Experiences of Sexual Minority Women in the UK with Healthcare

Background

Sexual minority women are terms used to define women who differ from the other women in the general population in terms of sexual behaviour (Muller & Hughes, 2016), orientation and relationship status (Meads et al., 2019). These are the women who are lesbians, bisexual or cohabit with their fellow women. Sexual minority women have unique health care needs, and this has not escaped the attention of public health professionals and clinicians (McN air, 2008). This realisation may have played a pivotal role in influencing the growing emphasis on reducing health disparities among sexual minority women. Several studies indicate that lesbian has a higher likelihood of manifesting in poor health, psychological distress, heavy smoking and drinking (Gonzales, Przedworski & Henning-Smith, 2016) and being afflicted by various chronic illnesses, relative to their heterosexual counterparts (Simoni et al., 2016). Likewise, bisexual women also manifest in substantial chronic distress, moderate smoking and heavy drinking, as well as being afflicted with multiple chronic illnesses (Gonzales et al., 2016). It goes to show that the health and wellbeing of sexual minority women are at risk from the behavior that they exhibit (Frost, Lehavot & Meyer, 2015). More importantly, there is a high likelihood that such behavior acts as a coping mechanism for the discrimination, stigma (Conron, Mimiaga & Landers, 2010) and prejudice they have to endure in society.

There has been a growing change of attitude towards sexual minority women, thanks in part to changes in policy and legislation. For instance, in the UK, the enactment of the 2008 Human Fertilization and Embryo Act acknowledges and supports the rights of lesbian families. As a result, a lot more health care professionals are coming into contact with sexual minority women while they seek health care services. Nonetheless, there is still a wide disparity in terms of the experiences of these minority groups while accessing health services, in comparison with the rest of the population.

The disparities in health and wellness as manifested by sexual minority women may be the result of living in a stressful social setting brought about by societal prejudice, stigma, and discrimination (Gorgos & Marrazzo, 2015). In this case, Sexual minority women are associated with marginalised minority groups (Hatzenbuehler, 2016), and this then creates a stressful social environment that they have to live in (Meyer, 1995). One of the frameworks that is used to study the mental issues associated with Sexual minority women is the minority stress theory. Baptiste-Roberts et al. (2016) define minority stress theory as the surplus stress that a person from a stigmatised social group gets exposed to, on account of their being part of a minority group.

While the minority stress model mainly dwells on mental health, it may also support physical health to a certain extent. Minority stress occurs in a continuum that starts with the distal stressors, all the way to the proximal stressors (Dahlhamer et al., 2015). Distal stressors refer to the objective conditions and events (Kosciw et al., 2018). In contrast, proximal stressors refer to individual subjective processes. In other words, proximal events hinge on individual perception (Meyer, 2003). Victimisation, discrimination and internalised homophobia are some of the most common sources of minority stress. Such sources are linked to poorer mental health outcomes for the individuals in question. To deal with minority stress, minority groups resort to resilience and coping. Nonetheless, such coping mechanisms might have grave effects on individual health and wellbeing.

Sexual minority women encounter various barriers in their quest to seek medical attention. These barriers are to be found at the individual and structural levels of the healthcare system. To begin with, the sexual orientation of sexual minority women acts as a barrier to their access to health insurance. Additionally, most health care providers attending to sexual minority women lack the competence required to attend to the unique health care needs of these minority groups. For these reasons, encounters of sexual minority women with the health care environment usually turn to be negative owing to internalised or perceived stigma. Consequently, sexual minority women may opt not to seek health care or delay such health care to avoid having to encounter such an environment.

Methodology

This study is based on a systematic review of primary sources relating to the topic in question. Clarke (2011) suggests that a systematic review acts as a highly reliable source of evidence for use by the researcher as guidance for his/her clinical practice. In conducting a systematic review, the objective is to succinctly summarise the various primary sources that the researcher has identified in such a way as to answer the research question (Clarke, 2011) succinctly.

One of the benefits of conducting a systematic review in research is that these sources are usually peer-reviewed, implying that the information contained therein has been vetted by experts in the field and is hence highly reliable. It adds to the authenticity of the research findings. Moreover, authors of systematic reviews are usually required to ensure that they register them with the relevant research networks depending on the field of study. In the case of health care and medicine, Cochrane Collaboration acts as the research network of choice through such a registration, the goal is to reduce bias during the review process. It also means that groups cannot duplicate the research and that systematic review remains up to date (Plos Medicine Editors 2011).

In choosing the articles for inclusion in this study, eligibility criteria was used as summarized in Table 1 below:

Table 1

The search was conducted from various online health databases, such as Cochrane Collaboration. The search for relevant articles was done using the Boolean operators ‘AND’ and ‘OR.’ Boolean operators are useful in improving the precision of a search strategy (Alderman, 2014; Empire State College, 2014). Relevant keywords such as sexual minority women; UK healthcare; experiences were used to conduct the search. The use of Boolean searching and keywords adds to the processes of accountability, reproducibility and transparency (MIT Libraries, 2018), which are desirable in the search process. Moreover, such a structured search strategy conforms to accepted principles as used in systematic review (Hammerstrøm & Wade, 2010; Lefebvre, Manheimer & Glanville, 2011).

However, the researcher encountered several difficulties while trying to select articles for inclusion in the study. One of the main challenges faced was identifying the suitable resources for use with the search. The internet is awash with numerous resources and narrowing down to the most credible resources is a difficult undertaking. Another challenge encountered was how to navigate the resources once identified. Here, the application of the eligibility criteria enabled in narrowing down to the most desirable articles for use with the research. Even after the relevant articles had been identified, there was still the problem of deciding on the type of literature to be collected from each source. A researcher is limited in terms of the word count for use with each research paper, and as such, it is vital to choose the most relevant literature judiciously. The search strategy is also limited to the resources available to the researcher to undertake such activities and the timeframe involved. In case the researcher is limited in terms of time and resources needed to conduct the search, this will also limit the number of articles that can be accessed for possible review.