Individuals who identify as sexual minorities are at a higher risk of primary Cesarean birth compared to their completely heterosexual peers, according to a recent study conducted by the Columbia University Mailman School of Public Health. The research found that these risks vary among different sexual-orientation subgroups, with the largest increase seen in people who identify as heterosexual but have had same-sex experiences.
The study used data from three major U.S. cohort studies: Nurses’ Health Study 2 and 3, and the Growing Up Today Study. These cohorts include participants born between 1947 and 1997, surveyed every one to three years. Sexual minority pregnancies made up 14 percent of all pregnancies in the sample, although less than 1 percent were from individuals identifying as lesbian or gay.
Overall, sexual minority participants had seven percent higher odds of experiencing a primary Cesarean birth than completely heterosexual participants. The study also noted that sexual minority pregnancies occurred more frequently among racially minoritized groups.
Disparities were especially evident when labor was induced. “Very little national data captures both detailed sexual-orientation measures and birth outcomes,” said , MD, PhD, assistant professor at Columbia Mailman School. “By combining three rich national surveys, we were able to identify elevated risks among subgroups—particularly heterosexual participants with same-sex experience—who have been largely absent from perinatal research. We urge researchers to incorporate detailed orientation and gender-identity measures in future longitudinal studies to better understand these patterns.”
Higher rates of induced labor were also found among sexual minority participants. “This is notable,” McKetta said, “because the Cesarean disparity was greatest following induction—raising concerns about potential differences, including provider bias, in decision-making around interventions.”
Cesarean births account for over 1.1 million surgeries annually in the United States and represent about 26 percent of low-risk births. While often necessary for medical reasons, Cesareans are considered overused and can lead to increased healthcare costs and maternal health complications.
“Future research should examine individual, interpersonal, and structural factors contributing to these disparities so we can design interventions that reduce them,” McKetta said. “Clinicians should also be mindful of unintentionally lowering the threshold for moving from induction to Cesarean among sexual minority patients, which may worsen existing inequities. Reducing unwarranted Cesareans in this population will improve health outcomes and support national goals to decrease primary Cesarean births.”
The study’s co-authors represent several institutions including Harvard Pilgrim Health Care Institute; Harvard T.H. Chan School of Public Health; University of Utah; University of Michigan; Boston Children’s Hospital; Brigham and Women’s Hospital; and Massachusetts General Hospital.
Funding for the study came from multiple NIH grants as well as support from private foundations such as the Thomas O. Pyle Fellowship, William T. Grant Foundation, and Mongan Institute Director’s Fund.
Columbia University affirms its commitment to community well-being and compliance with civil rights laws prohibiting illegal preferences or discrimination.
