The Health Status of LGBT Women
Violence and Safety Among LGBT Women and Youth
The Employment and Earnings of Women Living with Same-Sex Partners
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Poverty, Opportunity, and Economic Security Among Women Living with Same-Sex Partners
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Lesbian, gay, bisexual, and transgender (LGBT) Americans have gained strong momentum in securing greater rights and societal acceptance in recent decades. As of February 2015, 37 states and the District of Columbia had authorized same-sex marriage (Human Rights Campaign 2015), the President of the United States had issued an executive order prohibiting discrimination based on sexual orientation and gender identity among federal contractors (The White House 2014), the Justice Department had expanded the interpretation of the Civil Rights Act of 1964 to protect against discrimination of transgender government employees (U.S. Department of Justice 2014), and the U.S. Equal Employment Opportunity Commission had chosen to interpret “sex discrimination” in Title VII to include discrimination based on sex or gender identity and begun accepting charges on those bases (U.S. Equal Opportunity Employment Commission n.d.). In addition, in 2013 the Supreme Court struck down parts of the Defense of Marriage Act (DOMA), clearing the way for same-sex spouses in states that recognize same-sex marriage to file joint tax returns, receive service member spousal benefits, sponsor a partner for U.S. residency, and qualify for the Family and Medical Leave Act (FMLA), among other benefits (Human Rights Campaign 2014a).
These changes point to significant progress, yet much remains to be done to extend basic legal protections to LGBT individuals. As of 2014, 29 states—mostly Midwestern, Mountain, and Southern states—still lacked statewide protections against employment discrimination based on sexual orientation and gender identity (Hasenbush et al. 2014).
- One study that analyzed four surveys—the National Survey of Family Growth (NSFG), General Social Survey (GSS), National Health Interview Survey (NHIS), and Gallup Daily Tracking Survey—found that across the surveys the proportion of adults in the United States who identify as LGBT ranged from 2.2 percent (in the NHIS) to 4.0 percent (in the Gallup data; Gates 2014a). Analysis of the Gallup data indicates that among those aged 18 and older, 4.1 percent of women and 3.9 percent of men identify as LGBT, with adults in the West (4.6 percent) and East (4.3 percent) more likely to identify as LGBT than those in the South (4.0 percent) and Midwest (3.8 percent; Gates 2014a).
- The same study shows that across the four surveys, younger adults are more likely to identify as LGBT than older adults (7.2 percent of adults aged 18–29 percent in the Gallup data compared with 2.1 percent of those aged 60 and older; Gates 2014a).
- Among adults aged 18 and older, a higher percentage of Hispanics (5.7 percent) and blacks (5.6 percent) identify as LGBT than Asians (4.4 percent) and whites (3.6 percent; Gates 2014a). Those who identify with another race or as multiracial are the most likely to identify as LGBT (6.5 percent).1
- The median annual earnings for women who live with a same-sex partner2 ($48,000) are considerably lower than those of men who live with a same-sex partner ($58,000) and lower than married men in different-sex households ($56,000), but higher than earnings for married women in different-sex households ($42,000) and women who live in a cohabiting relationship with a different sex partner ($33,000).3 Women living with a same-sex partner also have higher earnings than men cohabiting with a different-sex partner ($38,000).
- Women aged 16 and older who live with a same-sex partner are much more likely to participate in the labor force than women of the same age range who are married to men (74.8 percent compared with 60.0 percent). Women who live with a same-sex partner, however, are less likely to be in the workforce than unmarried women who live with a male partner (76.4 percent).
- Women who live with a same-sex partner are considerably more likely to hold a bachelor’s or advanced degree (43.7 percent) than married women in different-sex households (34.9 percent) and women who live with a different-sex partner (25.0 percent). Men who live with a same-sex partner are the most likely to hold at least a bachelor’s degree (48.5 percent).4
Despite their strong participation in the labor force, high earnings, and high educational levels, many women living with a same-sex partner experience economic insecurity.
- Women who live with a same-sex partner are more likely to live in poverty than women married to men (7.4 percent compared with 6.2 percent) and men living with a same-sex partner (3.5 percent). Single women and women who live with (but are not married to) a different-sex partner have much higher poverty rates at 24.5 and 14.3 percent, respectively.5
- Same-sex couples are 1.7 times more likely than different-sex couples to receive food stamps, with women, bisexuals, and people of color within the LGBT community among the most likely to be recipients (Gates 2014b). About one-third (34 percent) of LGBT women did not have enough money for food in a one year period between 2011 and 2012, compared with 20 percent of non-LGBT women and 24 percent of LGBT men. In addition, during this time 37 percent of black LGBT adults and 55 percent of Native Americans LGBT adults experienced food insecurity, compared with 23 percent of white LGBT adults (Gates 2014b).
