Structural Heteropatriarchy and Birth Outcomes in the United States

Reflecting on the Significance of the Feminist Standpoint Epistemology in Researching the Experiences of Black Gay Men Who Work in Heteronormative and Patriarchal Male-Dominated Workplaces

Contemporary South African feminist knowledge on inequality in male-dominated workplaces is largely produced from the patriarchal and heteronormative standpoint that emphasizes the oppression of women and privileged positions of heterosexual men. While acknowledging the unwarranted subordination of women in workplaces, this paper challenges the prevailing notion that all men thrive on heterosexual male privilege in workplaces. I argue that the adoption of the feminist standpoint epistemology to Black gay men's experiences in heteropatriarchal male-dominated workplaces can illuminate hidden aspects of oppression and contribute to feminist knowledge. Having employed the feminist standpoint epistemology in two studies on the experiences of Black gay men in male-dominated workplaces, I reflect on how the intersecting identities of Black gay men provide a distinctive standpoint that enriches feminist knowledge within the South African context. The paper highlights the role of Black gay men in expanding feminist knowledge and advocating for change within heteronormative and patriarchal workplace cultures that suppress their voices and render them invisible.

Structural stigma and mental health among lesbian, gay, and bisexual adults: Policy protection and cultural acceptance

Emerging studies link the mental health of lesbian, gay, and bisexual (LGB) adults to structural stigma, focusing on state policies. Limited work considered cultural norms and the time changing nature of culture and policy. In this study, we draw from the structural stigma theory and hypothesize that both policy protection and cultural acceptance will independently promote LGB mental health and explore their interactive roles. Composing a novel state-year longitudinal dataset on policy and culture related to sexual minority people, we link it to a sample of cisgender LGB adults from the large-scale, representative Behavioral Risk Factor Surveillance System (2016-2023). Our multilevel regression models predicted depressive diagnosis and frequent mental distress from varied stigma measures, controlling for state-level and individual-level factors. The results revealed that LGB adults especially bisexual women faced elevated mental health challenges. Models generally showed structural stigma measures in the policy and culture domains were not independent, significant predictors of LGB mental health. Moreover, there was generally no significant and sizable interactions between policy and culture. One exception came from lesbian women, where policy protection was negatively associated with worse mental health, reducing frequent mental distress by around 6 percentage points across policy score ranges. We conclude by discussing the varied findings and encouraging future studies to incorporate the time-changing nature of policy and culture when linking structural stigma to LGB mental health.

Quantitative approaches to structural intersectionality research: Conceptual and methodologic considerations

There has been a recent influx in the development of novel measures of structural forms of discrimination, including structural racism, xenophobia, sexism, heterosexism, and cisgenderism. These systems of power and oppression are inherently interdependent and mutually constitutive, yet a paucity of research has investigated their joint impacts; this gap is likely reflective of the limited guidance that exists regarding how to effectively combine multiple measures of structural discrimination to examine their joint impacts on population health and health inequities. In this commentary, we seek to redress this by describing conceptual and methodologic considerations for population health researchers interested in conducting quantitative structural intersectionality research - an intersectionality-informed research approach focused on examining how systems of power and oppression intersect to shape population health and health inequities. Developing best practices for measuring and analyzing the joint impacts of structural forms of discrimination is crucial for effectively describing and quantifying their impacts on population health and health inequities, and for informing interventions, laws, and policies to advance health equity and social justice.

Variation Between LGBT Estimates and State Policy Context

State-level social policy and LGBT (lesbian, gay, bisexual, and transgender) population concentration are key measures that are often used as indicators reflecting geographic social climate. Still, research has yet to investigate how they may be interrelated, including the degree to which the LGBT population are subject to certain policies. Using population-based experimental data from the Household Pulse Survey and policy measures from the Movement Advancement Project, we compared measures of state-level policy and concentration of the LGBT population for 2022. After calculating the correlation between these two constructs, the authors identified state-level variation in these measures for each of the 50 states and Washington, DC. With a correlation of 0.58, the findings revealed variation at the state level and indicated that LGBT population concentration and state-level LGBT policy do not necessarily reflect synonymous social phenomena and constitute distinct but complementary measures for use in constructing indices of structural heterosexism and social climate.

