Parenthood experiences of LGBT+ individuals: a systematic review

SUMMARY

OBJECTIVE:  This systematic review aims to analyze the parenthood experiences of LGBT+ individuals.

METHODS:  The review was carried out between February and June 2020 and used key words about LGBT+ and/or parenthood, including, “lesbian and mother,” “lesbian and parenthood,” “gay and father,” “gay and parenthood,” and “trans and parenthood,” which were published in databases, such as PubMed, Google Academic, Wiley Online Library, and ScienceDirect.

RESULTS:  We reviewed 19 research articles, and the majority of these articles suggested that LGBT+s faced negative reactions and discrimination when they decided to become parents. Once they became parents, the relationship of most of the LGBT+ individuals with their partners and the surrounding social environment improved and social support for and self-esteem of the LGBT+ individuals increased.

CONCLUSIONS:  Compared to the heterosexual parents, LGBT+ individuals faced with various problems in their social, family, and professional lives during parenthood. Therefore, they need more family, legal, and social support.

KEYWORDS: Homosexuality; Parents; Sexual and gender minorities; Social support

INTRODUCTION

The concept of LGBT+ gained importance as a result of the struggles of people with different sexual identities for their rights. The concept refers to lesbian, gay, bisexual, transgender/transsexual, intersexual, and queer individuals¹. As such, sexual orientations of not only heterosexual but also of homosexual and bisexual people are defined². Given that all individuals have the right to sexual and reproductive health, we may suggest that LGBT+ individuals have the right to parenthood and have children³.

Individuals with different sexual orientations have different methods to become parents, including egg and sperm donation, surrogate motherhood, and assisted reproductive techniques⁴–⁶. Besides, LGBT+ individuals may adopt children, which is a widely recognized method of parenthood.

The review of the literature on the comparison of the experiences of LGBT+ parents with their heterosexual counterparts showed conflicting findings. Some of the studies found that LGBT+ parents raised happier children and spent more time to raise their children, independent of gender roles and rules⁶. However, the review by Carneiro et al. (2017) reported no difference between the experiences of gay and heterosexual fathers in terms of involvement in their children’s activities, level of intimacy, parenting problem-solving, and time spent with their children⁷. Other studies also dealt with childbearing problems in nontraditional societies, including social exclusion of the children, homophobia, and the absence of family support and legal protection⁸,⁹.

Despite the existence of systematic reviews on the parenthood experiences of individuals with different sexual orientations in the literature, we have not found any studies that dealt with the parenthood experiences of LGBT+ individuals⁷,¹⁰. We believe that reviewing the difficulties that LGBT+ individuals experience during parenthood may help policy makers, civil society groups, and health professionals that provide care to these people, including nurses, physicians, and social service experts.

Aim

This systematic review aims to analyze the parenthood experiences of LGBT+ individuals. The research questions include the following:

• What are the sociodemographic characteristics of LGBT+ individuals?

• What are the positive parenthood experiences of LGBT+ individuals?

• What are the negative parenthood experiences of LGBT+ individuals?

METHODS

Design

This systematic review used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) to prepare the protocol and report the article. PRISMA statement may be accessed via http://prisma-statement.org/.

Data sources and search strategy

We conducted this systematic review between February and June 2020 and reviewed scientific articles in English version which were published in different databases (e.g., PubMed, Google Academic, Wiley Online Library, Taylor and Francis Online, and ScienceDirect). We used the key words about LGBT+ and/or parenthood, including “lesbian and mother,” “lesbian and parenthood,” “gay and father,” “gay and parenthood,” “trans and parenthood,” “LGBT+ and parent,” “LGBT+ and parenthood,” “LGBT+ parent,” and “adoption parenthood experience.” We used the words “and” and “or” to search key words.

Study selection

We analyzed the qualitative, quantitative, and mixed-design studies on parenthood experiences of LGBT+ individuals that were published in English until June 2020.

Inclusion criteria

• Studies on LGBT+ individuals that had parenthood experience and lived with their children.

• Research articles that were published in English.

