What Unanswered Research Questions did we find?

Example questions:

“Are the experiences of Black and Asian LGBTQ+ people during conception/birth/early parenting different to those of white LGBTQ+ people?”

“How much do professionals actually know about religion and how that intersects with the perinatal period?”

“How much does this process acknowledge that LGBTQIA+ is not distinct and separate from; or other marginalised groups?”

“Intersectionality of being LGBTQ+ and a person of the global majority when it comes to childbearing - experiences, support and forms of healing”

“How best to support LGBTQIA community from global majority.”

“There is a strong intersectionality between the LGBTQIA+ community and the Neurodivergent community. Are there any resources to help those people from before pregnancy until after and what extra support can / should be given?”

View evidence here

Example questions:

“How should maternity systems and communications be structured to best support LGBTQIA+ people - separate specific services, leaflets, posters etc or integration?”

“Does caseloading benefit LGBTQ+ people?”

“How can we adapt antenatal care for LGBTQ+ people as it is currently geared towards heteronormative couples”

“How best to provide pregnancy care and postnatal care for same sex parents and particularly trans parents?”

“Does midwifery continuity of carer best support LGBTQIA+ families so that stories do not need repeating? How can this be facilitated?”

“Can I choose to have a named midwife who has had training in LGBT+ issues?”

“Should health care professionals be providing extra support?”

Stories:

“I want to access LGBTQ+ midwives and doctors, or request actively LGBTQ+ friendly healthcare providers. Pregnancy and childbirth are very vulnerable times, and I have a very serious fear of encountering homophobia in this process, especially working with healthcare providers in my day job who routinely express annoyance at providing care to trans people”

View evidence here

Example questions:

“What are the most effective ways to teach health professionals about the reproductive health issues of lesbians and bisexual women?”

“How can we best train our staff to have secure clinical skills and the professional knowledge needed to fully support all feeding options for LGBTQI+ people/families?”

“Do staff need specific training for physical health of trans clients during birth, or during terminations?”

“What should student midwives learn about how LGBTQIA+ people build/conceive their families?”

“how we can be assured that all maternity and neonatal staff (and students of these disciplines) have been educated to provide a high, contemporary standard (and thereafter receive ongoing education) to ensure that all individual LGBTQAI+ people receive a high standard of inclusive, compassionate and personalised care - from the preconceptual period through to the postnatal period (and seamlessly throughout the first 1001 days)”

“What are the training needs for qualified midwives to effectively support LGBTQIA+ people during the perinatal period?”

“How can lack of education around LGBTQIA+ people impact patient care and where are the key knowledge gaps?”

“What would be considered the gold standard of ‘cultural competency’ for healthcare staff working with LGBTQ+ people in the perinatal period?”

Stories:

“I want to know what training do midwives in the UK have around supporting non-traditional family types and understanding the way they might conceive? Asking this question after having to deal with midwives who clearly didn't know how to deal with our same sex donor conceived pregnancy. One midwife insisted on taking a family medical history from my partner despite us explaining repeatedly she was not genetically related to our unborn child”

View evidence here

Example questions:

“What impact does testosterone have on fertility, milk production and after birth healing?”

“What is the impact of taking testosterone on the likelihood of vaginal/perineal trauma during birth (given what we know about vaginal atrophy?)”

“How likely is it that I'll be able to conceive after being on testosterone, and is that affected by how long I was on testosterone or the type?”

“What are the effects of using testosterone during pregnancy on the development and physical health of the child?”

“Does testosterone impact ability to stay pregnant eg any long term impact on the uterus, cervix, etc”

“How likely is it that my trans female partner’s fertility will be affected by her hormones?”

“What are the effects of puberty blockers taken by gender dysphoric children and young people on their future fertility?”

“how long until periods return and when does ovulation/ferility return in relation to this and testosterone stopping?”

