Expectations for family building, assisted reproduction, and adoption among lesbians in the National Survey of Family Growth, 2017-2019.

Objective: To characterize the family-building goals and experiences of lesbians compared with those of heterosexual females in the United States.

Design: Secondary analysis of nationally representative, cross-sectional survey data.

Setting: National Survey of Family Growth 2017-2019.

Patients: 159 reproductive-age lesbian respondents and 5,127 reproductive-age heterosexual respondents.

Interventions: We characterized family-building goals and the use of assisted reproduction and adoption among lesbians using nationally representative female respondent data from the 2017-2019 National Survey of Family Growth. We performed bivariate analyses examining variations in these outcomes between lesbian and heterosexual individuals.

Main Outcome Measures: Wantedness of children, use of assisted reproductive technology, and pursuit of adoption among reproductive-age lesbian and heterosexual participants.

Results: We identified 159 reproductive-age lesbian respondents of the National Survey of Family Growth, representing 2.3% or approximately 1.75 million US individuals of reproductive age. The lesbian respondents were younger, less religious, and less likely to have children than heterosexual respondents. These groups did not differ significantly by race/ethnicity, education, or income. More than half of the individuals reported wanting a child in the future, with proportions similar between the lesbian and heterosexual individuals (48% vs. 51%, respectively; = .52). Accordingly, 18% of both the lesbian and heterosexual individuals reported that they would be greatly bothered if they were unable to have children. Nevertheless, health care providers reportedly asked the lesbians about their desire to get pregnant less frequently than they asked the heterosexual individuals (21% vs. 32%, respectively; = .04). Only 26% of the lesbians had ever been pregnant compared with 64% of the heterosexual individuals (<.01). Approximately one third (31%) of lesbians with medical insurance were seeking reproductive services compared with 10% of heterosexual individuals ( = .05). Lesbians were significantly more likely to be seeking adoption than heterosexual individuals (7.0% vs. 1.3%, respectively; = .01), although they were more likely to report being turned down (17% vs. 10%, respectively;  = .03), not knowing why they were unable to adopt (19% vs. 1%, respectively; = .02), and quitting because of the adoption process (100% vs. 45%, respectively; = .04).

Conclusions: Approximately half of US females of reproductive age desire to have a child, a proportion that is not different between lesbian and heterosexual individuals. However, fewer lesbians are asked about their desires to get pregnant, and fewer ever become pregnant. Lesbians are significantly more likely to pursue assisted reproductive services when covered by insurance and more likely to seek adoption. Unfortunately, lesbians are more likely to face challenges with adoption.