The appointments were all scheduled; the preliminary tests were done; the co-parenting agreements were signed; and the flights were booked. My wife and I were counting the days until our sperm donor, Steffan, would arrive in the U.S. to deposit his sperm. This was February 2020. Steffan was due to arrive in the U.S in April to provide his sperm donation, then several months later we planned to start our journey to grow our family in August 2020.

However, then came March 2020 and with it came COVID. Now fertility clinics were closed, international travel was limited, and our carefully thought out, well-timed plans had come to a screeching halt. Like many couples planning to conceive in 2020, the new reality drastically changed what is already a nerve-wracking endeavour.

Family building for LGTBQ folks has never been easy. For most cis/het couples who don’t face infertility issues (85-90%), the process is ideally a time for connection, romance, and the inevitable lovemaking. But for LGBTQ folks, the process is often filled with filling out legal forms, doctors’ visits, psychological tests, and major financial decisions – exacerbated by the cost of conception. Yes, technology has eased this process, given the relative accessibility of assisted reproductive technology (ART), the availability of sperm banks, and the advent of online support groups. Less and less do you hear of the queers making children in an awkward, often substance filled, turkey baster situation. However, there are still major structural barriers and a series of daunting hurdles we need to traverse.

The average fertility treatment cost without insurance ranges from $12,000 to $75,000 per treatment. This presents a significant barrier for many LGBTQ families, who are, on average, more likely to have lower incomes and less wealth than cis/het families. This means that LGBTQ families face heightened financial barriers from the get-go. Even if LGBTQ families choose not to follow the reproductive route, adoptions can cost upwards of $15,000 to $40,000 depending on the state.

LGBTQ families also face additional structural barriers, from donor/surrogate selection, to added testing, to increased FDA regulated wait-times for directed known donor sperm (6 months compared to no wait for a sexually intimate partners). And on top of these barriers, LGBTQ families must navigate a draconian legal maze as they seek to secure their family choices with individual legal protections to affirm parental rights, ensure various kinds of access and birth certificate recognitions, and correct parental genders. For families who desire to have three or more recognised parents, there may be no legal protections to ensure that all parties are recognised appropriately. All of these barriers are coupled with additonal challenges like finding a donor and/or surrogate, co-parent agreements, and increased fertility issues – as LGBTQ folks are more likely to start trying to conceive later in life and likely have engaged in substance use, both of which significantly affect fertility.

In March 2020, most fertility clinics closed their doors due to the risk of COVID, the lack of medical equipment/supplies, and the unknown risk of virus transmission through sperm. This was a devastating blow to many prospective parents planning to conceive during this time period. Every missed cycle was a missed chance to try for a child. I saw first-hand the effect this was having in my many ‘how to conceive’ support groups. I felt all my plans slipping away. I had waited so long to try to start a family. There was so much in my life it could not control from an uncertain job market, to publications, to finishing my PhD. Before COVID the choice to at least try to start a family felt in my grasp. So as an academic, I stepped back, critiqued the systems, and turned my frustration and fears into research. My co-author and I began compiling news stories and academic research to make sense of everything we were witnessing.

We found that in the U.S and many other countries, fertility clinics closed due to uncertainty about procedure safety and lack of medical equipment. While we support a brief initial closure, many closed for an extended period, citing fertility treatment as a ‘non-essential medical service’. Other clinics opened but did not take in new patients, forcing many prospective families, both cis/het and LGBTQ, to put their plans put on an indefinite hold. In addition to fertility center closures, prospective LGBTQ families uniquely had non-medicalised methods interrupted or halted.

Social distancing, lockdown, and travel laws meant that many people could not make the necessary connections to provide or receive biological materials. This affected lesbian couples who were unable to drive a state away to collect a sperm deposit, gay couples whose surrogate was in another country and barred from entering the U.S., and multi-parent families whose households were not allowed to meet – or felt it was too dangerous to meet – to try to conceive.

There were, of course, other effects as well. Recent research has shown that having fertility plans put on hold is psychologically equivalent to a miscarriage, and this situation is exacerbated when there is no definitive date to resume.

In the future, experts forecast that it’s not unlikely that we will encounter other pandemics over the coming years, or at the very least, a series of local and global disasters! Therefore, we have several recommendations that will benefit both LGBTQ families (and cis/het folks) facing infertility:

1. Access to fertility treatments should not be deemed non-essential, which would include addressing the problem of medical gatekeeping to ensure that treatment is accessible to all who desire it.
2. Federal guidelines for donor waiting periods should be significantly reduced or removed and replaced with an informed consent risk awareness procedures.
3. Medical and insurance companies should redefine infertility as all families who cannot conceive without the aid of medical assistance.
4. Federal aid should be enacted that reduces the inequality widening effects of the pandemic.

In addition, many folks are still banned from traveling, continuing the wait for many. We also recommend that governments, now with increased testing and vaccines, provide the possibility for people to travel to see family (broadly defined).

My story has a happy ending, for which I’m deeply grateful, given the barriers I’ve cited above that affect so many LGBQT+ folks. During the height of the pandemic, my wife and I were privileged to fly to my home country of England. With the help of Steffan and his wife Laura, we created our tiny human. Avril was born almost one year later in April 2021.

Penny Harvey is an assistant professor of human sexuality studies at the California Institute of Integral Studies. They research gender, sexuality, health, culture, and media. They can be reached at Pharvey@ciis.edu

Link to full article here Harvey & Ingraham, 2021

Reposted with permission from the Gender & Society Blog

Black Lives Matter, the anti-racist movement that spread globally after the tragic death of George Floyd on May 2020 in the US, had an unintended but very welcome consequence in India: national debate on India’s deep-rooted and highly gendered practice of color discrimination.

