Reproductive Healthcare Utilization Influences Among Women and Sexual/Gender Minority Survivors of Sexual Violence.

Abstract

Individuals who experience sexual violence are at increased risk of reproductive health problems but often underutilize preventative reproductive healthcare. This mixed-methods analysis qualitatively explored factors influencing reproductive healthcare attendance by women and sexual/gender minority (SGM) individuals who experienced sexual violence and quantitatively compared Pap test utilization and attitudes/beliefs about Pap tests between the two groups. Participants (n = 554) completed an online survey measuring sexual violence exposure, Pap test utilization, and attitudes/beliefs toward Pap tests, and provided an open-ended response describing experiences, beliefs, or social factors influencing their attendance at reproductive healthcare appointments. Contrary to our hypothesis, SGM participants were more likely to be up to date on their Pap test (χ2[543] = 8.4, p < .004) and endorsed more perceived benefits (t[453.5] = 5.9, p < .001, d = .49) and fewer perceived risks (t[404.2] = 2.2, p = .031, d = .19) to Pap testing compared to cisgender/heterosexual sexual violence survivors. In the participants' descriptions of their beliefs and perceived barriers, six qualitative themes were identified: Safeguarding Health and Routine Maintenance, Emotional Barriers, Agency and Disempowerment, Resource Barriers, Provider Characteristics, and Community Influence. Factors influencing healthcare participation that were more common in the SGM group were their sexual violence history, fear of pain, discomfort, or feeling judged by providers. This analysis provides insight into and offers recommendations regarding reproductive healthcare utilization in sexual-violence-exposed women and SGM individuals.