- Rates of economic insecurity and discrimination within the transgender community are especially high. One study analyzing the National Transgender Discrimination Survey found that transgender adults were nearly four times more likely than adults in the general population to have a household income below $10,000 and twice as likely to be unemployed. In addition, almost one in five (19 percent) had experienced homelessness. Ninety percent of survey respondents reported having experienced harassment or mistreatment in the workplace, and 47 percent said they have experienced an adverse job outcome, such as being fired, not hired, or denied a promotion (Grant, Mottet, and Tanis 2011).
- The percentage of LGBT Americans lacking health insurance coverage has decreased substantially since the Affordable Care Act’s provisions mandating health insurance went into effect in 2014. Still, LGBT Americans are less likely to be insured than their non-LGBT counterparts. Approximately 18 percent of LGBT adults aged 18 and older report not having health insurance, compared with 13 percent of non-LGBT adults (Gates 2014c).
- LGBT women are significantly more likely than non-LGBT women to report not having enough money to pay for health care or medicine (29 percent compared with 19 percent), and not having a personal doctor (29 percent compared with 16 percent; Gates 2014c).
These findings underlie the need to increase legal protections for LGBT individuals, eliminate discrimination, and foster acceptance of diverse gender identities and expressions.
Data on earnings, labor force participation, educational attainment, and poverty are based on IWPR analysis of 2013 American Community Survey microdata.
1 Figures are based on analysis of Gallup data (Gates 2014a).
2 Due to sample size limitations, data on women living with same-sex partners includes both those who are married and those who are not married.
3 Earnings data are for full-time, year-round workers aged 16 and older.
4 Percent of those with a bachelor’s degree or higher includes those aged 25 and older.
5 Poverty rates are for those aged 18 and older.
The Health Status of LGBT Women
LGBT women face health disparities that may stem from a variety of factors, including the stresses of being part of a sexual minority, societal stigma toward the LGBT community, barriers to accessing health insurance, and outright denial of care due to sexual orientation or gender nonconforming behavior (Grant et al. 2011; Institute for Medicine 2011; Lick et al. 2013; Ranji et al. 2014).
- Research indicates that lesbian and bisexual women aged 18 and older are less likely than heterosexual women to describe their health as excellent or very good (53.4 percent and 55.5 percent, respectively, compared with 59.8 percent; Ward et al. 2014). Among men, the pattern differs: those who identify as gay are the most likely to say their health is excellent or very good (66.2 percent, compared with 63.6 percent of bisexual men and 61.6 percent of heterosexual men)
- Analysis of data from one survey of nearly 5,000 LBGT individuals in the United States found that more than half (nearly 56 percent) of respondents reported having faced discrimination in a health care setting, including being refused needed care, having a health care professional use excessive precautions or refuse to touch them, being blamed for their health status, or having a health care professional use harsh or abusive language toward them (Lambda Legal 2010). Such discrimination may mean that LGBT women do not receive the care they need.
- One study analyzing Gallup-Healthways Well-Being Index data found that LGBT women are considerably more likely than non-LGBT women (29 percent compared with 16 percent) to report that they do not have a personal doctor. Among LGBT and non-LGBT men, the difference is not significant (29 percent and 27 percent, respectively; Gates 2014).
- Among women aged 20 and older, lesbian (36.7 percent) and bisexual women (40.9 percent) are considerably more likely to be obese than heterosexual women (28.3 percent; Ward et al.2014).
- Lesbian (25.7 percent) and bisexual women (28.5 percent) aged 18 and over are more likely than heterosexual women (15.0 percent) to be current cigarette smokers (Ward et al. 2014).
- Bisexual women aged 18 and older are more than twice as likely as heterosexual women of the same age range to report consuming five or more alcoholic drinks in one day at least once in the past year (33.8 percent compared with 14.3 percent). Lesbian women also are more likely than heterosexual women to report having had at least five alcoholic drinks in one day in the past year, although the difference is not as large (25.8 percent compared with 14.3 percent; Ward et al. 2014).
- LGBT women (29 percent) are more likely than LGBT men (21 percent) and non-LGBT women and men (19 and 15 percent, respectively) to say that they did not have enough money for health care needs at least once in the past year (Gates 2014).
- Lesbian and bisexual women aged 18 and older are more likely than heterosexual women to report having experienced serious psychological distress in the past 30 days. Approximately 10.9 percent of bisexual women and 5.3 percent of lesbian women say they have recently experienced serious distress, compared with 4.2 percent of heterosexual women (Ward et al. 2014).