Calls for racial justice around the world resonated with dark-skinned Indians who face colorism, or dark-skin prejudice, in their everyday lives. The backlash forced skin-whitening multinational companies, which rake in an annual revenue of $500 million, to change the names of skin-lightening products.

Growing up in North India as the daughter of a fair-hued mother and dark-skinned father,  the prejudice of colorism was intimate.  Accustomed to hearing “thank god she is ‘wheatish’ in complexion. Imagine if she had inherited her father’s dark skin,” I would then wait for the anticipated dramatic pause from a well-meaning relative or friend of my mother as they assessed me on the color hierarchy. We were all expected to shudder at the imagined future horrors from which  my “wheatish” skin had saved me.  One such possible horror  was rejection by appropriate suitors when I became of marriageable age.

Fast forward with me to a few decades to a village in rural West Bengal in east India. I was conducting a study on a new trend of marriage migration in North India that involved men sourcing brides from remote corners of India. Most homes of prospective, poor, marriageable women that I visited had tubes of frequently used skin-whitening creams lying alongside combs and bindis on the ledges of plastic mirrors hung on walls. Dark-hued young women admitted using these creams to gain favourable marriage prospects and lower dowry demands from local suitors.

Despite the vast majority of India’s people being dark-skinned, the obsession with fair skin dates back historically to the oppressive and exploitative caste system of the Hindus. Fairness is linked to higher caste status, while a darker hue is seen as a feature of  the low caste and those who do menial labor.

Colorism is starkly visible  in India’s arranged marriage market. Fairness of prospective brides is highly prized and newsprint or e-matrimonial advertisements use “fair complexioned” as a desired trait to filter out darker-hued women. In India, global capital has leveraged this national obsession to its advantage by marketing skin-bleaching products as an antidote to matrimonial hurdles.

THE RESEARCH

In my recently published research article in Gender & Society, I show that colorism is foundational to a new form of gendered violence for dark-skinned poor women. Skin fairness emerges as pivotal marriage capital and diminishes the chances of dark-complexioned poor Dalit (a politically self-aware term for untouchable castes) women to marry in their own communities.

I conducted interviews across 57 villages in the North and East Indian provinces of Haryana, Rajasthan, West Bengal, and Odisha. My interviews and focus groups with women and men in such marriages, their families, and villagers have revealed that light skin operates as a “currency” tradeable for a lesser dowry. North Indian bachelors, faced with a bride deficit due to the sex selective abortion of female fetuses, have begun traveling across the breadth of India to deliberately “source” wives from remote corners of the country. They offer the carrot of “no dowry and all wedding expenses paid” to poor families with darker-hued daughters of marriageable age. This results in women entering colorism-coerced marriage with rural North Indian men. This colorism-coerced marriage migration leads to a lifetime of cultural exile and internal othering in their marital homes and communities.

MARRIED LIFE SHAPED BY COLORISM

This oppressive skin-tone bias haunts such migrant brides as married women.  They have fewer fallback options due to distance from their parents and they must contend with their lack of ability to bargain about their own labor with their new conjugal families. Out of 113 interviewed brides, 57 told me that their husband and his family used dark-skin shaming to discipline them into docility and compliance whenever they resisted demands for excessive work.

These women face forcible cultural assimilation in North India, where the culture, language, customs, food habits, and even physical environment is different from their own. Caste discrimination within the family and in the community ranges from caste slurs, exclusion from family and kin gatherings, and segregation because of perceived untouchability. North Indian ethnocentrism, a peculiar blend of ethnic chauvinism, caste discrimination, and colorism directed specifically against east Indians from the provinces of Bihar and West Bengal, exacerbates the stigmatization of dark-hued migrant brides. Their very identity gets invested with connotations of crime, filth, savagery, and dim-wittedness, exposing them to ridicule and hate. My study also revealed that ethnocentric hate extends intergenerationally to the women’s children.

WE MUST “OUT” THIS NEW FORM OF GENDERED VIOLENCE

It is important to understand how new forms of gendered violence emerge for poor women in contemporary society. Such gendered violence builds patriarchy and caste oppression. Colorism creates a situation ripe for marriage brokers and traffickers to take advantage of poor women’s vulnerability. Societal pressure to marry off adult daughters renders poor parents gullible in the face of such offers and they often fail to check the prospective groom’s background, consigning their daughters to a lifetime of misery.

Multinational companies aggressively peddle feminine skin fairness as “marriage capital” to drive up the sales of their skin-bleaching products. The seductive narrative of a better life outcome has an estimated 60–65 percent of India’s women between 16 and 35 years of age using skin bleaching  products. Global capital which produces and markets these products has a vested interest in keeping such discriminatory hierarchies alive as India is one of its biggest and fastest growing markets. We need to rid ourselves of skin-tone bias and disrupt profiteering by transnational capital if we want to truly dismantle colorism and ensure that this new form of gender oppression gets stamped out.

Reena Kukreja is Assistant Professor in the Department of Global Development Studies at Queen’s University, Canada. She is cross-appointed to the Department of Gender Studies and Cultural Studies Program at Queen’s University. She divides time between teaching, research, and film-making. Her forthcoming book Partial Truths Negotiated Existences focuses on cross-region marriage migration in India and how the neo-liberal accumulative process in India has dispossessed poor women of matrimonial choice.

Reposted with permission from the UT Austin Population Research Center. 

The American College of Obstetricians and Gynecologists (ACOG) recommends that healthcare providers routinely offer their patients intrauterine devices (IUDs) immediately after delivery of the placenta and contraceptive implants prior to hospital discharge. ACOG recognizes that IUDs and implants, collectively called LARC (for long-acting reversible contraception), are a safe and effective contraceptive option for patients right after delivery. These immediate postpartum LARC insertions are effective in decreasing the rates of unintended pregnancies and short intervals between pregnancies.

Previous studies in Texas have shown that many women want to obtain an IUD or implant after delivery but are unable to do so.

