title: Congruence across Sexual Orientation Dimensions and Risk for Unintended Pregnancy among Adult U.S. Women.
abstract: To date, no studies have investigated whether sexual minority women (SMW) are more likely to experience unintended pregnancies compared with their heterosexual peers. The aim of this study was to explore whether adult SMW were more likely to have unintended pregnancies compared with heterosexual women, to examine the role of identity-attraction congruence in unintended pregnancy risk, and to evaluate possible mediators.
  
  
  
  Data on pregnancies to women ages 18 to 44 were drawn from the 2006 through 2013 National Survey of Family Growth (n = 25,403). Weighted logistic regression models estimated the likelihood of reporting an unintended (rather than intended) pregnancy by identity-attraction congruence and the extent to which this association was mediated by sexual experiences with men, including age at first sex and number of sexual partners. Supplementary analyses addressed the issue of abortion underreporting.
  
  
  
  Pregnancies to SMW were more likely to be unintended compared with pregnancies to heterosexual women (adjusted odds ratio, 1.26; 95% confidence interval, 1.08-1.46). This was driven by the elevated risk experienced by heterosexual-identified women with same-sex attractions, specifically (adjusted odds ratio, 1.28; 95% confidence interval, 1.08-1.51). Greater unintended pregnancy risk among these women was mediated by a greater number of male sex partners compared with heterosexual women.
  
  
  
  Unintended pregnancy risk among SMW has historically received little attention from scholars and clinicians. Future research should explore the specific conditions that put heterosexual-identified women with same sex attractions at increased risk for unintended pregnancy. Clinicians should consider these dynamics when screening patients for contraceptive counseling.
authors.affiliation: Department of Sociology, University of South Carolina, Columbia, South Carolina. Electronic address: hartnetc@mailbox.sc.edu.
authors.forename: Caroline Sten
authors.initials: CS
authors.lastname: Hartnett
authors.affiliation: Department of Global & Community Health, College of Health & Human Services, George Mason University, Fairfax, Virginia.
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Lindley
authors.affiliation: Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
authors.forename: Katrina M
authors.initials: KM
authors.lastname: Walsemann
mesh_terms: D000293:Adolescent; D000328:Adult; D003075:Coitus; D005260:Female; D018452:Homosexuality, Female; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012725:Sexual Behavior / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult