When Health Care Isn’t Caring: LGBT Women1 Results from Lambda Legal’s Health Care Fairness Survey In 2009, Lambda Legal conducted a survey, with the help reported that taxation of same-sex partner benefits was a of over 100 partner organizations, as part of a national problem for them, compared to 77 percent of non-female Health Care Fairness campaign. This survey is the first to respondents. Female respondents were also more likely examine experiences with refusal of care and barriers to than non-female respondents to be low-income and in health care access among LGBT and HIV communities2 relationships, providing some reasons why they were more on a national scale. The information in this report is vulnerable to these types of discrimination. gleaned from the 4,916 surveys completed. This fact sheet describes the discrimination, substandard care and barriers to health care experienced by LGBT Taxation of same-sex partner benefits refers to the women.2 Nearly 38 percent of respondents to this survey taxes that an individual must pay when he or she covers (1,866 people) identified as female. Of this group, 86 a same-sex partner or domestic partner under an percent (1,607 people) identified as non-transgender employer health insurance plan. The estimated amount female; almost 8 percent (143 people) identified as the employer pays to cover the partner is considered transgender; 5 percent (98 people) identified as gender taxable income by the federal government, as well as non-conforming or androgynous; and 1 percent (20 by a number of state governments, because they do people) identified as two-spirit. (Survey respondents could not allow same-sex couples, married or otherwise, the select more than one of these categories.) exemption that married heterosexuals receive for the value of their spousal health benefits. Discrimination and Substandard Care The results of this survey overall show that disturbing In several categories of discrimination covered in numbers of lesbian, gay, bisexual or transgender (LGBT) this survey, lesbian, gay or bisexual (LGB) female respondents as well as those living with HIV have respondents were more likely than their non-female experienced significant health care discrimination. counterparts to experience discrimination and substandard care. Respondents who identified as female were most likely to be affected by two particular types of discrimination: • Over 37 percent of LGB female respondents reported being denied infertility services and taxation of same- that they were treated differently than other people, sex partner benefits. compared to almost 28 percent of non-female gay and bisexual respondents. Nearly 18 percent of female respondents reported being denied infertility services, making them more than twice as • Over 53 percent of LGB female respondents reported likely as non-female respondents to report being denied being treated by health care providers who were these services. Eighty-two percent of female respondents unaware of the specific needs of LGB people, compared to 39 percent of non-female gay and 1 Generally, when “LGBT” is used, the “G” refers to gay men. However, when bisexual respondents. female-identified respondents were asked in this survey to identify their sexual orientation, nine percent said they were “gay,” therefore we are describing this Transgender or gender-nonconforming (TGNC) group as “LGBT women.” respondents who identified as female (also referred to as transfeminine) reported experiences of 2 There were not enough female-identified respondents living with HIV to analyze this group separately. As a result, this fact sheet only contains information discrimination and substandard care. These responses about female-identified LGBT survey respondents as a whole, both HIV positive were similar to those for TGNC respondents who identified and negative. as male (transmasculine). www.lambdalegal.org/health-care-report LGBT Women Discrimination and Substandard Care: Female LGB Compared to Female Transgender or Gender-nonconforming (TGnC) 57.9 60% LGB TGNC 53.2 50% 43.3 37.2 40% 30% 23.3 18.7 18.7 20% 14.1 10.0 8.4 9.4 10% 7.5 6.8 3.7 0% Physically Refused to Refused Blamed me Harsh language Treated me Unaware of rough or abusive touch me needed care differently health needs • Over 23 percent of female TGNC respondents Intersectionality theory makes it clear that it is impossible reported that they had been refused needed care to separate different types of discrimination and because of their gender identity. oppression because they intersect and interact to create, • Female TGNC respondents reported that medical sustain or deepen negative outcomes. In fact, the professionals were unaware of their specific needs (58 intersectional experience is greater than the sum of the 3 percent), treated them differently than other patients different types of discrimination. (43 percent), blamed them for the medical problem The intersectionality of sexism, homophobia, transphobia for which they sought care (19 percent) or used harsh and/or stigma based on HIV status can help explain why or abusive language toward them (19 percent). These LGBT female survey respondents were more likely to responses were similar to those for TGNC respondents experience some discrimination and barriers to care than who identified as male (transmasculine). non-female respondents. among TGNC survey respondents, those who identified as LGBT women have unique experiences that may not be female were somewhat less likely to say they were denied best addressed by policies and programs designed with trans-specific care (among those who wanted it). Thirty the incorrect assumption that all LGBT people are male. percent of female TGNC respondents reported this type Similarly, programs designed for heterosexual women of discrimination compared to 37 percent of non-female may not meet the needs of LGBT women. By taking TGNC respondents. intersectionality into account, policies and programs can more sufficiently address the particular ways in which LGBT Intersecting Forms of Discrimination women experience discrimination. It is well documented that women experience significant health disparities due to sexism and other factors. While Barriers to Health Care this survey was designed to examine the discrimination Female respondents also reported being worried about LGBT people and people living with HIV experience their ability to obtain needed health care. These concerns in health care based on their sexual orientation are barriers to care and can lead to a reluctance to seek (homophobia), gender identity (transphobia) and/or care and, as a result, poorer health outcomes. Female HIV status (HIV stigma), it is important to point out that respondents were worried that: LGBT people and people living with HIV may experience • There are not enough health professionals adequately discrimination based on a multiplicity of factors including gender, age, health status, race, ethnicity, class and 3 Kimberle Crenshaw, Demarginalizing the Intersection of Race and Sex: A Black national origin. Feminist Critique of Antidiscrimination Doctrine, Feminist Theory, and Antiracist Politics, 1989 U. CHI. LEGAL.F. 139,140. WHEN HEalth CaRE ISN’T CaRING www.lambdalegal.org/health-care-report LGBT Women Fears and Concerns About Accessing Health Care: Female LGB Compared to Female Transgender or Gender-nonconforming (TGnC) 100% LGB TGNC 88.5 85.3 80% 67.2 56.8 60% 53.4 54.1 48.8 46.8 40% 31.8 32.9 25.9 20% 8.8 0% I will be Not enough Not enough I will be Not enough Community fear refused care support groups substance treated differently trained professionals or dislike abuse providers trained to care for LGBT people (54 percent for LGB • Take intersectionality into account when females and 89 percent for transgender females); developing policies, programs and services. • Medical personnel will treat them differently because of • advocate for improved laws and accreditation their sexual orientation or gender identity (33 percent standards. for LGB females and 67 percent for transgender females); and Governments should: • They will be refused the medical care they need • Include equal coverage of LGBT people and because of their sexual orientation or gender identity people living with HIV in all antidiscrimination and (nearly 9 percent for LGB females and nearly 49 percent equal opportunity mandates. for transgender women). • Require all health care facilities and education programs that receive government funding to Key Recommendations develop and implement goals, policies and plans to ensure that LGBT people and people living with Health care institutions and providers should: HIV are treated fairly; and provide ongoing cultural • Establish nondiscrimination, employment, fair competency training for all health care students visitation and other policies that prohibit bias and and professionals. discrimination based on sexual orientation, gender • Change laws to require recognition of the families identity or expression and HIV status; recognize of LGBT people, including those who live within families of LGBT people and their wishes; and less common family structures, and require health provide a process for reporting and redressing care providers to do the same. discrimination if it occurs. • Pass laws that explicitly protect LGBT people and • Mandate cultural competency training for all health people living with HIV from discrimination in health care students and professionals about sexual care settings. orientation and gender identity