Despite the decriminalization of same-sex relationships among consenting adults, the LGBTQ community in India continues to face discrimination. The stigma and non-acceptance in society pushes them to hesitancy, especially when seeking healthcare services, for fear of judgment.

The problem becomes more complex when doctors and healthcare staff are not skilled and sensitised enough. The barriers to accessing healthcare services for the LGBTQ community stem from fears about confidentiality and discriminatory attitudes of healthcare providers.

Dr Prathima Reddy, director, senior obstetrician and gynaecologist at Fortis La Femme Hospital, Richmond Road, Bengluru, says lesbian and bisexual women face a host of problems when approaching healthcare services, especially for their mental health.

“Mental health issues, specifically depression, tend to be more common in lesbians. This may be due to a lack of familial and societal support when growing up. In some societies, a sense of isolation with a hidden lifestyle may contribute to emotional stress that can predispose to substance abuse, depression and suicide. Also, intimate partner violence is common, but under-reported by the sufferer,” says the doctor.

She adds that compared to heterosexual women, lesbian women have fewer pregnancies. This may put them at risk of cancers, such as breast, endometrial or ovarian cancer. “This may be due to, as studies suggest, nulliparity, late childbearing, absence of breastfeeding and reduced use of combined oral contraceptive pills.”

How must doctors help

According to Dr Reddy, there are numerous ways obstetrician–gynecologists can better meet the needs of lesbian and bisexual patients. Specific suggestions include:

* Informing receptionists and other office staff that patients of all sexual orientations and gender identities are welcome, and that they should be treated with the same respect as other patients.

* Modifying office registration forms and questionnaires that require patients to identify their relationship and behavioural status to obtain more accurate and useful information. Examples include:

• Are you single, married, widowed, or divorced, or do you have a domestic partner?
• Are you, or have you been sexually active with anyone — male, female, or both male and female partners — or are you not sexually active?
• Who are you sexually attracted to — men, women, or both men and women?

The form can state that responding is optional.

* Have a non-discrimination policy for your office posted in the reception area — ‘This office appreciates diversity and does not discriminate based on race, age, religion, disability, marital status, sexual orientation, or perceived gender.’

* Using inclusive language with all patients and neutral terms such as ‘partner’ or ‘spouse’ rather than ‘boyfriend’ or ‘husband’.

LGBTQ health in Covid

“The pandemic has been an extremely difficult period for everybody. But for the LGBTQ community, the lockdown policies have exacerbated mental health issues. The psychological consequences of these social isolation measures and stay-at-home orders may be more severe for individuals who experience identity concealment and parental rejection at home,” the doctor concludes.

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