Suicidality at the intersection of sex, sexual orientation, and gender expression among secondary school students in Hong Kong: a population-based study

Background

Previous suicide research has seldom examined the collective impact of multiple social identities/positions, and suicidality among sexual and gender minority adolescents remains understudied in Chinese contexts. Using intersectionality as both a theoretical and analytical framework, we investigate the combined effects of sex, gender expression, and sexual orientation on suicidal ideation and suicide attempts among secondary school students in Hong Kong.

Methods

Data from 8023 adolescents (mean age = 14.76, SD = 1.66; 44.56% girls) who participated in the 2021 wave of the Youth Sexuality Study (YSS) were included in analysis. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) estimated the prevalence of suicidal ideation and suicide attempts for adolescents across various combinations of social identities/positions (i.e., sex x gender expression x sexual orientation), assessed the extent to which these identities/positions accounted for the total variance in suicide behaviors, and examined the interactive intersectional effects (i.e., two-way or higher-level interactions) between the identities/positions.

Findings

Girls categorized as non-heterosexual with nonconforming gender expression, girls categorized as non-heterosexual with neutral gender expression, and boys categorized as non-heterosexual with nonconforming gender expression reported the highest prevalence of suicidal ideation and suicide attempts. The total variance in suicidal ideation and suicide attempts attributable to the identities/positions were 12.60% and 10.50%, respectively. However, there were no significant interactive intersectional effects.

Interpretation

Adolescents with multiple marginalized identities/positions showed the highest prevalence of suicidal ideation and suicide attempts. Comprehensive suicide prevention strategies should go beyond individual-level risk factors and promote holistic systemic changes. Intervention solely targeting one identity/position may not be sufficient.

Funding

The data used in this study is made available by Family Planning Association of Hong Kong and the Research Subcommittee for the Youth Sexuality Study 2021. The work was supported by the Department of Health of the Hong Kong SAR Government.

Comparing Behavioral Health of Lesbian, Gay, Bisexual, Questioning, and Heterosexual Middle School Students

Purpose: Lesbian, gay, bisexual, and questioning (LGBQ) high schoolers experience high prevalence of poor behavioral health, but little is known about LGBQ middle schoolers. We sought to quantify behavioral health disparities of LGBQ middle school students. Methods: Using 2021 New Mexico Middle School Youth Risk and Resiliency Survey data (N = 12,400), we estimated the size of the LGBQ middle school population and calculated adjusted risk ratios to investigate behavioral health disparities between LGBQ and heterosexual youth. Results: A quarter of the sample identified as LGBQ. These youth reported significantly more suicidal behaviors and poorer mental health than heterosexual youth. LGBQ youth were more likely to use most substances compared with heterosexual youth. Conclusion: LGBQ middle school students demonstrated high prevalence of poor behavioral health. These findings show that disparities begin earlier than previously assumed and underscore that sociocultural landscapes for sexually diverse youth remain challenging.

Mapping the scientific literature on obstetric and perinatal health among sexual and gender minoritized (SGM) childbearing people and their infants: a scoping review

BACKGROUND

Evidence suggests sexual and gender minoritized (SGM) childbearing individuals and their infants experience more adverse obstetric and perinatal outcomes compared to their cisgender, heterosexual counterparts. This study aimed to comprehensively map obstetric and perinatal physical health literature among SGM populations and their infants and identify knowledge gaps.

METHODS

PubMed, Embase, CINAHL, and Web of Science Core Collection were systematically searched to identify published studies reporting obstetric and perinatal outcomes in SGM individuals or their infants. Study characteristics, sample characteristics, and outcome findings were systematically extracted and analyzed.

