issued support for same-sex civil marriage. In 2013, the American Academy of Pediatricians expressed its support for allowing same-sex couples to marry and to become foster and adoptive parents. Other professional groups (for example, the American Psychiatric Association and the American Counseling Association) have followed suit. Collectively, these statements recognize that combating discrimination against LGBTQ+ families is important, discrimination is itself a public health issue, and families should receive professional and unbiased care and services.
Parenting and Family Building
Family and adoption rights are one way that LGBTQ+ parents are discriminated against if they have biological children, want to adopt, or want access to infertility treatment. Only five states actively ban discrimination based on sexual orientation and gender identity for foster and adoptive parents, an additional three states ban discrimination based on sexual orientation, and ten states have laws that allow discrimination against LGBTQ+ prospective foster parents. Most states are largely silent on the topic, opening up a range of treatment toward same-sex adopting families, from active discrimination that is based in law to indifference.[52] Little change has been made to recognize same-sex parents despite the overwhelming evidence that being raised in an LGBTQ+ family is not inherently harmful or destructive to the children.[53]
5 Positive Things to Sat to a Queer Family [Trying to Conceive]
Watch “5 Positive Things to Say to a Queer Family [Trying to Conceive]” (https://youtu.be/7nXTz1eN0Ko). A doula based in Brooklyn, New York, Morgane Richardson advises viewers how to positively interact with a queer family that is trying to conceive.
What is your biggest takeaway from this advice? Was there anything that surprised you or made you curious to learn more?
Explore one of the resources that Richardson identifies; how does it deepen your understanding of the issues?
How does Richardson define allyship? What advice about allyship did you find helpful?
Numerous studies have, however, documented the health and stress impacts of unequal laws on families that are headed by same-sex couples. For instance, should a child fall ill, a parent who is not legally recognized may be excluded from making medical decisions or may be separated from their child during an emergency because they are not recognized by medical staff as a parent or guardian. Unnecessary legal hurdles and simultaneous societal discrimination against same-sex households appear to be the root of stress, not the LGBTQ+ parents themselves.[54]
Legal Systems
Same-sex couples report navigating many legal challenges that vary depending on how the couple structures their family life. Interviews with fifty-one LGB parents in California found that the law affected their lives and decisions in three dominant arenas: (1) how to have children, (2) where to live, and (3) how their family was (or wasn’t) recognized.[55] Although some legal protections exist nationally, legal protections for LGBTQ+ families vary widely by state, highlighting the need to carefully consider the three arenas when determining how to best protect one’s family.
LGBTQ+ polyamorous couples who wish to have their entire family recognized and legally protected face numerous challenges, the biggest being that in almost all states and countries you may designate only one spouse in a legal marriage. These designations often mean that polyamorous couples cannot obtain health insurance for all their spouses or partners.[56]
Health Care and Human Services Providers
Same-sex couples, with or without children, report unequal treatment in health care and human services care compared with their heterosexual and cisgender peers. For same-sex couples seeking health care for their children, invisibility, or not being recognized by health care providers as a family unit, is one barrier to quality health care. A survey of nursing and medical students found that 69 percent did not directly ask about the relationship among family members or were unsure if they should directly ask if the two same-sex adults were a couple responsible for the child receiving care.[57] Not being seen and legitimized as a family unit is stressful to the couple and can also complicate care if one parent is not recognized as a guardian or is left out of decision-making processes.
Supportive and affirming policies, practices, and professionals are particularly needed to serve the aging LGBTQ+ community. The aging LGBTQ+ population is underserved and experiences higher risk of medical issues compared with their heterosexual peers.[58] Having higher need, combined with stigma from health care providers, leads to unsatisfactory and unequal treatment in out-of-home care. Couples who are aging and require out-of-home care often report anxiety about how they will be treated by staff and whether they will be seen, treated, and respected as a couple.[59] One study found that over half of elder LGBTQ+ adults were opposed to assisted living, and 80 percent were opposed to out-of-home care because of fear of discrimination, including how their partner would be treated and whether their advance directives for health care would be recognized and respected.[60]
Discrimination from human services providers in care and decision-making has long been of concern. For example, LGBTQ+ people in general and same-sex couples in particular face bias and outright discrimination when trying to adopt a child from foster care or through a social services agency. A survey of 169 diverse gay and lesbian parents found that over one-third were not emotionally supported when they were seeking to adopt (their adoption worker did not express support for them), in contrast to the experience of straight adopting couples, and nearly 15 percent felt very stressed when coming out as lesbian or gay to their adoption worker, fearing that it would limit their chances of having a child placed in their home.[61]
Schools and Educators
LGBTQ+ families with children interact with education systems with varying degrees of support for their families and identities. Challenges may include being treated differently from straight and cisgender parents, not having their family structures represented in the curriculum, and not having both same-sex parents respected as equal parents when decisions need to be made about their child. In addition, some LGBTQ+ parents have described trying to help their children explain their family structure (e.g., “I have two dads”) to other children at school, which is especially difficult when the classroom lacks LGBTQ+ cultural competency. These challenges can have a negative effect on the well-being of LGBTQ+ families and their children. College teaching and education programs need to place greater emphasis on training future educators, before they enter the classroom, in how to demonstrate cultural competence when working with LGBTQ+ families.[62]
Trends and Changes in the Legal Landscape
As Patterson and colleagues have pointed out, today’s quickly shifting legal landscapes regarding LGBTQ+ relationships, marriage equality, reproductive technologies, and foster parenting and adoption by LGBTQ+ individuals have brought challenges but also promise for improving the lives of LGBTQ+ families. However, these advances remain vulnerable to changing attitudes and political majorities. After marriage equality became law through the landmark Obergefell v. Hodges (2015) ruling by the U.S. Supreme Court, state legislatures began considering legislation to limit its influence, and court cases based on the right to religious freedom try to reverse gains. The future legal landscape for LGBTQ+ people appears uncertain.[63]
Strategies for Change: Queer Cautions and Resistance
LGBTQ+ communities, and the families that form within the community, are not monolithic. Therefore, any discussion of family within such a diverse and intersectional community will be a complicated one. For some LGBTQ+ people, the LGBTQ+ movement’s recent emphasis on assimilationist approaches to social change, such as fighting for access to heteronormative institutions like marriage, is misguided and actually privilege heterosexuality over queer lives. Some highlight the diverse and creative ways that LGBTQ+ people create families, emphasizing the importance of choosing families and raising concerns about laws and legally sanctioned institutions that often place limitations on what counts as family.
Some LGBTQ+ people are concerned that vital and limited resources in the fight for things like a national nondiscrimination law have been reallocated to the fight for marriage equality. Thus, ironically, a lesbian living in a state like Texas can now marry her wife but be unable to order a wedding cake if the local baker opposes LGBTQ+ families or marriage. Others look beyond the argument that marriage provides a way to gain access to important resources and benefits (e.g., health insurance, inheritance and property rights, visitation rights in hospitals and jails, adoption rights), instead asking why these benefits must be tied to marriage in the first place. Some scholars suggest that queer communities should reject all notions of family building altogether. They point out that rather than making these benefits available to all, marriage equality has created a new set of boundaries that define who has access to certain privileges that remain inaccessible for others in the broader LGBTQ+ community.[64]
Profile: LGBTQ+ Family Building: Challenges and Opportunity
Christa Craven
Queer people have a long history of creating family in many different ways, including creating chosen families among adults (and sometimes children) who may not be biologically related. Yet with the enhancement of legal rights in recent years, such as same-sex marriage, many LGBTQ+ people are feeling more pressure than ever to form families that include biological or adopted children or both. People have said to me, “After we got married, the next logical question from our families and friends was, ‘When will you have kids?’” With greater access to reproductive technologies and adoption for same-sex parents over the last few decades, LGBTQ+ people have significant opportunities to build families. However, experts estimate that a quarter of all pregnancies end in loss, and a similar number of adoptions fall through; 12 percent of U.S. women are diagnosed with infertility; and transgender people are often faced with difficult reproductive decisions relating to transition. With the rise in LGBTQ+ family making—the “gayby boom”—the numbers of reproductive losses through miscarriage, stillbirth, failed adoptions, infertility, and sterility have also increased.
In addition to heteronormative assumptions about who should have children, LGBTQ+ intended parents face another layer of invisibility and isolation as they combat the well-documented cultural silence surrounding reproductive loss. Even among those who support LGBTQ+ families, there is often political silencing of queer family-making narratives when they do not produce a happy ending. Moreover, the reproductive challenges LGBTQ+ families continue to face have received little attention and have been exacerbated by increasingly restrictive laws regarding LGBTQ+ adoption and family recognition following the 2016 U.S. elections. LGBTQ+ family making is politicized even within queer communities by progressive efforts to create a seamless narrative of progress toward enhanced marital and familial rights. These contentious political battles often eclipse the challenges and barriers LGBTQ+ parents face in establishing and gaining recognition as families.
Physicians and public health experts estimate that 10–20 percent of all recognized pregnancies in the United States and 30–40 percent of all conceptions end in pregnancy loss. Estimates for other countries vary substantially. The knowledge that a pregnancy has ended is likely higher for LGBTQ+ people, who are often more intentional in planning their families than their straight peers and thus more likely to be doing early home pregnancy tests. Public perception regarding pregnancy loss differs substantially from public health estimates. A 2015 survey of over a thousand U.S. adults showed that 55 percent thought miscarriage was rare (occurring in 5 percent or less of pregnancies).[65] In addition, 12 percent of U.S. women are diagnosed with infertility, and fertility preservation options are not always made available to transgender people considering hormones or surgery. Likewise, a review of U.S. studies among different populations estimates adoption failure rates, or what adoption agencies euphemistically refer to as “disruptions,” of 10–25 percent.[66] Statistics on adoption are not kept in most countries.
I interviewed over fifty LGBTQ+ people to understand how they experience loss, grief, and mourning. They included those who carried pregnancies, nongestational and adoptive parents, and families from a broad range of racial/ethnic, socioeconomic, and religious backgrounds. I found that stories of loss, death, and reproductive challenges that accompany queer family making are often ignored or silenced both inside and outside LGBTQ+ communities, resulting in personal and political isolation. Three examples drawn from my study highlight the need for more inclusive support resources.[67]
Alex and Nora’s Story
When I spoke with Alex and Nora, they had experienced a second-trimester loss less than a year before. Nora, a cisgender lesbian, had physically carried their first daughter, but she had developed health complications that made another pregnancy dangerous for her health. The couple agreed that Alex, who had previously identified as a female-to-male transman, would carry their next child. Alex had adopted a genderqueer lesbian identity after becoming pregnant and was pregnant at the time of our interview. Nora explained how her experience of their loss was not only a physical and emotional one but also personally and legally complex.
In losing our daughter . . . , I lost not only a biological and a physical connection. . . . I also lost the ability to have legal rights [to our future children], to have my name on this child’s birth certificate. . . . I’m not even going to be able to petition for that [where we live].
In 2011, Nora would have had no legal rights to their child borne by Alex because the couple lived in a state where nongestational queer parents were denied access to second-parent adoption of their children. But to Nora, having to formally adopt in any jurisdiction and be evaluated on her fitness as a parent was devastating.
Nonetheless, the couple continued to consider pursuing legal adoption in another state or country and then returning to their home state to request a reissued birth certificate that would recognize them both as legal parents. Unlike same-sex marriages or civil unions, which were not recognized in much of the United States before 2015 and not recognized in countries where laws do not permit same-sex unions, adoptions are recognized across jurisdictions. However, financial instability—Nora was a full-time graduate student and Alex an administrative assistant—put this option for giving both of them legal parental status out of the couple’s reach.
Although the couple lived in a liberal midwestern town, the homophobic state and federal laws that governed Nora’s relationship—or lack of legal relationship—with the child borne by her partner heightened her experience of loss. They encountered silencing within queer communities following their loss, which resulted in feelings of isolation. As Alex explained, LGBTQ+ reproductive loss “complicates the political rhetoric. It’s the same reason you don’t hear about gay divorce, because it complicates the political rhetoric of trying to get marriage equality.”
Significant changes in the legal landscape for LGBTQ+ couples and families have occurred in the 2010s, in the United States and throughout the world. After the national recognition of same-sex marriage in 2015 following the Obergefell v. Hodges U.S. Supreme Court case, many LGBTQ+ parents assumed that the presumption of parenthood (that both individuals in a marital union are legal parents to any child born within that union) would be extended to lesbian and gay married couples, as it is for heterosexual couples. However, legal precedent on this issue has been inconsistent, which can leave LGBTQ+ families—even those formed within legal marriages—vulnerable in ways that heterosexual married couples are not. Additionally, any children born to same-sex parents outside a legal marriage must still be formally adopted by the same-sex second parent. In the case that the couple legally marries (or the marriage becomes legally recognized) after the child is born, a stepparent adoption is required.
As of April 2019, only fifteen states allow unmarried parents to petition for second-parent adoption. Laws also exist in some states that allow discrimination against LGBTQ+ parents by adoption agencies that cite religious beliefs against same-sex parenting. In 2019, U.S. legal experts in the American Bar Association acknowledged that, despite the federal recognition of same-sex marriage in 2015, “state-sanctioned discrimination against LGBT individuals who wish to raise children has dramatically increased in recent years.”[68] Many adoptive parents also expressed the fear that homophobia and heterosexism within adoption agencies and among birth families meant they had a higher likelihood of adoption disruption than heterosexual couples.
Mike’s Story
Mike’s particularly heartbreaking story concerned suffering the loss of twins in an adoption. He and his partner, Arnold, had traveled to Vermont to get a civil union during the 1990s and began the adoption process shortly afterward in their home state, which didn’t legally recognize their relationship. With their stable jobs and multiracial family—Mike is a white pediatrician and Arnold an African American high school teacher—the adoption agency they worked with thought they were an ideal family to place biracial twins, whose eighteen-year-old mother had two children already and was living in a battered women’s shelter. They moved forward with an open adoption, meeting with the birth mother on multiple occasions and attending all doctor appointments. When the twins were born, the names that Mike and Arnold gave them appeared on their birth certificates. They spent ten days at home with the twins, but on the tenth day—the last day that birth mothers in their state could legally reclaim their children—at thirty minutes to midnight, the call came.
Mike and Arnold later spoke with staff from their adoption agency, who explained that the birth mother had contacted the biological father of the twins, whom she had been estranged from for months, to tell him that she had put them up for adoption to a gay male couple. He did not approve of having a gay couple raise the twins and convinced her to reclaim them. Despite the birth mother desperately trying to reverse that decision to reclaim the twins and making several calls to Mike and Arnold pleading with them to take the children, the adoption was never formalized. Arnold had struggled with depression previously, and after losing the twins, he began to abuse drugs and alcohol and was unable to return to work. Ultimately, after two years, his addiction led to the end of their relationship.
When we spoke, Mike had recently begun the adoption process again as a single man. This time, however, he was pursuing the adoption of an older child. He said,
[This adoption is] in the foster system, with parents whose parental rights had already been terminated. . . . I don’t want the chance of a birth parent reclaiming again. There’s no way I could do that again. . . . It was like they [the twins] had suddenly died. One minute they were here and the next hour they weren’t here. It was horrible.