Stories:

“I would love for there to be some proper research into the long term impact of HRT on fertility for trans people. I am a trans man, when I started testosterone in xxxx I was told by the Gender Identity Clinic it would sterilise me and I’d never have biological children. I’ve since learned this is untrue and came off testosterone after 8.5y to have 2 babies in xxxx and xxxx. Whilst there is anecdotal evidence that fertility isn’t impacted permanently by HRT there is no actual research on if HRT makes it harder to conceive (either testosterone or oestrogen)”

View evidence here

Example questions:

“Any provision for mental health services or counselling for the whole family to prepare for the discrimination we face?”

“Where can I find specific mental health support for ppd [post partum depression] that includes lgbt issues? Eg family estrangement”

“where can LGBTQIA+ partners [non-gestational parents] access parenting or mental health support? is that at dads groups or somewhere else?”

“Can my wife suffer from postnatal depression even though she didn’t give birth?”

“What are the barriers and facilitators to accessing mental health services for LGBTQIA+ community?”

“How does being a LGBTQIA+ parent impact feelings of guilt and failure as a parent?”

“What do trans parents need for effective psychological support in the perinatal period?”

“mental health and wellbeing of gay men through domestic or cross-border surrogacy”

“For a non-binary person or someone who is transgender birthing are they offered mental health support in case of dysphoria?”

“A comparison of Gestational and Non gestational parents’ perinatal mental health”

“Why don't we have a more diverse range of mental health support offered for all people across all intersectionalities who are affected by issues of pregnancy/birth/loss/abortion etc?”

Stories:

“During the first two week after the arrival of our son, I struggled with my mental health. I would cry uncontrollably and unexpectedly. What is the impact of females who are in a same sex relation but do not carry the child?”

“How can the emotion of shared motherhood be held better by the medical professionals? I feel like there is a huge part of the process that is paperwork and data, and the emotional toll of the process isn’t really recognised for us. Maybe this is because we have no known ‘infertility’, other than the fact we are two women!”

View evidence here

Example questions:

“Do lgbtqia+ people experience more birth trauma than Heterosexual people?”

“How to choose between different types of treatment like IVF, IUI, etc?”

“What is the best and safest way for lesbians to get pregnant?”

“Are lesbians less likely to get good healthcare and baby safety outcomes, which we know happens to other minority groups such as Black mums”

“Are the side effects of reciprocal IVF in fertile lesbians same or similar to those in infertile heterosexual women using donor-egg IVF?”

“Does this procedure [reciprocal IVF] increase my risk of pregnancy complications that might impact on my long-term health?”

“Are maternal/birthing people’s mortality rates any higher for LGBTQIA+ people?”

“When being a same sex couple is the only reason that IUI/IVF is used to become pregnant, do all the risk factors associated with IUI/IVF pregnancies still exist, in the same likelihoods?”

“Are there differences in healthcare outcomes for lgbtqia+ birthing people and if so which groups are effected and what might be causing it?”

“How much more likely are children who have been conceived by LGBTQIA people to have genetic / chromosomal abnormalities or be born early?”

“What are the success rates for IVF for a surrogate? (As I would assume they would be different from the overall success rates at a fertility clinic)”

Stories:

“I have been told that my pregnancy is high risk because it was via IVF, but I am under 30, with no known health issues, and used donor sperm. There's very little information on if I'm still high risk or if risks associated with IVF are due to the risk factors that other people using IVF may already have (e.g. age, reproductive health issues)”

View evidence here

Example questions (including examples of emotional labour, as well as questions relating to emotional labour):

“Why is it up to us to educate health professionals around the differences between biological sex, gender etc?”

“How does the fear of transphobia during pregnancy impact?”

“Will my care team understand and be accepting of my identity, pronouns, and non-normative chosen family structure?”

“how can I feel safe when worrying about people's judgements and how that might impact on my care?”

“Will the midwifery and obstetrics team understand that our family are nervous for different reasons than heteronormative families?”

“how many trans people choose to not come out during pregnancy for fear of transphobia and other negative outcomes?”

