Disparities in Health Insurance Coverage and Access to Care for Children By Mother's Sexual Orientation

Matern Child Health J. 2020 May;24(5):630-639. doi: 10.1007/s10995-019-02857-7.


Objective: Few population-based studies have examined the health care experiences of children with sexual minority parents. The purpose of this study was to compare health insurance status, access to care, and health services utilization for children by mother's sexual orientation.

Methods: We used data on children with lesbian mothers (n = 195), bisexual mothers (n = 299), and heterosexual mothers (n = 23,772) in the 2013-2017 National Health Interview Survey. Logistic regression models were used to compare health insurance status, access to care, and health services utilization while adjusting for demographic and socioeconomic characteristics of the child, mother, and household.

Results: After controlling for sociodemographic factors, there were no statistically significant differences in health insurance coverage, access to care, or health services utilization between children of lesbian mothers and children of heterosexual mothers. Compared to children with heterosexual mothers, children with bisexual mothers were more likely to have public health insurance (OR 2.33; 95% CI 1.07-7.68), delayed medical care due to cost (OR 2.33; 95% CI 1.12-4.86), unmet medical care due to cost (OR 2.86; 95% CI 1.07-7.68), and a visit to the emergency room (OR 1.74; 95% CI 1.27-2.39) in the prior year after controlling for child-level characteristics. Some of these differences were attenuated after controlling for maternal demographics and household characteristics.

Conclusions for practice: Children with bisexual mothers experience barriers to routine medical care. Addressing socioeconomic dimensions of health care access and targeted outreach to bisexual parents will help promote health equity for children growing up in sexual minority households.

Keywords: Access to care; Health disparities; LGBT health.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Health Surveys
  • Healthcare Disparities
  • Heterosexuality / statistics & numerical data*
  • Humans
  • Infant
  • Insurance Coverage / statistics & numerical data*
  • Male
  • Middle Aged
  • Mothers / statistics & numerical data*
  • Sexual and Gender Minorities / statistics & numerical data*
  • United States
  • Young Adult