Starting in July 2014, physicians at a large public safety net hospital in Texas, which serves a predominantly Hispanic population, began offering their patients immediate postpartum LARC methods. In this hospital, all women could potentially receive an IUD or implant prior to discharge, regardless of insurance coverage, if they did not have any medical contraindications to the device and were offered it.

After immediate postpartum LARC became available in the hospital, providers were instructed to include counseling about immediate postpartum LARC during prenatal care and at the time of admission for delivery. The goal in the contraception counseling sessions was to discuss all forms of birth control with all patients, even with those desiring sterilization, and for the patient and the provider to make a patient-centered decision about the patient’s contraceptive method preference.

During the study period, many physicians relied on trained or ad hoc interpreters to provide contraceptive counseling to their non-English-speaking population during prenatal care and hospital stays. Trained interpreters typically conducted the service over the phone whereas ad hoc interpreters, usually family members, translated for the physician in person.

This research brief reports on a recent study in which the authors analyzed data from 199 women who delivered a baby in the safety net hospital and wanted to wait at least two years to have another child. Participants were interviewed before hospital discharge and followed for two years.

The authors document who was offered and not offered immediate postpartum LARC, and who received it. Among those who received an IUD or implant immediately following delivery, they describe when women were offered these methods, as well as their satisfaction with the methods, and whether they continued using them in the two years after delivery.

Key Findings

• Who was offered an IUD or implant for the immediate postpartum period?
  • 52% were offered an immediate postpartum LARC method
  • English-speaking Hispanic women were 3 times more likely than Spanish-speaking Hispanic women to be offered an immediate postpartum IUD or implant
• Who received an immediate postpartum IUD or implant?
  • 37% of all participants
  • 72% of the women who were offered an immediate postpartum LARC method
• Among the people who received a LARC method before hospital discharge:
  • 59% were offered it during prenatal care; 41% while at the hospital
  • 72% were very satisfied or somewhat satisfied with the method at 3 months postpartum; this dropped to 65% by 6 months postpartum. Main reasons for a drop in satisfaction: undesirable menstrual changes and pain
  • 77% were still using an IUD or implant two years after delivery.

Policy Implications

Immediate postpartum LARC is safe and acceptable and should be widely available throughout the state. Covering the costs of this postpartum contraceptive option for all patients, regardless of insurance status, should be the goal for all hospitals that offer the service.

Health care providers could improve patient satisfaction by ensuring that they present the full range of contraceptive options throughout pregnancy to all women. In addition, it is critical that providers work with patients to come to a patient-centered decision on their contraceptive method of choice.

Providers should also strive to deliver more consistent unbiased contraceptive counseling for all patients throughout prenatal care, which may help to decrease the impact of providers’ implicit biases.

Finally, high-quality formal interpretation services should be the gold standard for all clinical encounters to ensure that all patients, regardless of their native language, are offered the full range of contraceptive methods in a way that respects patients’ reproductive autonomy.

Reference

Wallace Huff, C, Potter, J.E., & Hopkins, K. (2020). Patients’ experiences with an immediate postpartum long-acting reversible contraception program. Women’s Health Issues 31(2):164-170.

Suggested Citation

Wallace Huff, C, Potter, J.E., & Hopkins, K. (2021). Who is offered and who gets an IUD or implant before leaving the hospital after having a baby? PRC Research Brief 6(6). DOI: 10.26153/tsw/12388.

Acknowledgements

This work was supported by the Susan Thompson Buffett Foundation and a center grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2C HD042849), awarded to the Population Research Center at The University of Texas at Austin. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Cristina Wallace Huff, wallacehuff@uthscsa.edu, is an assistant professor in Obstetrics and Gynecology at The University of Texas Health Science Center at San Antonio; Joseph E. Potter is a professor of sociology and a faculty research associate in the Population Research Center, The University of Texas at Austin and Kristine Hopkins is a research scientist and faculty research associate in the PRC. 

Reposted with permission from the Texas PRC 

Emotion work, or devoting effort toward assessing and managing another person’s emotional needs to support their emotional well-being, is a common dynamic in intimate relationships that helps foster intimacy and closeness between spouses.

Emotion work is generally understood to benefit the well-being of the recipient. However, providing emotion work can be stressful and might undermine the emotion worker’s psychological well-being. Previous research on different-sex couples suggests that emotion work is a gendered process in which women provide more emotion work than men and that women are more concerned with the importance of emotion work within their relationship. For these reasons, emotion work may more strongly undermine psychological well-being for women than for men. Finally, prior research also suggests that when a spouse has depressive symptoms, emotion work may be more stressful.

This brief reports on a recent research study¹ which explored the psychological toll of emotion work in contexts often overlooked in family studies, namely same-sex compared with different-sex marriages and marriages in which a spouse has depressive symptoms.

The authors analyze daily experiences data—based on questionnaires completed daily for 10 days—from both spouses in same-sex and different-sex marriages (n = 756 cisgender women and men, 378 married couples). Using these data, the authors employ a gender-as-relational perspective in which gendered relationship dynamics reflect one’s own gender in relation to whether one is interacting with a woman or a man. They do so to explore how the association between emotion work and psychological well-being may differ for women and men in same-sex compared with different-sex marriages and to address how having a spouse with elevated depressive symptoms may affect this association.

Key Findings

• Emotion work appears to negatively affect the worker’s own psychological well-being.
• The provision of emotion work, in general, is associated with lower levels of well-being for both women and men and in same-sex compared with different-sex marriages, with two important exceptions.
  • The provision of emotion work may be more psychologically taxing when one’s partner is a man, perhaps because men are less likely to be aware of, or to reciprocate, emotion work exchanges.
  • The well-being of women married to women, compared with women married to men, seems to be less negatively affected by emotion work.
• Whether the emotion worker is in a same-sex or a different-sex marriage, the provision of emotion work seems to undermine psychological well-being more when the spouse:
  • has elevated depressive symptoms or
  • is a man rather than a woman. See figure below.
• In sum, not only is it more challenging to provide emotion work to a spouse with elevated depressive symptoms or to provide emotion work to a spouse who is a man, it is particularly more challenging when that spouse is a man with elevated depressive symptoms.

Spouses who provide emotion work to a depressed man report the lowest levels of psychological well-being

Emotion workers married to a non-depressed man or a depressed woman also report lower levels of psychological well-being

This figure shows that whether the emotion worker is in a same-sex or different-sex marriage, providing emotion work to a depressed male spouse is the most detrimental to psychological well-being. In addition, doing emotion work for a male spouse, whether he is depressed or not, is detrimental to well-being, as is providing emotion work to a depressed spouse, whether male or female.

Note: The most emotion work = emotion worker reported one standard deviation above the sample mean; the least emotion work = reported one standard deviation below the mean.

Policy Implications

These findings imply that a more nuanced understanding of the marital dynamics that influence the psychological well-being of both partners in a relationship—with potentially different costs and benefits for women and men in same- and different-sex relationships—is needed to ground effective policies and interventions to support couples and their mental health. The strain of emotion work likely takes a toll on marital quality as well as the health behaviors and health of both partners. Moreover, given that emotion work is more taxing if it is given to a male spouse who has depressive symptoms, it is important for mental health professionals to pay more attention to the marital context when treating both the providers and recipients of emotion work.

Reference

¹Umberson, D., Thomeer, M.B., Pollitt, A.M & Mernitz, S.E. (2020). The psychological toll of emotion work in same-sex and different-sex marital dyads. Journal of Marriage and Family, 82, 1141-1158. https://doi.org/10.1111/jomf.12686

Suggested Citation

Umberson, D., Thomeer, M.B., Pollitt, A.M & Mernitz, S.E. (2020). Emotion work exacts a psychological toll on the emotion worker in both same-sex and different-sex marriages, but the toll is highest when the spouse is a depressed man. PRC Research Brief 5(7). DOI: 10.26153/tsw/9563.

Acknowledgements

This research was supported by grant R21AG044585 from the National Institute on Aging (awarded to Umberson) and grant P2CHD042849, Population Research Center, and T32HD007081, Training Program in Population Studies, both awarded to the Population Research Center at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. This study was also funded in part by the National Institute on Alcohol Abuse and Alcoholism grant number F32AA025814 (awarded to Pollitt). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health

Debra Umberson (umberson@prc.utexas.edu) is a professor of sociology; Christine and Stanley E. Adams, Jr. Centennial Professorship in Liberal Arts; and director of the Population Research Center, The University of Texas at Austin; Mieke Beth Thomeer is an assistant professor of sociology at the University of Alabama at Birmingham; at the time of publication Sara Mernitz and Amanda Pollitt were NICHD postdoctoral fellows at the Population Research Center. Amanda Pollitt is now an assistant professor in the department of health sciences at Northern Arizona University. 

Sarah Schoppe-Sullivan, Ph.D. is a professor of Psychology and the director of the Children and Parents Lab at the Ohio State University. Dr. Schoppe-Sullivan is a Fellow of the American Psychological Association, the Association for Psychological Science, and the National Council on Family Relations, and a member of the board of the Council on Contemporary Families. Her research focuses on coparenting and father-child relationships. Her website can be found here.

I had the opportunity to interview Dr. Schoppe-Sullivan regarding her recent publication The Best and Worst of Times: Predictors of New Fathers’ Parenting Satisfaction and Stress. The data used in this research come from a longitudinal study, the New Parents Project (NPP), which was funded by the National Science Foundation, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and Ohio State’s Institute for Population Research. The study included 182 dual-earner different-gender couples who were expecting their first child and followed these fathers (and mothers) across their transition to parenthood.

MP: Much of your research includes fathers. Why it is important to include fathers in parenting research?

SS: Ideals about fathers as parents have changed and fathers’ involvement in parenting has increased. Many more men today want to be more involved in parenting than their fathers or grandfathers were. There is also a greater expectation that fathers will be more actively involved in parenting. Therefore, it doesn’t make sense to only focus on mothers in parenting research when we have fathers that are spending more time with children and are more invested in building close relationships with them.

MP: One of the key findings in your study was that new fathers—especially those less confident in their romantic relationships—were more satisfied in parenting when mothers used more gate opening behavior. You define maternal gate opening as encouragement by mothers regarding the partner’s parenting. How might mothers exhibit gate opening behaviors?

SS: Gate opening can include proactive behaviors, such as saying, “hey, why don’t you take the baby for the afternoon”. This actively facilitates the father’s involvement. However, more reactive behaviors can also be encouraging, such as positive reinforcement—telling the father he did a good job after changing the baby’s diaper or giving the baby a bath. Mothers can also say things like “wow, the baby really enjoys being with you”. Praising the father to other important people, like grandparents and neighbors, while the father is within earshot can also boost fathers’ confidence.

MP: Even as men become more involved in parenting, mothers are still devoting more time to parenting and related responsibilities. In asking new mothers to increase their gate opening behaviors, are we placing yet another burden on mothers?

SS: Yes, this comes up a lot. In the consideration of maternal gatekeeping, it is important that we don’t place too much of a burden on new mothers and suggest that it is their responsibility to encourage fathers to be more involved. Mothers should never need to take responsibility for getting a father who is not interested or motivated, or who has attributes that result in less desirable parenting behaviors, to be involved in parenting. On the other hand, for many families it is critical for both parents to positively reinforce each other, especially in those very early weeks and months of parenthood. It is important to recognize when your partner, regardless of whether they’re a mother or a father, is doing a good job. I would place more emphasis on positive reinforcement rather than that mothers need to be nagging or pulling unwilling, uninterested dads to be involved, because that isn’t going to be good for the child or family.