Stories:

“How can I be sure that I won't encounter homophobia while seeking out care? I work with healthcare professionals who loudly complain about using gender neutral language when speaking about pregnancy, and I am absolutely terrified that my pregnancy will be high risk and my life will be in the hands of someone who doesn't think I should be allowed to get pregnant in the first place.”

“I had an IUI pregnancy. Whilst attending hospital scans and appointments many professionals didn’t know what IUI was and asked many questions, including wanting to know how much it all cost (which was exhausting and usually took up the majority of the appointments rather than talking about myself and my baby).”

“When my wife & I went to the doctors, we were asked more questions by them as to what was going on with the women’s health strategy for lesbians wishing to get pregnant via IVF”

View evidence here

Example questions:

“Accessible inclusive language for birthing parents”

“What is the effect on the parents and child when using inclusive language throughout treatment, birthing, antenatal classes, and within the first year of baby’s life? Is there a distinguished benefit to being more inclusive?”

“Is there a national standard for gender-affirming language?”

“What language is important to use or avoid?”

Stories:

"I wanted to feel safe and nurtured in maternity services, but as a trans man I found that the amount of times that I was directly and indirectly called a woman was really painful and caused so much unnecessary and avoidable stress. It was death by a thousand cuts, from the posters on the wall to the staff at the front desk or each new sonographer. Thankfully I had great continuity of carer from the homebirth midwifery team and they were all really careful to use language that was right for me, my body and my family. Because they used inclusive language, I felt safe with them. It should be that everyone who is pregnant feels that way through all of their pregnancy.”

View evidence here

Example questions:

“Mental health implications: wanting children but unable to find a surrogate or have the funds”

“What support exists for queer people who experience miscarriage, pregnancy loss and baby loss?”

“Why don't we have a more diverse range of mental health support offered for all people across all intersectionalities who are affected by issues of pregnancy/birth/loss/abortion etc?”

“What support needs to be available for non-bio and/or non-birthing partners when experiencing pregnancy or baby loss?”

“The impact and outcomes of lgbtq parents experiencing pregnancy, baby and child’s loss”

“Qualitative experience of LGBTQI+ individuals around pregnancy loss, stillbirth and neonatal death”

View evidence here

Example questions (including examples of the impact, as well as questions relating to the impact):

“Why is it, if the rules have changed nationally, that local CCGs still don't offer funded treatment?”

“Why do we pay so much and why does it change depending on where you live?”

“Why do different trusts offer different numbers of 'tries' for iui and IVF”

“Why is it a postcode lottery whether the NHS helps or if you need to spend £10,000s on fertility treatment?”

“Why are more trusts not implementing the fertility equality access that was passed as law for female same sex couples? It seems to be a slow process and a lot of couples must be missing out.”

View evidence here

Example questions:

“Are the additional risks around ivf applicable to queer people undergoing treatment, or does that arise due to heterosexual couples seeking the same treatment due to fertility issues?”

“Are LGBTQIA+ offered / recommended induction inappropriately - some are offered this due to having had fertility treatment but presumably fertility issues are the determining factor here - if at all. Not fertility treatment.”

Stories:

“My midwife referred me to a consultant at the beginning of my pregnancy and the consultant stated she didn’t really understand why as I was low risk and only undertook IVF due to being in a same sex couple. Because of this I am still under a consultant even though I medically don’t need to be which initially added to my stress and worry now I’m just a little embarrassed to be singled out like this. I’d like to know why this is”

View evidence here

Example questions:

“What is being done to address the queerphobia in abortion services? Specifically the transphobia”

“What are the LGBTQIA+ specific support services for people who are going through / have gone through abortion?”

“Is it possible that healthcare staff could be trained to treat patient care in gender neutral ways, when dealing with abortion?”

“Why don't we have a more diverse range of mental health support offered for all people across all intersectionalities who are affected by abortion?”