Exclusion criteria

• Articles on the intentions and motivations of LGBT+ individuals.

• Articles on the relations between LGBT+ individuals and their parents.

• Articles on the opinions of health professionals on the parenthood of LGBT+ individuals were excluded from the systematic review.

Methodological quality assessment

Quality assessment of the reviewed articles was independently conducted by two researchers. We used 12 criteria proposed by Polit and Beck (2009) to evaluate the quality of evidences. The two researchers independently scored 1 that met the criteria and 0 for the studies that did not meet the criteria¹¹. Coherence between the researchers was assessed by using Cohen’s kappa (κ), where the values of 0.41–0.60, 0.61–0.80, and 0.80–1.00 referred to moderate, substantial, and almost perfect agreement, respectively¹². Kappa (κ) in our study was 0.54, indicating moderate agreement.

RESULTS

Study design and sample characteristics

We reviewed 4 quantitative, 14 qualitative, and 1 mixed-design scientific studies. Parenthood experiences of five gay, five lesbian, one transsexual, and eight LGBT+ people were included in our systematic review.

Demographic characteristics

Age of the participants who were included in our systematic review ranged between 22 and 59 years, and the majority of the participants were above the age of 40. Most of the participants had postgraduation degree. Besides, the majority of the participants had high-income levels (Table 1).

Table 1
Studies on parenthood experiences of LGBT+ individuals.