RESULTS

Our search yielded 8,740 records; 55 studies (1981-2023) were included. Sexual orientation was measured by self-identification (72%), behavior (55%), and attraction (9%). Only one study captured all three dimensions. Inconsistent measures of sexual orientation and gender identity (SOGI) were common, and 68% conflated sex and gender. Most (85%) focused on sexual minorities, while 31% addressed gender minorities. Demographic measures employed varied widely and were inconsistent; 35% lacked race/ethnicity data, and 44% lacked socioeconomic data. Most studies (78%) examined outcomes among SGM individuals, primarily focusing on morbidity and pregnancy outcomes. Pregnancy termination was most frequently studied, while pregnancy and childbirth complications (e.g., gestational hypertension, postpartum hemorrhage) were rarely examined. Evidence of disparities were mixed. Infant outcomes were investigated in 60% of the studies, focusing on preterm birth and low birthweight. Disparities were noted among different sexual orientation and racial/ethnic groups. Qualitative insights highlighted how stigma and discriminatory care settings can lead to adverse pregnancy and birth outcomes.

CONCLUSIONS

Frequent conflation of sex and gender and a lack of standardized SOGI measures hinder the comparison and synthesis of existing evidence. Nuanced sociodemographic data should be collected to understand the implications of intersecting identities. Findings on perinatal health disparities were mixed, highlighting the need for standardized SOGI measures and comprehensive sociodemographic data. The impact of stigma and discriminatory care on adverse outcomes underscores the need for inclusive healthcare environments. Future research should address these gaps; research on SGM perinatal outcomes remains urgently lacking.

TRIAL REGISTRATION

The review protocol was developed a priori in February 2023, registered on Open Science Framework ( https://doi.org/10.17605/OSF.IO/5DQV4 ) and published in BMJ Open ( https://bmjopen.bmj.com/content/13/11/e075443 ).

Transgender-Specific Adolescent Mental Health Provider Availability is Substantially Lower in States with More Restrictive Policies

OBJECTIVE

Transgender adolescents experience adversity accessing mental healthcare, which is exacerbated by transgender-specific mental health provider shortages in the United States. Factors associated with variability in transgender-specific mental health provider availability across states - especially at the macro-social level - have yet to be identified, hindering efforts to address these shortages. To remedy this gap, we queried whether transgender-specific adolescent mental health provider availability varied by states' transgender-specific policy climate.

METHOD

We quantified states' policy climate by factor-analyzing tallies of the presence/absence of 33 transgender-specific state laws/policies in six domains: parental/relationship recognition, nondiscrimination, education, healthcare, criminal justice, and identity documentation. We then tested whether states' transgender-specific policy climate was associated with rates of transgender-specific adolescent mental health providers - identified via Psychology Today - per transgender adolescent in all 50 states and the District of Columbia.

RESULTS

Transgender-specific adolescent mental health provider availability was substantially lower in states with more restrictive laws/policies for transgender people (rate ratio = 0.65, 95% CI [0.52, 0.81], p = .00017), controlling for state-level conservatism, religiosity, and urbanicity. States' transgender-specific policy climate was unrelated to rates of adolescent Attention-Deficit/Hyperactivity Disorder-specialty providers, Oppositional Defiant Disorder-specialty providers, and youth mental health provider shortages broadly, providing evidence for result specificity.

CONCLUSIONS

Transgender adolescents appear to have access to considerably fewer transgender-specific mental health providers in states with more restrictive laws/policies for transgender people, which may compound their already high mental health burden in these contexts. Intervention and policy efforts are needed to address these shortages, particularly in states with increasingly prohibitive laws/policies targeting transgender adolescents.

Sexual Orientation-Specific Policies Are Associated With Prenatal Care Use in the First Trimester Among Sexual Minority Women: Results From a Prospective Cohort Study

BACKGROUND

Previous research has shown sexual minority women (SMW) are more likely to report multiple maternal and infant health outcomes compared to heterosexual women and that these outcomes are moderated by the policy environment. Little is known, however, about prenatal care use disparities or the social determinants of prenatal care use for SMW.

PURPOSE

To examine the relationship between sexual orientation-specific policies that confer legal protections (e.g., hate crime protections, housing discrimination, same-sex marriage) and prenatal care use among women using a prospective, population-based data set.

METHODS

Using the National Longitudinal Study of Adolescent to Adult Health and logistic regression, we link measures of state policies to the use of prenatal care in the first trimester among women who had live births. The use of prospective data allows us to adjust for covariates associated with preconception care use prior to pregnancy (n = 586 singleton births to SMW; n = 4,539 singleton births to heterosexual women).

RESULTS

Sexual orientation-specific policies that conferred protections were associated with increased use of prenatal care among pregnancies reported by SMW (OR = 1.86, 95% CI 1.16, 2.96). In fact, in states with zero protections, we found no differences in prenatal care use by sexual minority status; however, in states with two or more protective policies, SMW were more likely to access prenatal care in the first trimester than heterosexual women. There was no relationship between sexual orientation-specific policy environments and prenatal care use among pregnancies reported by heterosexual women.

CONCLUSIONS

Recent research has documented that SMW are more likely to have adverse perinatal and obstetrical outcomes than their heterosexual peers. These findings suggest that Lesbian/Gay/Bisexual-specific policy protections may facilitate the use of prenatal care among SMW, a potentially important pathway to improve reproductive health among this population.

The anti-gender threat: An ethical, democratic, and scientific imperative for NIH research/ers

Anti-gender campaigns in the United States and globally have promoted policies and legislation that significantly limit bodily autonomy for women, transgender, and nonbinary people. This attack on the human rights of women and gender-diverse communities not only reflects implicit and explicit bias but also detrimentally impacts population health and well-being. We outline the domestic and global rise of anti-gender campaigns and their deep historical connections to broader forms of discrimination and inequality to argue that there is an ethical, democratic, and scientific imperative to more critically center and contextualize gender in health research. While the inclusion of gender as a complex concept in research design, implementation, and dissemination is important, we emphasize that gender inequities must be understood as inextricable from other systems of discrimination and exclusion. To that end, this commentary outlines two actions: for researchers to advance critical approaches to gender as part of a broader landscape of discrimination, and for the US National Institutes of Health to integrate both sex and gender into funded research.

Workshop summary: National Institutes of Health (NIH) 2022 scientific workshop on gender and health

In this manuscript, we summarize the goals, content, and impact of the Gender and Health: Impacts of Structural Sexism, Gender Norms, Relational Power Dynamics, and Gender Inequities workshop held by the National Institutes of Health (NIH) Office of Research on Women's Health (ORWH) in collaboration with 10 NIH Institutes, Centers, and Offices. Specifically, we outline the key points emerging from the workshop presentations, which are the focus of the collection of articles in this supplement. The overarching goals of the workshop were to convene NIH staff, the external scientific community, and the public to discuss methods, measurement, modifiable factors, interventions, and best practices in health research on gender as a social and cultural variable and to identify opportunities to advance research and foster collaborations on these key topics. Themes emerging from the workshop include the need for intersectional measures in research on gender and health, the role of multilevel interventions and analyses, and the importance of considering gender as a social and structural determinant of health. Careful, nuanced, and rigorous integration of gender in health research can contribute to knowledge about and interventions to change the social and structural forces that lead to disparate health outcomes and perpetuate inequities.

Health consequences of structural sexism: Conceptual foundations, empirical evidence and priorities for future research

A nascent body of work has begun exploring the health consequences of structural sexism. This article provides an overview of the concept of structural sexism and an elaboration of the potential pathways connecting it to health. Next, it reviews existing measurement approaches and the current state of empirical evidence on the relationship between structural sexism and health in the United States. Finally, it highlights key priorities for future research, which include: expanding and refining measures, increasing public data availability, broadening the scope of inquiry to include a wider range of outcomes, exploring mechanisms, incorporating intersectionality, and applying a life course lens.

Structural heteropatriarchy and maternal cardiovascular morbidities

The United States has some of the poorest maternal health outcomes of any developed nation. Existing research on maternal cardiovascular morbidities has focused predominantly on individual- and clinic-level drivers, but we know little about community- and structural-level factors that shape these outcomes. We use a composite measure of "structural heteropatriarchy" which includes measures of structural sexism and structural LGB-stigma to examine the relationship between structural heteropatriarchy and three cardiovascular-related maternal morbidities using the National Longitudinal Study of Adolescent to Adult Health (n = 3928). Results using multivariate regressions show that structural heteropatriarchy is associated with increased risk of reporting maternal morbidities. Our findings provide further evidence that sexuality- and gender-based stigma operate together to shape health disparities, including maternal health.

Structural Sexism and Preventive Health Care Use in the United States

Preventive health care use can reduce the risk of disease, disability, and death. Thus, it is critical to understand factors that shape preventive care use. A growing body of research identifies structural sexism as a driver of population health, but it remains unknown if structural sexism is linked to preventive care use and, if so, whether the relationship differs for women and men. Gender performance and gendered power and resource allocation perspectives lead to competing hypotheses regarding these questions. This study explores the relationship between structural sexism and preventive care in gender-stratified, multilevel models that combine data from the Behavioral Risk Factor Surveillance System with state-level data (N = 425,454). We find that in states with more structural sexism, both men and women were less likely to seek preventive care. These findings support the gender performance hypothesis for men and the gendered power and resource allocation hypothesis for men and women.

Structural transphobia is associated with psychological distress and suicidality in a large national sample of transgender adults

PURPOSE

Transgender adults face increasingly discriminatory laws/policies and prejudicial attitudes in many regions of the United States (US), yet research has neither quantified state-level transphobia using indicators of both, nor considered their collective association with transgender adults' psychological wellbeing, hindering the identification of this potential social determinant of transgender mental health inequity.

METHODS

We therefore used factor analysis to develop a more comprehensive structural transphobia measure encompassing 29 indicators of transphobic laws/policies and attitudes at the state level, which we linked to individual-level mental health data from a large national sample of 27,279 transgender adults (ages 18-100) residing in 45 US states and the District of Columbia (DC).

RESULTS

Controlling for individual- (i.e., demographics), interpersonal- (i.e., perceived discrimination), and state- (i.e., income inequality, religiosity) level covariates, transgender adults from US states with higher (vs. lower) levels of structural transphobia reported more severe past-month psychological distress and were more likely to endorse past-year and lifetime suicidal thoughts, plans, and attempts.

CONCLUSION

Findings provide novel evidence that state-level transphobic laws/policies and attitudes collectively shape a range of important mental health outcomes among transgender adults in the US. Multilevel intervention strategies, such as affirming mental health treatments, provider-training interventions, and supportive legislation, are needed to address structural transphobia's multifaceted nature and negative mental health consequences.

Family building and pregnancy experiences of cisgender sexual minority women

BACKGROUND

Although 10% to 20% of cisgender women aged 18 to 40 years have a sexual minority identity (eg, bisexual, lesbian, and queer), there is limited research on the family building and pregnancy experiences of sexual minority cisgender women. Improving our understanding of the family building and pregnancy experiences of cisgender sexual minority women is critical for improving the perinatal health of this population.

OBJECTIVE

This study aimed to compare the mode of family building, past pregnancy experiences, and future pregnancy intentions among cisgender sexual minority women by sexual orientation.

STUDY DESIGN

This is an observational study which was conducted using cross-sectional data collected in 2019 from a national sample of 1369 cisgender sexual minority women aged 18 to 45 years.

RESULTS

Most participants (n=794, 58%) endorsed multiple sexual orientations, most commonly queer (n=641, 47%), lesbian (n=640, 47%), and/or bisexual (n=583, 43%). There were 243 (18%) cisgender sexual minority women who were parents. Pregnancy was used by 74% (181/243) of women to build their families. Among participants who used pregnancy, 60% (108/181) became pregnant through sexual activity with another parent of the child, whereas 27% (64/243) of women used donor sperm. An additional 10% (n=24) became parents through second-parent adoption, 10% (n=25) through adoption, and 14% (n=35) through step-parenting. Bisexual women more often used sexual activity to become parents (61/100, 61%) compared with queer (40/89, 45%) and lesbian women (40/130, 31%). In contrast, lesbian (50/130, 39%) and queer (25/89, 27%) women more often used donor sperm to become parents compared with bisexual women (11/100, 11%). Among the 266 (19%) cisgender sexual minority women who had ever been pregnant, there were 545 pregnancies (mean, 2.05 pregnancies per woman). Among those pregnancies, 59% (n=327) resulted in live birth, 23% (n=126) resulted in miscarriage, 15% (n=83) resulted in abortion, and 2% (n=9) resulted in ectopic pregnancy. A quarter of women had future pregnancy intentions, with no differences by sexual orientation. Overall, few participants (16%) reported that all of their healthcare providers were aware of their sexual orientation.

CONCLUSION

Cisgender sexual minority women primarily built their families through pregnancy and a quarter have future pregnancy desires. In addition, there were important differences in family building methods used by sexual orientation. Providers should be aware of the pregnancy and family-building patterns, plans, and needs of cisgender sexual minority women.

Mapping the scientific literature on obstetrical and perinatal health among sexual and gender minoritised (SGM) childbearing people and their infants: a scoping review protocol

INTRODUCTION

Sexual and gender minoritised (SGM) populations are disproportionately impacted by multilevel risk factors for obstetrical and perinatal outcomes, including structural (eg, stigma, discrimination, access to care) and individual risk factors (eg, partner violence, poor mental health, substance use). Emerging evidence shows SGM childbearing people have worse obstetrical outcomes and their infants have worse perinatal outcomes, when compared with their cisgender and heterosexual counterparts; this emerging evidence necessitates a comprehensive examination of existing literature on obstetrical and perinatal health among SGM people. The goal of this scoping review is to comprehensively map the extent, range and nature of scientific literature on obstetrical and perinatal physical health outcomes among SGM populations and their infants. We aim to summarise findings from existing literature, potentially informing clinical guidelines on perinatal care, as well as highlighting knowledge gaps and providing directions for future research.

METHODS AND ANALYSIS

We will follow the Joanna Briggs Institute (JBI) scoping review framework and report findings according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. We will conduct a broad systematic search in Medline/PubMed, Embase, CINAHL and Web of Science Core Collection. Eligible studies will include peer-reviewed, empirical, English-language publications pertaining to obstetrical and perinatal physical health outcomes of SGM people or their infants. No temporal or geographical limitations will be applied to the search. Studies conducted in all settings will be considered. Records will be managed, screened and extracted by two independent reviewers. Study characteristics, key findings and research gaps will be presented in tables and summarised narratively.

ETHICS AND DISSEMINATION

Ethical approval is not required as primary data will not be collected. The findings of this scoping review will be disseminated through a peer-reviewed journal and conference presentations.

PROTOCOL REGISTRATION

Open Science Framework https://osf.io/6fg4a/.