“When trans masc people/non binary people AFAB (assigned female at birth) become pregnant how informed are health care professionals about options for pregnancy and implications for hormone therapy. Given the rollback of trans rights and access to health care is pregnancy explored as an option in pre abortion counselling?”

View evidence here

Example questions (including examples of people looking for information, as well as questions relating to the content and how people find information):

“As a professional: best places to signpost prospective LGBT+ parents to”

“Where can we go for tailored support to our family?”

“Where can I find information on being a non birthing, non biological related mother”

“Where are resources for gender nonconforming birthing parents and why aren't they given out by HCPs [healthcare professionals]?”

“Will resources shared with me reflect my pregnancy and parenting experience?”

“How can I find LGBTQ+ inclusive guidance to give to patients?”

“Is there tailored and easy to understand advice available on fertility treatment process, funding and steps?”

View evidence here

Example questions:

“How to most effectively induce lactation without birthing (effectively meaning being able to establish a full milk supply and with the healthiest milk constituents). Within this area, does this change based on assigned gender at birth (eg trans women compared to cis women), does this change based on gender affirming medication taken previously or currently (puberty blockers, testosterone, oestrogen)?”

“On behalf of the non-birthing mother in a same sex female couple, could the non-birthing mother induce lactation without taking any medication?”

“Would I be supported, and by who, to do adoptive breastfeeding if we adopted a baby?”

“Can my partner and I both breastfeed the baby, and if so, how would we go about it?”

“How can the non-birthing mother induce lactation/how effective is it, how much does it cost and is it recommended?”

“Who should take responsibility for the care for a non-gestational person who wishes to induce lactation in order to share in breast/chest feeding? This appears to be a grey area - the lactation support experts fall under the maternity remit but as the person is not pregnant, it is challenging to gain support”

“Will I, as a trans woman, be able to breastfeed any future kids?”

“Can induced lactation in non birthing mother create enough of a supply to fulfil exclusive breastfeeding demand?”

“On wards where only [birth] Mothers can stay, how do we support families with two nursing parents?”

View evidence here

Example questions:

“what is the best time to go back on testosterone after giving birth?”

“How long is it likely to take my period to come back after I stop taking testosterone?”

“When is it safe to restart testosterone after giving birth?”

“How does HRT [hormone replacement therapy] impact feeding?”

“Preconception care for people on gender affirming hormonal replacement therapy (usually testosterone). How long should they come off testosterone prior to trying to conceive?”

View evidence here

Example questions:

“How can you make sure everyone is included in all aspects of the pregnancy for a same sex couple and surrogate?”

“What pregnancy support would gay couple prefer when having a surrogate birth?”

“how can surrogates be better prepared for the potential changes in relationships with parents following birth?”

“How are visiting/birth partner restrictions managed/altered for people going through surrogacy?”

“What is the best way to support a gestational surrogate before during and after their pregnancy?”

“How can healthcare pathways especially around planning for labour and delivery, but during the whole pregnancy, be adapted for parents working with a gestational surrogate?”

View evidence here

Example questions (including examples of the impact, as well as questions relating to what the impact is):

“Why do same sex partners have to be married at the time if conception to both go on the birth certificate when this is not the same for hetro couples and no due diligence is done to prove that the person going on the birth certificate is actually the child's father?”

“Why is the non birthing partner in same sex female relationship under the title of Father/ Parent on child's birth certificate? Why is the word Father first?” “Why is the word Father on the birth certificate of the child who has a same sex female couple as parents?”

“What is the impact of registering as "mother" on a trans mans mental health?”

Stories:

“I am a trans man and my wife a cis women are expecting our baby next week. My wife is currently pregnant which was via sperm donation. There is a grey area regarding myself being ‘father’ instead of ‘parent’ (which is often used in same sex couples) on the birth certificate. This is something I am very anxious about getting push back from on the day.”

View the evidence here

Example questions:

“Are midwives etc taught gender inclusive language?”