Yet as many adoptive parents told me, what was sometimes most difficult about their losses was that the child had not died and that their heartache couldn’t be “a pure sense of grief or loss” that one might experience mourning the death of a loved one. Rather, the child they had come to know and love was “out there somewhere,” and that knowledge created ongoing questions and multilayered grief.
Mike’s story is one of multiple interlocking losses and demonstrates how reproductive losses do not always involve the death of a child, nor are they centered solely around the absence of that child (or children) in one’s life. LGBTQ+ adoptive parents, as well as those who experienced pregnancy loss, infertility, and sterility frequently spoke about the “loss of innocence” that shattered their initial expectations of linear progress surrounding reproduction. Reproductive losses can also result in the loss of dreams for particular kinds of family, as Vero’s story highlights.
Vero’s Story
When Vero came out in the late 1970s, she initially thought she didn’t want to have kids. She explained when we connected over Skype, “I waited longer than I should have . . . being gay, being raised in a Hispanic Catholic family, I didn’t even see it as a reality.” Coming out before the 1990s gayby boom and then leaving home as a teen to serve in the U.S. Army for ten years, like many other LGBTQ+ people who grew up during this time, she felt that forming a family would not be an option for her. But as she found a more supportive community, and many of her LGBTQ+ friends began having kids, “it started to feel like a reality.” Although she didn’t initially wish to carry a child, when she desired children with a long-term partner who was unable to carry, she decided to begin monitoring her ovulation. A year and a half later, that relationship had ended.
But I kept thinking about it and . . . thinking about it and decided that that was something I really wanted with or without that relationship. So, I went on with the process. I had a donor. Everything was good to go. . . . And so, I went to get a physical and during that physical was when they found my cancer. And so, it quickly became—I was staged pretty high and so that quickly became the focus. Even though it [having a baby] was sitting in the back of my head, it was more about getting it [the cancer] staged, having biopsies, and starting treatment, blah blah blah. So, all of that kind of consumed me. . . . I didn’t have to think about it [losing my ability to conceive] right away. But then that came. [Fighting back tears.] I still get emotional about it.
At the time, Vero’s doctors estimated that the advanced stage of her cancer gave her between three months and ten years to live. Although well-meaning friends suggested she consider adoption after initial chemotherapy treatment seemed successful, Vero felt that would not be fair to the child because of the uncertainty about her future health. When I asked Vero how she did cope once she was able to focus on her experience beyond the immediacy of her cancer treatment, she spoke about struggling because, she said, “some people don’t even see my experience as a loss, because I never conceived.” She also had complex feelings that others seemed not to understand:
Once all of the dust settled [after three years of chemotherapy and experimental treatment], I felt very grateful. I mean, if it hadn’t been for this child that I had already named but that I never had, I wouldn’t even be here. [Through tears.] I think what helped me find peace in it all was the gratitude that I was still here and in the last sixteen years that my life would have been completely different. It took a really different turn . . . not a 180, but at least a 45-degree angle [laughing]. It gave me more time to be with all of my friends’ kids. . . . If I’d waited any longer than I did to get my physical, I probably wouldn’t have made it, period. It kind of gave me a different gift. It hit me in a bunch of different ways, and it still hits me every once in a while. I was thinking about it just yesterday: that kid would probably have been fourteen or fifteen by now, and how different my life would be . . . just completely different.
Vero’s experience underscores not only the depth and complexities of losing one’s dream of family but also how grief can shift and evolve over time. As others have frequently said, “It never leaves you.”
Together, Alex and Nora’s, Mike’s, and Vero’s stories paint a vivid picture of the multiple interlocking losses that frequently accompany the loss of a child or dreams of a child. LGBTQ+ parents face general social taboos about discussing reproductive loss, but these expectations are frequently magnified by the legal and political barriers they face in gaining recognition as families. Additionally, they face pressures within LGBTQ+ communities where stories of loss are often silenced in efforts to present a political vision for LGBTQ+ progress.