- LGBT youth are more likely to experience mood and anxiety disorders, depression, and suicidal ideation and attempts than their non-LGBT counterparts (Institute for Medicine 2011). Analysis of Youth Risk Behavior Surveys conducted between 2001 and 2009 found that across nine jurisdictions—Delaware, Maine, Massachusetts, Rhode Island, Vermont, Boston, Chicago, New York City, and San Francisco—the prevalence of attempted suicide among high school students during the 12 months before the survey ranged from 3.8 to 9.6 percent (median: 6.4 percent) among heterosexual students, from 15.1 to 34.3 percent (median: 25.8 percent) among gay or lesbian students, from 20.6 to 32.0 percent (median: 28.0 percent) among bisexual students, and from 13.0 to 26.7 percent (median: 18.5 percent) among students who describe themselves as unsure of their sexual orientation (Kann et al. 2011).
- Transgender adults often face specific challenges to maintaining good health, including harassment and discrimination in medical settings, economic insecurity and lack of access to health insurance, refusal of care, and lack of knowledge among providers about the health care needs of transgender persons (Grant, Mottet, and Tanis 2011). Analysis of the National Transgender Discrimination Survey found that 19 percent of respondents reported having been refused care due to their transgender or gender nonconforming status, 28 percent said they had experienced verbal harassment in medical settings, and 50 percent reported having to teach their medical provider about transgender care. One in four respondents (26 percent) reported having used drugs or alcohol to cope with the impacts of discrimination (Grant, Mottet, and Tanis 2011).
The Affordable Care Act has made inroads in addressing some of these challenges. An analysis of Gallup-Healthways Well-Being Index data published in August 2014 indicated that the percentage of LGBT adults aged 18 and older without health insurance decreased after the ACA went into effect at the beginning of 2014; however, LGBT adults were still more likely than their non-LGBT counterparts to lack health insurance (17.6 percent of LGBT adults polled between January and June 2014 lacked coverage, compared with 13.2 percent of non-LGBT adults; Gates 2014). In addition to expanding access to coverage, the Affordable Care Act prohibits discrimination based on sex and gender identity in any health program receiving federal funds. The U.S. Department of Health and Human Services has issued additional regulations governing health insurance marketplaces and the plans sold in them that prohibit discrimination on the basis of sexual orientation (U.S. Department of Health and Human Services 2012b).
Violence and Safety Among LGBT Women and Youth
[See National Data]
LGBT Americans face heightened exposure to hate crimes and physical violence. Although one study that analyzed four national surveys found that across the surveys the proportion of adults in the United States who identified as LGBT ranged from 2.2 to 4.0 percent (Gates 2014), sexual orientation-based hate crimes made up about 21 percent of hate crimes reported by law enforcement in 2013 to the Bureau of Justice Statistic’s Uniform Crime Reporting program (U.S. Department of Justice 2014). This percentage is probably an underestimate given that state and local agencies are not required to release statistics to the FBI, and a number of LGBT survivors of hate violence may not report their abuse to the police (National Coalition of Anti-Violence Programs 2014).
An analysis of the 2010 National Intimate Partner Violence Survey finds that bisexual women are significantly more likely than heterosexual or lesbian women to have experienced violence: 46.1 percent of bisexual women aged 18 and older report having experienced rape, 74.9 percent report having experienced sexual violence other than rape, 36.6 percent say they have been stalked, and 61.1 percent report having experienced intimate partner violence (Table 7.1). Among lesbian and heterosexual women, the prevalence of these forms of violence is considerably lower.
LGBT youth are also vulnerable to violence and discrimination. One study, that analyzed data from the 2013 National School Climate Survey, found that during the 2012–2013 school year, an estimated 74.1 percent of LGBT students aged 13 to 21 were verbally harassed because of their sexual orientation and 55.2 percent because of their gender expression (Figure 7.6). Almost one in three (32.6 percent) were physically harassed (e.g., being shoved or pushed) because of their sexual orientation and more than one in five (22.7 percent) because of their gender expression. A smaller, but still substantial, percentage of LGBT students were physically assaulted because of their sexual orientation or gender expression (Figure 7.6). In addition, nearly half of LGBT students (49.0 percent) experienced cyberbullying, and more than half (55.5 percent) reported personally experiencing LGBT-related discriminatory policies or practices at school (Kosciw et al. 2014). LGBT students who experienced higher levels of victimization had lower GPAs than those who experienced lower levels of victimization. They were also more than three times as likely to miss school in the month before the survey, twice as likely to have no plans to pursue postsecondary education, and had lower self-esteem and greater levels of depression (Kosciw et al. 2014).