MP: How might new parents work together and recognize each other’s anxieties in order to assist each other in the transition to parenthood?

SS: It is a really good idea for expectant couples and new parents to have frequent conversations and check-ins regarding how they are doing and feeling. Often couples may participate in childbirth education classes or go to a hospital to learn how to properly install a car seat. Those things are very important, but they don’t necessarily take the place of facing the emotional and relationship changes that are also happening. So having those conversations are important both before the child is born and afterwards too. A quick “how are you doing?” or “can I help you in any way?” can be useful and help bridge disconnection that can happen when you are focused on your baby and can hardly find time to take a shower.

MP: Your findings suggest that expectant fathers who are more confident in parenting adjust better to parenthood. Do these findings apply to families welcoming a second or third child?

SS: Fathers who already have experience with infants might have an advantage. It is often true that women have had more experience with infants and young children than men have had before becoming parents themselves. So, men who have actively cared for a first child may adjust better to parenting subsequent children.

MP: The results of this paper are from a study of dual-earner, high socioeconomic status families headed by mothers and fathers. Are your findings applicable to other types of families, such as same-sex parent families, or families from different socioeconomic backgrounds?

SS: Looking at most of the findings, they are not terribly specific to fathers only, or only new fathers who are partnered with new mothers. For example, we found that expectant fathers who were more anxious were at risk of experiencing elevated stress postpartum. I really think that would apply to parents in many different circumstances. The finding that entering into parenthood with greater parenting confidence predicts less parenting stress and greater satisfaction would also likely hold across different populations of expectant and new parents. There is also evidence that gatekeeping occurs in same-sex couples too. Therefore, many of the factors that we examined—anxiety, parenting cofidence, gatekeeping—may be fairly universal influences on adjustment to parenthood.

Madeline is a recent graduate from the Ohio State University and will be beginning her studies in Developmental Psychology at the University of Missouri’s graduate school this fall.

Parenthood is a beautiful yet immensely stressful endeavor. What is less understood is how LGBTQ (lesbian, gay, bisexual, transgender, or queer) individuals fare in their experience of parenthood, and how this endeavor affects their health and well-being (note that these individuals are referred to as “queer”—an umbrella term for sexual and gender minorities in the following text for simplicity). To celebrate pride month, we share the findings of our research on the health and well-being of queer parents.

Generally speaking, parents tend to experience more stress and report worse health than those without children in part due to the emotional, physical, and financial stress of childrearing. In particular, compared to heterosexual parents, queer parents may experience more stress deriving from higher levels of discrimination experienced in daily interaction and social institutions such as adoption agencies, school systems, and health services. Lesser known is how queer parents fare in comparison to their childless peers. Additionally, queer parents who are people of color (POC) may experience even more stress resulting from racial discrimination than their white peers, adding to their plight as parents and queer people. However, the health and well-being of racial minority queer parents has received relatively little attention in both academic research and public media.

Our study, recently published in the Journal of Marriage and Family, compared two main health outcomes — mental well-being and smoking— between parents and non-parents for a group of gay and lesbian adults. Based on respondents’ self-reported information—whether their gender identity (i.e., male, female, transgender) corresponds with their birth sex (i.e., individuals whose assigned birth sex is the same as their gender identity are hereafter referred to as “cisgender” adults), we analyzed three subgroups: cisgender gay men, cisgender lesbian women, and transgender gay/lesbian adults. We used data from the 2010 Social Justice and Sexuality Project, a survey of racially diverse sexual and gender minority adults residing in all 50 US states and Puerto Rico.

Overall, our results suggest that parents and non-parents have different health outcomes. This finding further depends on the gender identity of these gay and lesbian adults. In the analysis on current smoking status, we found that among cisgender gay men, fathers were more likely to be current smokers than non-parents. We identified a few potential explanations from prior work. First and foremost, cisgender gay fathers experience substantial stress related to their gay father status. In U.S society, parenthood is still considered to be based on a heteronormative union between a cisgender man and a cisgender woman. In this cisgender heterosexual union, women continue to undertake the majority of child care, even though men have picked up more childrearing work over the past few decades. Furthermore, cisgender gay fathers may be more visibly out than cisgender gay non-fathers. Taken together, the juxtaposition of sexual minority identity and fatherhood status challenges people’s conventional understanding of families and parents and thus can exposes gay fathers to more discrimination and stress in daily life. For instance, some cisgender gay fathers may experience more stress due to the limited legal protections that allow them to negotiate non-residential co-parental arrangements and interact with their children. As for why cisgender gay fathers smoked more but did not report worse mental well-being than cisgender gay non-parents or cisgender lesbian adults, it is likely related to the fact that men are more likely to self-regulate stress through externalized behaviors such cigarette smoking compared to women.

In the analysis on mental well-being, which was based on four questions assessing how people felt happy and hopeful, we found that among gay and lesbian transgender people, parents appear to have better mental health than those without children. This finding echoes prior work on the resilience of transgender parent families—for example, transgender parents are able to adopt more fluid gender norms and facilitate more support for family members. In addition, prior research has found that in general, transgender adults tend to have worse health than cisgender adults. In our sample, transgender gay/lesbian adults also reported worse mental health than cisgender gay and lesbian adults. When we compared all six subgroups in our sample (i.e., parents and non-parents from three gender identity groups), we found that transgender gay/lesbian nonparents also had worse mental well-being than their cisgender childless peers. In sum, this finding also suggests that transgender gay/lesbian non-parents may experience excessive stress that makes them particularly vulnerable to deteriorating mental health.