Author and year	Participants	Country	Research design	Methods to become parents	Sociodemographic characteristics	Findings
Blake et al.4	74 gay fathers	The United States	Qualitative	Surrogacy	*Average age was 47.2 years 98% university or above *A high income	*Some of the gay couples who chose surrogacy as a path to parenthood received negative feedback about the ethical dimensions of surrogacy. *Negative attitudes before the birth changed into positive ones after birth.
Lindheim et al.5	78 gay couples	The United States	Cross-sectional	Surrogacy, IVF	*44.7% aged between 40 and 49 years * 76.6% were university graduates and 69.9% had high income	*Parents received negative reactions of their children/society about their family structures. *Participants faced with difficulties in their professional life after becoming parents, such as use of annual leave and changes in working hours. *Children of the participants were disappointed for not having a mother. After explaining about their unique family structures, participants asked their children to choose one of the parents as mother.
Erera and Engelchin17	9 gay fathers	Israel	Qualitative	Pregnancy with heterosexual relationship	*Age ranged from 35 to 56 years *8 is high education *Economic status (2 poor, 7 good)	*Respondents stated the importance of the presence of both father and mother for their children. *Most of the respondents underlined the functions of mothers in raising their children, including affection, care, and love. Due to this reason, they formed a family with a co-parent biological mother.
Bergman et al.15	40 gay fathers	The United States	Qualitative	Surrogacy	*Age ranged from 27 to 52 years *No data on education level. *37 respondents had a mean annual income of US$270,000.	*Parenthood brought losses and missed opportunities in the work lives of most of the participants. *After having children, frequency of business and leisure travels decreased and travels mostly involved visits to families of origin and domestic family-oriented trips. *Relationship with families and self-esteem improved after the participants became fathers. *Participants felt themselves more valuable after becoming fathers.
Goldberg16	29 lesbian couples	The United States	Mixed method	IVF	*Mean age of biological and nonbiological mothers was 35 and 37.7 years *Most were highly educated *Mean annual income was US$100,600.	*41% stated that the desire to experience pregnancy and childbirth and have a biological connection to the child were determining factors in their decisions. *Most couples found it relatively easy to decide on who would carry the children. Fertility reasons, health, career plans, and age of the couples influenced their decisions. *Perceived family support increased after the transition to parenthood.
Forenza et al.19	4 lesbian, 1 bisexual, and 4 gay parents.	The United States	Qualitative	Adoption	* No data on age, education, and income levels of the participants	*Legal regulations were the primary obstacles for their parenthood. * After becoming parents, participants de-emphasized their LGB+ identities in favor of self-categorization as a parent.
Bos et al.22	100 lesbian and 100 heterosexual families	Netherlands	Qualitative	…	* No data on age, education, and income level of the participants	*Lesbian social mothers reported significantly more than heterosexual fathers that they felt the need to justify the quality of their parenthood. *Lesbian biological mothers were more satisfied with their partner than heterosexual mothers.
Van Ewyk and Kruger6	10 lesbian couples	South Africa	Qualitative	8 donor insemination, 2 opted for adoption.	*Age of parents ranged from 25 to 49 years. *Education level: high school to tertiary degree and middle class.	*Lesbian couples reported a decrease in their sexual activities and socialization after parenthood. * Participants reported that co-parenting alleviated much of stress and prevented exhaustion and that sharing the responsibilities prevented frustration.
Van Rijn-Van Gelderen et al., 2018	38 gay, 61 lesbian, and 41 heterosexual	The United Kingdom, France, the Netherlands	Cross-sectional	Surrogate carriers, sperm donors, and IVF without sperm or egg donation	* Age ranged from 22 to 59 years. * Nearly two-thirds were employed full time and most families had good income	*Parents reported low levels of parental stress, anxiety, and depression regardless of family type. *There was no significant difference between the family groups in terms of parental stress, depression, anxiety, partner relationship satisfaction, and caregiver role. *Parents in all family types were satisfied with intimate relationships.
Faccio et al., 2013	14 transsexuals and 14 men	Italy	Qualitative	-----	*Age ranged between 39 and 58 years *Socioeconomic and education levels were high	*Most of the parents did not receive help for child care. *Transsexual parents considered themselves as competent parents who spent sufficient time for child care.
Lévesque et al., 2020	19 heterosexual and 4 same-sex couples	Canada	Qualitative	Pregnancy with heterosexual relationship	*Age ranged from 27 to 49 years *47.8% completed university degree *Majority were employed full time with satisfactory financial situation	*Participants reported fatigue, lack of sleep, social isolation, financial precariousness, discrimination at work, and balancing work and family life as main difficulties. *Parents spent less time on social activities and families and more time to meet the needs for children. *Lesbians expressed social norms influenced their relations with the children and created anxiety.
Ryan and Whitlock, 2007	96 lesbian parents	The United States	Cross-sectional	adoption	*Mean age ranged from 41 years to 45 years. *Majority held bachelor’s degree or above *Mean annual income was US$95,000.	*Major sources of counseling were adoption agencies, friends, adoption books, and social services and the participants found counseling service to be helpful. *Majority of the parents considered adoption process as a positive experience. * Legal sources of information on adoption supported the decision and helped them to feel good.
Brown et al., 2009	183 gay and lesbian parents	The United States	Qualitative	adoption	*Mean age was 45 years for women and 43 years for men *Majority had bachelor’s degree or above and high annual household income	*Parents experienced difficulties to access LG adoptive families and felt the need for role models for their children. *Parents struggled with how to address children’s emotional and behavioral difficulties. *Financial difficulties, finding time for family/relationship, and social acceptance were problems. *Parents considered children as the center of their lives and source of joy. *Parents expressed they were supported by their families and friends during the adoption process.
Peterson et al.40	3 gay fathers	The United States	Qualitative	Surrogacy, adoption	*Ages ranged from 30 to 50 years. *Participants had college or university degree *High income	*Family support and support within workplace were influential on their decisions to become parents. *Although parenthood was exhausting, they expressed that sharing experiences with their children was very important.
Goldberg35	84 parents (17 lesbian, 13 gay, and 12 heterosexual)	The United States	Qualitative	Adoption	*Mean age was 38.5.	*Legal challenges to adoption were the major problems during the adoption process. *Participants believed that social agencies could help adoptive parents to overcome the problems they experienced during the processes of adoption and preparation to parenthood.
Jennings et al.38	41 gay, 40 lesbian, and 49 heterosexual parents	The United Kingdom	Qualitative	Adoption	*Mostly around the age of 40 years *No data on education level *Most were working	*Parental decision was framed by societal prejudice, both as to whether their children would be discriminated against and whether they as parents would be supported. *Legal changes, visibility of gay and lesbian parents in the media, and the prompts of family and friends encouraged the participants to adopt children.
McConnachie et al.39	30 gay father, 29 lesbian mother, and 38 heterosexual parent families	The United Kingdom	Cross-sectional	Adoption	*Mean age was 46 years and above *Education and income levels were relatively high	*Gay fathers adopted older children compared to heterosexual parents. *Children in gay father families showed greater attachment security due to the characteristics of parents, the characteristics of the children, or the combination of two factors. *Secure-autonomous attachment of the children in gay father families was higher than children in heterosexual parent families. *Gay fathers were lower in depression and parenting stress than heterosexual parents.
Park et al., 2016	24 gay men, 24 lesbians, and 3 bisexual women	California and Nebraska states of the United States	Qualitative	Donor insemination, adoption, surrogacy IVF	*Mean age was 41 years. *Majority had college degree or above and annual income was high	* Parents wanted a safe and supportive environment for their children, which could be maintained by balancing the legal conditions with other factors, including job security, connection to family and friends, and a desire to create social change. *Participants reported their plans to move to another state, which had more legal protections for same-sex families. *Majority of the couples in both states were supported by their families, but only a few families were not supported their decision to parenthood.
Gartrell et al.37	131 lesbian parents	The United States	Qualitative	Donor insemination	*Mean age was 59.8 years *Most had a college degree or higher education and were employed full time	Distress about their children’s experience of exclusion, nonacceptance of lesbian parent family by their family of origin, homophobia or hostility toward their nontraditional families, and lack of legal protections were the most challenging parenthood experiences of lesbian parents. *Other difficulties included dissatisfaction with the role of known donor in the family and disregarding the co-mother as parent.

