Sexual Orientation and Pregnancy Among Adolescent Women in the National Survey of Family Growth, 2002-2015.

Purpose: Given elevated pregnancy rates, fluctuating sexual identity, and varying sexual experience among adolescent sexual minority women (ASMW; lesbian/bisexual identity, attraction to/sex with females), research should assess adolescent pregnancy by sexual attraction with identity and experience. This study examined associations of three aspects of sexuality-identity, attraction, and experience-with pregnancy among ASMW versus non-ASMW.

Methods: Population-weighted data were drawn from the 2002 to 2015 National Survey of Family Growth (NSFG), 15- to 19-year-old female subsample (n = 5481). Multivariable logistic regression models (adjusted for age, race/ethnicity, and survey cycle) compared pregnancy among ASMW versus non-ASMW by sexual identity, attraction, and experience separately, and in a combined model in which interaction of aspects of sexuality and survey cycle was tested. The combined model was then stratified by survey cycle.

Results: Although not significant in the combined model, sexual minority versus heterosexual identity (adjusted odds ratio [aOR] = 1.74, 95% confidence interval [CI] = 1.21-2.51, p = 0.003) and sexual minority versus exclusive male attraction (aOR = 1.49, 95% CI = 1.10-2.01, p = 0.011) individually predicted higher pregnancy odds. There was significant interaction between attraction and survey cycles. Sexual minority attraction predicted significantly decreased pregnancy odds (aOR = 0.59, 95% CI = 0.38-0.90, p = 0.014) in combined 2002 to mid-September 2013 NSFG data, but increased odds (aOR = 1.59, 95% CI = 0.63-4.02, p = 0.324) in the rest of 2013-2015.

Conclusion: These results suggest the importance of measuring sexual attraction when examining pregnancy disparities among ASMW. Sex education and teen pregnancy prevention programs should reflect sexual diversity.