“As a non binary person, are healthcare professionals routinely trained on respecting pronouns etc. for pregnant people or not?”

“How often do health care professionals generalise same sex couples as 'your friend' rather than partner?”

“Will the medical staff respect my requests for gender neutral language? Will I be seen as difficult for asking?”

“How to address people using the wrong language E.g daddy instead of donor”

“Why isn’t language LGBT friendly? Why does paperwork and advice mainly refer to a mum and a dad?”

“How can I ensure my healthcare providers use the correct pronouns and parent titles for us, especially in the hospital when we are in a vulnerable space?”

Stories:

“As a lesbian, it makes me feel uncomfortable when I'm at an appointment with my partner and the healthcare provider seems uncomfortable knowing how to address us”

“Notes systems in the NHS were awful during my pregnancy, leading to me having to correct at every appointment that the baby doesn’t have a father, but two mums. Can this be improved?”

View evidence here

Example questions:

“If my wife is carrying, will I have the same bond as she does?”

“How will my partner feel not being genetically related to our child?”

“Lots of NHS advice seems to push non birthing parents out of perinatal period, or assumes their role is solely to support birthing parent. I'd love to see more research on the impact of this narrative on non birthing parents' mental health, their bond with the baby, the whole family's wellbeing. Or what's the impact when they are more proactively involved e.g. Invited to all appointments, questions and decisions about babies directed to both parents, offered skin to skin soon after birth etc.”

“Are there any hormonal changes that go on in the body of the non birth mother when expecting a baby and becoming a new parent? I know there are studies that show dads have a reduction in testosterone. I couldn’t find any info on what happens to second mums.”

View evidence here

Example questions (including examples of the uncertainty around the experience, as well as questions relating to what the experiences are):

“Will work give me leave even if I’m not the birthing parent? What are the legal obligations? What if we’re both breastfeeding? What employers will give me good leave?”

“Is there any clear guidance to explain options and benefits of splitting maternity leave for lgbtq+ couples”

“How to manage parental leave with thoughts on the induction of lactation for the non birthing partner”

View evidence here

Example questions (including examples of the uncertainty around the experience, as well as questions relating to what the experiences are):

"How does the fear of transphobia during pregnancy impact trans people… bonding with their baby?"

"Does dysphoria when pregnant mean I won't love my baby?"

View evidence here

Example questions (including examples of the uncertainty around the experience, as well as questions relating to what the experiences are):

"If a parent is producing milk and didn’t carry their baby, does the milk still have what the baby needs - and is this different at different ages?"

"Some trans women say they can lactate with the help of hormones. Is this safe for the baby?"

View evidence here

Example questions (including examples of the uncertainty around the experience, as well as questions relating to what the experiences are):

"Why isn’t language LGBT friendly? Why does paperwork… mainly refer to a mum and a dad?"

"In documentation, we have maternal and paternal info which is used for confirming consanguineous relationships etc. How can this be described in a way that relates more to pregnant people in the 22st century?"

"Can we please make it easier for lactating non-birthing person to access breastfeeding support. Hospitals often have a protocol to only support the birthing parent to feed their baby."

"How can NHS trusts use technology to ensure inclusiveness for LGBTQIA* community- ie if noted at booking lesbian couples, automatically then change all future documents as wife and wife, mother and non-birthing mother or if trans man, noted as male and father."

"How to change services so they don't all say "dad", "paternity leave" etc"

"Can the Badger notes system be made more inclusive for same sex couples doing reciprocal IVF (as it was a struggle for my wife to have notes made on both of our medical history when relevant for genetics etc)"

View evidence here

Example questions (including examples of the uncertainty around the experience, as well as questions relating to what the experiences are):

"When searching for a donor of a minority ethnic background to match a partner, there is a limited selection, and an exact match often cannot be found. What are the impacts on donor conceived children of having a donor that is not an exact match to their parents' ethnic background and/or religion?"

"How to improve recruitment of ethnic minority donors?"

View evidence here