Parenthood experiences

This study reviewed positive and negative parenthood experiences of LGBT+ individuals and their parenthood processes (Table 1).

Positive experiences

Primary studies on LGBT+ parents found that parenthood was more important than work life and careers of LGBT+ individuals¹⁹ and that the relationship with their partners⁹ and families⁷ and the levels of self-esteem and social support increased after parenthood⁷. Besides, these parents perceived themselves as more important in the society and stated that legal processes on adoption made their work easier²⁰ (Table 1).

Negative experiences

Although participants in some of the studies expressed that the society was more tolerant of LGBT+ parents, the majority of studies reported that social discrimination continued even after parenthood⁷,¹¹,²¹–²⁵.

Problems of LGBT+ individuals in work life included precariousness, discrimination, and being unable to benefit from the rights of heterosexual employees, such as maternity and paternity leave, breastfeeding leave, unpaid leave, or flexibility in working hours⁷,¹⁹,²¹.

DISCUSSION

This study, which reviewed positive and negative parenthood experiences of LGBT+ individuals, analyzed 19 qualitative and quantitative research articles. Findings of these studies on sociodemographic characteristics of the participants and their negative and positive experiences are discussed below.

Demographic characteristics

Marriage is an affirmative action to raise children. Although current average age for marriage and having the first children for heterosexual parents ranges from 30 to 35 years, it is mostly higher for LGBT+ individuals¹³,¹⁴. This delay is primarily related to the fact that it takes a longer period for LGBT+ individuals to make themselves accepted, have a profession, and reach their career goals, compared to their heterosexual counterparts¹⁵,¹⁶. This situation is positively considered in the literature since it prevents adolescent pregnancies, which have a negative impact on the health status of mother and children. Besides, our review revealed that education and income status of the LGBT+ individuals were higher than their heterosexual counterparts. This finding may be explained with reference to the need for higher economic status in order to be an LGBT+ parent¹⁵,¹⁷,¹⁸.

Parenthood experiences

Positive experiences

Best parenthood experiences of LGBT+ individuals include acceptance by their families and the society that they live in and increase in their self-esteem⁴,¹⁵,¹⁶. As such, their identity as parent may be accepted by the society irrespective of their sexual identities¹⁹. Besides, various studies noted that same-sex parents had better social relations with their co-workers after the transition to parenthood⁴,¹⁵,¹⁶,²⁰,²¹.

