A qualitative analysis of family building desires and barriers among LGBTQ+ military service members

Abstract: Objective: To explore family building desires and evaluate any barriers to seeking infertility care as reported by LGBTQ+ service members. Materials and methods: We utilized a qualitative research approach rooted in the phenomenological tradition to explore the experiences of our participants. Semi-structured, 30 minute interviews occurred between August and September 2023 via telephone or video conferencing with 20 LGBTQ+ participants (9 cis-females and 11 cis-males) who were recruited through social media. Respondent ages ranged from 23 to 52 years, with the average ages for the cis-female cohort calculated to be 31.2 years, compared to 34.0 years for the cis-male cohort. Most respondents were married (70.0%). We interviewed enlisted service members, officers, and veterans of the U.S. Air Force, Army, and Navy. We continued interviewing participants until we reached data saturation. Following our interviews, audio recordings were transcribed for analysis using an automated transcription service. Transcripts were then coded using a constant comparative approach by our research team. Results: After coding the interviews, five themes emerged: 1) barriers to initiating care; 2) institutional barriers within the military; 3) political barriers; 4) bias and justice; and 5) military retention. Common barriers to initiating treatment included lack of knowledge, financial barriers, lack of Tricare coverage, and concerns this process may negatively impact their military career. Military-specific institutional barriers included inability to obtain an infertility referral, whether the interviewee felt they had command support, frequent moves, and long military commitments, which influenced the respondent’s decision on when to initiate family building. Most respondents cited their social network and social media as avenues they would use or have used in order to obtain more information. Conclusions: An overall lack of knowledge regarding the family building process may impede LGBTQ+ individuals from initiating their family building journey. Despite advancements in family building support in the military, our results suggest significant barriers still exist for LGBTQ+ service members. These barriers can be targeted by future policy efforts when determining how to best support family building within the military. Impact statement: LGBTQ+ military service members cite numerous barriers to pursuing infertility treatment, such as barriers to initiating care and obtaining a referral, which must be addressed should equitable access to reproductive care be achieved. Support: None.

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