Our research sample is mostly composed of racial and/or ethnic minorities. Thus, our results may reflect the unique experience of gay/lesbian parents of color as a result of their multiple marginalized identities. A focus on queer people of color is particularly important as LGBTQ populations are more racially diverse than the general population. The mass media industry also seems to have taken note of this demographic change. For example, ‘Sesame Street’ featured two seemingly inter-racial gay fathers (a Latino father and a white father) along with their daughter Mia, played by a Latina girl in an episode aired recently for Pride Month—the first time that this iconic Children’s television show has included a queer parent family of color in its 51-year history.

To celebrate pride month, we share our paper, which highlights the unique experiences of LGBTQ parents—how their sexual and gender statuses shape their health and well-being relative to their LGBTQ childless peers. We hope that our research can help policy makers recognize the challenges queer families face and make deliberate efforts to support these families and their rich communities. For researchers, we encourage you to continue to further examine queer parenthood. For media producers who are important curators of content for future generations, we are looking forward to more representations of queer parent families that can help build a more inclusive society for us all.

Zhe (Meredith) Zhang is a postdoctoral research fellow in the Department of Sociology at Rice University. Follow her @zhezhang. Kiana Wilkins is a doctoral student in the department of Sociology at Rice University. Follow her @kianawilkins.

Reposted with permission from the Harvard Business Review.

Reposted with permission from the Texas Population Research Center 

Approximately one-third of women and one-fifth of men aged 60 and over in the U.S. live alone and are at heightened risk of social isolation due to social distancing and other safety precautions introduced to curtail the spread of COVID-19.

A national study conducted in 2015 found that among older adults, in-person contact was associated with lower levels of depression, but telephone or electronic contact were not. Research is mixed about whether social distancing due to COVID-19 leads to older people feeling more lonely. For example, one study found that in February 2020, older Americans who lived alone reported more loneliness than older adults who lived with others. However, there was no increase in reports of loneliness during the stay-at-home orders. Another study of Germans found that older adults reported less loneliness than younger adults, regardless of whether they lived alone or with others during the pandemic.

This brief reports on a recent study which examines how daily positive emotions (gratitude and contentment) and negative emotions (loneliness, sadness, and stress) vary based on whether people live alone during the pandemic and who they encountered throughout the day.

The authors surveyed 226 people aged 69 and older living in the Austin, Texas area during May and June 2020. The older adults reported on their living situation, social contact (in person, by phone, electronically) with different social partners, and emotions during the morning, afternoon and evening the prior day. Of those surveyed, 81 lived alone and 145 lived with spouses, family or other people. Nearly all the older adults were taking safety precautions, sheltering in place and avoiding contact with people outside their home.

Key Findings

• Older adults who live alone were, unsurprisingly, less likely to see others in person or to receive or provide help than those who lived with others. Contrary to expectations, those who live alone did not report more time on the phone or using electronic communication, such as text, email, or use social media.
• Older adults who live alone experienced more positive emotions when they saw someone in person compared to those who had no in-person contact (see Figure, left panel).
• In contrast, older adults who live alone experienced more negative emotions, especially loneliness, when they talked to someone on the phone (see Figure, right panel). This may be because talking to others by phone may remind people of their feelings of being alone during the pandemic.
• Older adults who live alone were more likely to have contact with friends, rather than family.
• Among older adults who live with others, contact with others – in person or by phone – did not affect positive or negative emotions throughout the day (see Figure).

Note: See published paper for confidence intervals for all results.

Policy Implications

These findings suggests that in-person contact may confer unique benefits to positive emotional well-being. In other words, technologically-mediated communication cannot replace the physical presence of others. Those who want to support emotional well-being in older adults who live alone with in-person contact should do so while following COVID-19 safety guidelines, such as limited contact with other individuals who are also sequestering, keeping that contact at a distance of at least 6 feet, visiting outside and mask wearing. Because phone calls for older adults who live alone may increase feelings of loneliness, older adults may want to schedule phone calls for days they may also see a friend in person from a distance and while wearing a face mask. Friends and relatives who telephone also might set up the next phone call when they finish to remind the older adult of ongoing contact.

Reference

Fingerman, K.L., Ng, Y.T., Zhang, S., Britt, K., Colera, G., Birditt, K.S., & Charles, S.T. (2020). Living alone during COVID-19: Social contact and emotional well-being among older adults. Journals of Gerontology Series B: Social Science. Published online ahead of print.

Suggested Citation

Fingerman, K.L., Ng, Y.T., Zhang, S., Britt, K., Colera, G., Birditt, K.S., & Charles, S.T. (2021). Older adults who live alone benefited from seeing people in person during the pandemic but not necessarily by talking on the phone. PRC Research Brief 6(1). DOI: 10.26153/tsw/11348.

Acknowledgements

This study was supported by grants R01AG046460 and P30AG066614 from the National Institute on Aging (NIA) and grant P2CHD042849 awarded to the Population Research Center (PRC) at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging or the National Institutes of Health.

Karen L. Fingerman (kfingerman@austin.utexas.edu) is a professor of human development and family sciences a faculty research associate in the Population Research Center, and director of research of the Center on Aging and Population Sciences, all at The University of Texas at Austin; Yee To Ng and Shiyang Zhang are PhD students in human development and family sciences at UT Austin; Katherine Britt is PhD student in nursing at UT Austin; Gianna Colera is a master’s student in professional counseling at Texas State University; Kira S. Birditt is a research associate professor at the Survey Research Center and director of the Aging and Biopsychosocial Innovations Program at the University of Michigan Institute for Social Research; and Susan T. Charles is a professor of psychological science and nursing science at the University of California at Irvine.

Recent discussions have focused on loan forgiveness as a remedy for growing student loan debt in the United States. How have their loans affected – or not affected – students’ lives? What do young adults say they would do if their loans were forgiven?

College costs are rising, and declining state government investments in higher education mean that the burden of those high costs has increasingly fallen on the shoulders of individuals. In 1980, individuals paid roughly 30% of the cost of higher education, with states or the federal government covering 70%, but by 2010 government covered just half the cost, leaving 50% of costs to students and their families. While the Federal Pell grant program (targeted to low-income students) was greatly expanded during the Great Recession, allowing more students to draw upon those funds, it was not enough to make up for state budget cuts in direct higher education funding. These cuts caused tuition rates to grow over the past several decades at rates far outpacing the growth in family incomes. Meanwhile, government aid has increasingly shifted from outright grants to loans. In the early 1970s a majority of government funding came in the form of grants, while in recent years the majority is in loans that must be repaid, and cannot even be discharged through bankruptcy.

Thus, over the past few decades more students have owed more money to the government or private lenders after graduating from college. In 1990, 4-year college graduates of public universities owed an average of $8,200 (or just over $16,000 in 2020 dollars.) By 2000 the load of graduating seniors had nearly doubled to $15,100 (around $22,700 in 2020 dollars), and by 2020 it had doubled again to just over $30,000! The number of students at 4-year public colleges taking out loans to finance their degrees has also grown, from fewer than half (46%) of 1993 graduates, to about two-thirds (66%) of 2016 graduates. These loans are particularly hard to pay off for students and graduates with lower family wealth, especially affecting Black borrowers.

Meanwhile, student debt increasingly serves as a strong disincentive for marriage and childbearing, and although in general, college-educated individuals are more likely to marry than less-educated Americans, many hesitate to do so if they or their prospective partners still have college loans to pay off. Indeed, in the study we report upon below, almost half (47%) of undergraduate students told us people should delay having children and almost a quarter (23%) thought they should delay getting married if they have student loan debt to repay.

In a study published in Sociological Inquiry, “Social Norms and Expectations about Student Loans and Family Formation,” we report findings from a survey we conducted in 2017, and in new findings calculated especially for this CCF briefing paper, we report on a follow-up survey we conducted in 2020.

We first surveyed 2,990 undergraduate students – including 1,988 (66.5%) with student loans – at two regional public universities in the U.S., one in the Northeast and one in the Southeast, in early 2017. Of the 671 who reported they were about to graduate, 504 agreed to take a follow-up survey and provided an email address. Three and a half years after graduation, in November and December 2020, many of those email addresses no longer worked, but we were able to contact 194 (almost 40%) of those respondents, 142 of whom had taken out loans. Statistical tests indicated that these students were not significantly different from the original group of graduating seniors in terms of percent reporting student loans or average amount of loans in the first survey, racial distribution, or gender.

In 2017, we asked students who had taken loans to tell us what they expected the loans to do for them. In 2020, we asked a similar set of questions to the subset follow-up sample to find out if their expectations matched reality.

Anticipated and Actual Effects of Loans

Three and a half years after graduation, only 13 people in the sub-sample (9%) had paid off their loans completely. Yet in some respects the reality of their lives after graduation was better than they had anticipated back in 2017. While 55% of students with loans originally told us they anticipated living with parents or roommates after graduation or working at jobs they did not like in order to pay off loans, only 41% percent of the graduates with loans had ended up using these strategies during the time between graduation and our 2020 follow-up interviews. And while almost 32% of students had anticipated having to delay children until their loans were paid off, only 20% of the graduates with loans whom we surveyed reported actually doing this, while 18% said they were delaying marriage.

Nevertheless, this is a relatively high proportion of postponed marriages and children, and in other respects, even before the Covid-19 crisis, the reality of post-graduate life was more difficult for these students than they had anticipated back in 2017. While more than half the students we interviewed in 2017 had expected that the loans they took out to get their degree would ensure them a better job, only 21 percent of graduates in our 2020 follow-up reported they had been able to get a better job because of their degree. Nearly one-fifth (18%) of graduates reported they could not buy a house because of their loans, while 22% said they had foregone or delayed graduate school because of their loan debt. Only 12-13% of undergraduates had anticipated either one of these possibilities.

Figure 1: Anticipated and Reported Effects of Loan Debt, 2017 (College Students, N=1950) and 2020 (2017 College Graduates, N=142).

Compounding Disadvantages in the Covid Generation

Not only do many of the young adults in our study have loans holding them back, but the Covid-19 pandemic has compounded the delayed launch into adulthood and family formation for many. In the 2020 study we asked graduates, with and without loans, how the pandemic was affecting their lives. Just over 40% of 2017 graduates reported being fired, furloughed, or having their hours reduced because of the pandemic. To deal with the loss of income, 7% of this group had moved back home with their parents, and another 9% who had been planning to move out of the parental home had changed their minds. Fifteen percent delayed buying a house, 11% said they couldn’t pay rent or other regular bills, and 20% said they had had to get financial help from family.

The pandemic also affected romantic relationships and family formation. Seven of the graduates in our follow-up survey reported putting off a legal marriage and wedding, while another 3 got married legally while putting off a wedding party. Thirteen reported breaking up with a romantic partner because of Covid disagreements, or because the distance and stress got to be too much. On the other hand, some relationships accelerated because of the pandemic: 5 reported getting married sooner than originally planned. Another 6 moved in with a romantic partner sooner than expected, but past research has shown that such behavior actually reduces a couple’s chance of marrying at a later point.

The impact of the pandemic on fertility plans was especially noteworthy. Fifteen of our informants reported putting off having children because of the pandemic, with 3 of them delaying fertility treatments. Another 6 decided to have fewer children, or to not have children at all, because of the pandemic. None had children sooner than expected.

What would students do differently if their loans were forgiven?

Reports of what students and graduates would do if their loans were forgiven were consistent across the two surveys. Almost three-fourths said they would put the money in savings, and more than half said they would save up to buy a house. Among graduates, two-thirds said they would use that money to pay off other debt, and almost 53% would save for retirement. About 21% said they would get married sooner and 19% said they would have children sooner.