Studies on lesbian mother families found that exhaustion and parental stress were lower for these families since parental responsibilities were equally shared⁶,¹⁶. This positive effect was evident in other studies that compared lesbian mother families with gay, bisexual, and heterosexual parent families¹⁸,²²–²⁴. This finding may be explained with reference to the absence of heteronormative codes in lesbian mother families.

Some of the studies on LGBT+ parents focused on the relationship between children and their parents and found that the LGBT+ parents, who spent more time on their children, considered their children a source of joy and the center of their lives²⁰,²⁵. Our review also found that social lesbian mothers felt the need to express the quality of their parenthood compared to their heterosexual male counterparts²². This finding may be related to the intention to overcome social prejudice and the need for self-expression.

Most of the LGBT+ individuals reviewed in our study considered parenthood a positive experience. Adopted same-sex parents used adoption agencies, friends, adoption books, and health professionals as sources of counseling and information and believed that the counseling and information services were sufficient²⁶,²⁷. Today, LGBT+ individuals do not have the right to marriage in most of the countries²⁸. However, satisfaction of the same-sex parents with the recognition of the right to marriage and parenthood in some of the countries may be considered a positive dimension of this study.

Negative experiences

This review found that same-sex parents in various studies faced with various negative reactions due to their sexual identities when they decided to become parents⁵,¹⁵,¹⁹. Primary studies noted that parenthood of LGBT+ individuals was socially questioned, homophobia was common in their family and social environment, and LGBT+ individuals were under the pressure to form healthy parent-child relationship⁷,¹⁵,²⁹–³². These studies also found that heterosexual parents suffered from problems, such as fatigue, lack of sleep, social isolation, and inability to balance work and family lives⁷,¹⁵,²⁹.

In addition to these negative experiences, LGBT+ individuals opted for costly assisted reproductive techniques compared to their heterosexual counterparts⁴–⁶. This situation, coupled with the increase in the costs, resulted with financial difficulties. In some cases, one of the same-sex parents left their job to care for the child, which, in turn, forced the other parent to seek for additional employment⁵,¹⁵.

Child adoption is one of the most common methods of parenthood among the LGBT+ individuals³³. Individuals who chose adoption as a way to become parents mostly suffered from legal problems, including procedures on adoption and legal recognition³⁴,³⁵. However, participants in the study by Ryan and Whitlock (2008) did not express any problems during the transition to parenthood²⁷. These differences are closely related to the variety of legal regulations on parenthood of same-sex couples across the countries, even the states of same countries²⁷.

Implication of practice

This review may raise social awareness on parenthood experiences of LGBT+ individuals and provide the basis to solve their negative parenthood experiences. Besides, it may be guiding for health professionals, civil society organizations, legislators, and policy makers.

Strength and limitations

The review of the studies on the parenthood experiences of LGBT+ individuals reveals the existence of different studies for each groups⁷,¹⁰. The strength of our study is related to the fact that it systematically analyzed the parenthood experiences of all same-sex couples under the banner of LGBT+. Methodological dimensions and analysis methods of the studies reviewed within the scope of this research constitute both the strength and the limitation of this research.

Given the fact that most of the studies were conducted in the United States, a country that had higher income and education levels, the findings of this research may not be generalizable.

CONCLUSIONS

Although LGBT+ individuals are prone to discrimination due to their sexual identities, social acceptance increases after their transition to parenthood, which has a positive impact on their mental wellbeing. Once they become parents, LGBT+ individuals suffer from various difficulties, including financial problems and the burden of care.

• Funding: none.

ACKNOWLEDGMENTS

Our article was edited by Academic Studies Department of SPOD, which struggles to reduce the oppression, violence, and discrimination suffered by LGBTI+s. We would like to thank all SPOD members, especially Sevcan Tiftik, for their valuable contributions (http://www.spod.org.tr/EN/Pages/1/About%20Us).

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Publication Dates

• Publication in this collection
  25 May 2022
• Date of issue
  Apr 2022

History

• Received
  03 Feb 2022
• Accepted
  08 Feb 2022