The use of gender-neutral language in maternity settings: a narrative literature review

Background/Aims

Midwives are vital healthcare professionals that are autonomous and passionate specialists on women, pregnancy, birthing and families. Staying up to date with contemporary issues enhances their ability to provide high-quality evidence-based care. One aspect of maternal care that is changing is the use of gender-neutral language. The aim of this review was to examine the use of gender-neutral language in maternity settings and collate the literature to expose any knowledge gaps.

Methods

A narrative literature review was conducted, using primary research and literature reviews from the Cochrane Library, CINAHL and MEDLINE databases. A total of 106 articles were included.

Results

Data analysis yielded four themes: etymology and the origins of language in maternity, the effects of language in maternity, attitudes, and social media and language. The literature identified the perspective of the lesbian, gay, bisexual, transgender, intersex, queer or questioning, asexual and other sexually or gender diverse population who have accessed maternity and childcare services. Not all literature was maternity specific, but provided insight into how to improve maternity services.

Conclusions

It is recommended that education be provided for healthcare professionals when working with the LGBTIQA+ community. Updating paperwork and policies at a structural level will have a vast impact holistically on LGBTIQA+ maternity consumers.

Sexual Orientation-Related Nondiscrimination Laws and Maternal Hypertension Among Black and White U.S. Women

Background: Black women and sexual minority women are more likely to report adverse maternal health. Little research has investigated maternal health disparities at the intersection of race/ethnicity and sexual orientation or the mechanisms that contribute to these disparities. Materials and Methods: We analyzed data from the National Longitudinal Study of Adolescent to Adult Health. Our sample was restricted to Black and White women who had at least one live birth and were followed-up in Wave V of the data (n = 3,396). We used multivariable logistic regression to analyze the associations between race, sexual orientation identity, and a four-item state-level index of sexual orientation-related nondiscrimination laws. Results: We found that higher numbers of state-level sexual orientation-related nondiscrimination laws were associated with lower risk of maternal hypertension among U.S. women overall (odds ratio [OR] = 0.82, 95% confidence interval [CI] 0.73-0.93), and Black women had a higher risk of maternal hypertension relative to White women (OR = 1.32, 95% CI 1.00-1.79). Interactions between race, sexual orientation identity, and sexual orientation-related policies show that, regardless of sexual orientation identity, sexual orientation-related nondiscrimination laws were associated with a lower risk of maternal hypertension among White mothers (OR = 0.80, 95% CI 0.70-0.92). However, among Black women, these laws were associated with a lower risk of maternal hypertension among lesbian and bisexual women (OR = 0.18, 95% CI 0.05-0.68) only. Conclusions: Laws that prevent discrimination related to sexual orientation in various societal domains may play an important role in improving maternal health outcomes among White women in general and Black lesbian and bisexual women in particular.

Society for Medical Anthropology Statement on Supreme Court Dobbs v. Jackson Women's Health Organization Decision

This statement summarizes key findings from anthropological and related scholarship on the harmful consequences of inadequate abortion access, leading the Society for Medical Anthropology to register profound concern about the recent Supreme Court decision in Dobbs v. Jackson. After circulation to SMA members for input, a finalized version passed a membership vote by an overwhelming margin. This statement complements one produced by the Council for Anthropology and Reproduction, available here.

Interlinking Structural Racism and Heteropatriarchy: Rethinking Family Structure's Effects on Child Outcomes in a Racialized, Unequal Society

In the field of family science and in the broader family policy discourse, debate is ongoing about the importance of family structure for child outcomes. Missing from this debate is a full integration of how the foundational pillars of White supremacy, namely structural racism and heteropatriarchy, impact both family formation and child outcomes, especially among diversely configured Black families. From a critical intersectional lens, we argue that conceptual models used to explain racialized child outcomes based on family structure effects are problematic because they compare family structure statuses without accounting for structural racism and interlinked heteropatriarchal conditions. We present a new conceptual model that integrates structural racism and heteropatriarchy to examine the salience of family structure statuses for child outcomes and discuss approaches to research design, empirical measurement, and interpretation in order to bring this new model into practice.