More inclusive support resources that embrace the diverse realities and challenges of forming LGBTQ+ families are necessary for bereaved LGBTQ+ individuals and families. A notable finding of my study was that over half the participants faced financial struggles in their efforts to expand their families. For most, the urgency to become pregnant or adopt again after a loss drove them to invest more (both financially and emotionally) in those efforts. Yet many discussed this financial investment with a great deal of ambivalence, for fear that it would detract from the emotional loss they experienced. Their stories challenge the assumed affluence of LGBTQ+ individuals who seek to expand their families, even among those who do so via expensive assisted reproductive technology and adoption.
As a queer parent who found few resources after my own second-trimester loss and who bore witness to the ways that my partner was further isolated as a nongestational parent, I have always given this project a public focus. When I published Reproductive Losses: Challenges to LGBTQ Family-Making, I launched a companion website (http://www.lgbtqreproductiveloss.org) an interactive and expanding resource for LGBTQ+ individuals and families. Readers can access an archive of commemorative photos and stories, as well as advice to LGBTQ+ parents experiencing loss and those who support them. But there is far more work to be done to overcome the silencing and isolation surrounding reproductive loss; create opportunities for sustained dialogue among LGBTQ+ intended parents, medical and adoption professionals, and other support professionals; and acknowledge that grappling with grief and mourning—particularly in a moment of legal and political uncertainty—is inescapable for many queer people.
Key Questions
What are some of the negative consequences of homophobia, heterosexism, and minority stress for LGBTQ+ people in terms of relationship building, and creating families?
What myths have you heard regarding the quality of LGBTQ+ relationships? What does research say about those myths?
Why is it challenging to research LGBTQ+ families and relationships?
What are some of the challenges that LGBTQ+ families face as they interact with legal systems?
Check Your Knowledge
Contributed by Has Arakelyan, Rio Hondo College
Multiple-Choice Questions
1. Why have many private sector corporations strengthened their LGBTQ+ workplace policies?
A) to avoid paying taxes
B) to not lose customers or employees due to anti-LGBTQ+ sentiment
C) to comply with international law
D) to reduce product prices
2. What is the Corporate Equality Index?
A) a benchmarking tool rating corporate policies and practices for LGBTQ+ inclusion
B) a government tax form
C) a list of LGBTQ+ celebrities
D) a health insurance plan
3. What is a criticism of corporate LGBTQ+ inclusion policies?
A) They always lead to higher salaries.
B) They only benefit straight employees.
C) They are required by law in every state.
D) They may be used to mask labor violations and exploit workers’ need for meaning.
4. What is meant by “assimilationist” strategies in the context of LGBTQ+ rights?
A) rejecting all forms of political change
B) only supporting LGBTQ+ celebrities
C) striving for access to power through interest-group and legislative lobbying
D) focusing on international issues
5. How many states actively ban discrimination based on both sexual orientation and gender identity for foster and adoptive parents?
A) 5
B) 25
C) 50
D) 0
Discussion Questions
Do you think corporate LGBTQ+ inclusion policies are genuine progress or mostly a marketing strategy? Why?
How might assimilationist strategies both help and limit the LGBTQ+ rights movement?
What are the potential risks when states are “silent” on discrimination against LGBTQ+ foster and adoptive parents?
Why is it important for professional organizations (like the AMA or NASW) to publicly support LGBTQ+ families?
In your view, what additional steps could be taken to ensure equal parenting and family-building rights for LGBTQ+ people across all states?
Multiple-Choice Questions - Answers
1. B) to not lose customers or employees due to anti-LGBTQ+ sentiment
2. A) a benchmarking tool rating corporate policies and practices for LGBTQ+ inclusion
3. D) They may be used to mask labor violations and exploit workers’ need for meaning.
4. C) striving for access to power through interest-group and legislative lobbying
5. A) 5