Figure 2: What would college students (N=1942, data collected in 2017) and 2017 graduates (N=129, data collected in 2020) do differently if loans were forgiven 1 year after graduation / 1 year after survey?

Implications

Our study suggests that the growing burden of student loan debt, especially in conjunction with the economic recession caused by the pandemic, is influencing multiple arenas of young adults’ lives, preventing many from forming the families they would like to have, closing opportunities for continuing investment in post-graduate education or training, restricting savings for emergencies and retirement and the ability to pay off other debt, and acting as a drag on the broader economy in many other ways.

Acknowledgments

The authors thank Jazmyn Edwards, Stephanie Pruitt, and Kenneshia Williams for their research assistance on this project, and Stephanie Coontz for editing this research brief. This material is based upon work supported by the National Science Foundation under grant numbers 1947603 and 1947604, a Rutgers University-Camden Faculty Research and Creative Activities Award, a Rutgers University Research Council Grant, and a University of North Carolina at Greensboro New Faculty Mentoring Program Second Year Grant, Faculty Research Grant, and Faculty First Award Grant, as administered by the Office of Sponsored Programs.

Arielle Kuperberg is Associate Professor of Sociology and Women’s, Gender and Sexuality Studies at the University of North Carolina at Greensboro and the editor of this blog. Follow her on twitter at @ATKuperberg. Joan Maya Mazelis is the author of Surviving Poverty: Creating Sustainable Ties among the Poor (NYU Press 2017). She is an associate professor of sociology in the Department of Sociology, Anthropology and Criminal Justice at Rutgers University–Camden, an affiliated scholar at Rutgers–Camden’s Center for Urban Research and Education, a Faculty Affiliate at the University of Wisconsin’s Institute for Research on Poverty, and co-leader of the New Jersey/Philadelphia chapter of the Scholars Strategy Network, an organization of scholars that connect their research to legislatures, civic organizations, and the media. Follow her @JoanieMazelis.

Reposted with permission from Newsweek, where this article was first published on May 9, 2021

In our nation, babies are born into a system of well-child care—a series of planned health care visits designed to protect their health from day one through age six. But what about their mothers? No such system exists for them after the postpartum visit.

Our fragmented health care system offers no bridge across the chasm that separates maternity care and ongoing primary care. This chasm harms many mothers; for Black and Indigenous people, the gap in care too often means the difference between life and death. The U.S. maternal mortality rate is the highest among affluent nations, and Black and Indigenous mothers are 3.5 times more likely to die from pregnancy-related causes than are white mothers. One-third of these deaths occur between one week and one year postpartum (in the chasm); and for every maternal death, there are at least 100 near misses. When complications, such as hypertension and diabetes, are not followed by primary care after pregnancy, chronic illness can develop.

We write as scientists, clinicians and advocates to argue for an emergency plan to fill the gaping hole in women’s health care.

Pregnancy care should be conceptualized not as a singular event or series of events, but as a key source of information for women’s health care prevention and treatment needs across the life course. Creating a bridge to support such health care could also help to address the persistent disrespect and racism commonly experienced by Black mothers in health care settings.

Pregnancy is a stress test on women’s bodies, revealing clues about underlying and future health. Complications such as gestational diabetes, hypertensive disorders of pregnancy, pre-eclampsia, depression and substance use disorder affect up to a quarter of pregnant people. These conditions play an important role in women’s health in the year after birth and are harbingers of future chronic illness that can be prevented or ameliorated.

Gestational hypertension and preeclampsia, for example, double the risk for heart disease and stroke, the leading causes of death in women aged 35-54. Gestational diabetes, which occurs in about 10 percent of pregnancies in the U.S. annually, raises the likelihood of type 2 diabetes sevenfold in the decade after pregnancy. About one-third of the 10 million adult women with type 2 diabetes first had gestational diabetes, which could have opened the door to effective prevention. Yet for most the door does not open; only 20-50 percent receive the recommended testing and preventive care in the years following pregnancy. The physical, emotional and economic burden of type 2 diabetes (estimated at $327 billion per year) and all chronic illness over one’s life course is enormous for families and society.

What do we have to do to create a system of health care for mothers that mirrors well-child care?

The American Rescue Plan Act, with its child tax credit, investments in child care and allowance for states to choose to extend Medicaid coverage to pregnant mothers from 60 days to one year postpartum, is a step in the right direction. But there is much more that could be done.

Health systems could be held accountable to metrics that track the racism and disrespect in maternal health care. High-touch models of care (doulas, midwives) offered during pregnancy could be extended to the full postpartum year to assure follow up of complications and connection to primary care. Medicaid for pregnancy-eligible women could be extended to 365 days (instead of the current 60 days) and all insurers could manage integration between maternity and primary care providers. Reforms in electronic medical record systems could promote transfer of pregnancy experiences to future providers. Research funding could support the development of evidence-based approaches to assure that women stay connected to preventive care beyond pregnancy and the postpartum period, across their life course.

These and other changes are laid out in a recently released national agenda co-created by a collaboration of women with lived experience, clinicians, researchers, advocates, policy-makers and health system leaders.

Given that women bear the burdens of pregnancy and child birth, we would do well to honor mothers by establishing policies and practices that build a bridge between maternal care and well-coordinated primary care for mothers. Individuals, for their part, can voice support for legislation and funding initiatives that invest in insurance coverage and continuous, coordinated care that mothers, particularly Black and Indigenous mothers, need long after babies are born.

Lois McCloskey is associate professor of community health sciences and director of the Center of Excellence in Maternal and Child Health at Boston University School of Public Health. Ann Celi is associate physician at Brigham and Women’s Hospital and assistant professor of medicine at Harvard Medical School. Chloe Bird is a senior sociologist at the nonprofit, nonpartisan RAND Corporation.