554928
research-article2014
JHLXXX10.1177/0890334414554928Journal of Human LactationFarrow
Commentary
Lactation Support and the LGBTQI Community
Journal of Human Lactation 2015, Vol. 31(1) 26–28 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0890334414554928 jhl.sagepub.com
Alice Farrow1 Keywords barriers, bisexual, breastfeeding, chestfeeding, cisnormative, disclosure, discrimination, gay, gender identity, health disparities, heteronormative, intersex, lactation support, lesbian, queer, questioning, sexual orientation, support, transgender Although it is recognized that diverse members of the lesbian, gay, bisexual, transgender, queer, questioning, and intersex (LGBTQI) community face significant barriers to accessing appropriate health care,1,2 very little has been written and little research has been done on access to lactation support for this community. Heteronormative and cisnormative assumptions are predominant in the language (including images) in mainstream breastfeeding literature and the language used by providers. This would appear to be a significant barrier to accessing lactation support by LGBTQI parents, as well as limiting the adequacy of that support, forming a barrier to a positive working environment for LGBTQI providers who are vital to the process of change toward LGBTQI inclusion in the field. Heteronormativity is “the mundane production of heterosexuality as the normal, natural, taken-for-granted sexuality,” which leads to social exclusion or marginalization of nonheterosexuals.3 Heteronormativity can easily be seen in breastfeeding literature and practice as the assumption that families are made up of a man, a woman, and a child or children. Cisnormativity is the assumption that everyone is cisgender or cissexual (ie, “people who are not transsexual and who have only ever experienced their subconscious and physical sexes as being aligned”).4 Cisnormativity is manifested in institutional erasure and practices that “exclude or ignore the possibility of providing service to trans clients,”5 such as the predominant use, within the lactation profession, of female gendered language when referring to breastfeeding parents. Each letter of the acronym LGBTQI represents a diverse group of people with different needs and issues. Readers may be familiar with other variations of this acronym in the form of LGB, LGBT, or LGBTQ. The author has chosen the form LGBTQI (as it encompasses the diverse acronyms used in the studies referenced) when speaking of the community generally, and abbreviated forms of this acronym when referring to a smaller grouping of identities. The letters contained in LGBTQI do not represent all gender identities and sexual or affection orientations, knowledge of which is in rapid evolution, especially within popular culture; social media has recently recognized this by allowing account holders to
identify in dozens of ways6 or to not identify at all. Acronyms, therefore, can be problematic and limiting as descriptors of this community and should be held under scrutiny for their accuracy and usefulness. Advocacy and research have visibly focused on the white Caucasian lesbian and gay communities, which are not representative of LGBTQI people worldwide. English language terms and acronyms are not inclusive of the terms used in other cultures such as the Native American Two Spirit people and the Indian Hjira. Sexual orientation and gender are only 1 facet of an intersectional identity, and some LGBTQI people belong to more than 1 minority group and therefore are subject to intersectional discrimination. Members of the LGBTQI community experience acceptance and equality diversely according to culture, religion, country or region of residence, sex, gender, and sexual or affection orientation. Health research shows that LGBTQI people have limited access to health care due to factors such as poverty, homelessness, gender-specific care and services, ineligibility for health insurance coverage due to marriage discrimination laws, fear of violence, refusal of care, substandard care without consideration of noncisgender heteronormative needs, and derogatory or moralistic comments from providers.1,2 Transgender health care is problematized by the implication that transsexualism is a disorder.1 Resultant reluctance to seek care, including routine checks and specialist referrals due to the stress of disclosure of sexual orientation and/or gender identity to health care providers, widens gaps in health disparity for this community.2,7 Studies have found that all members of the LGBTQ community are affected by heteronormative and gendered language and invisibility,5,8-10 but transgender and bisexual individuals experience more invisibility and erasure within society and the health care system than other members of the LGBT community,2,5,11 1
The Open University, Milton Keynes, UK
Date submitted: August 4, 2014; Date accepted: September 19, 2014. Corresponding Author: Alice Farrow, Via Francesco Catel 25, 00152 Rome, Italy. Email: [email protected]
Downloaded from jhl.sagepub.com at CHINESE UNIV HONG KONG LIB on November 16, 2015
27
Farrow and transgender people are particularly affected by institutional barriers such as gender-specific health insurance coverage and care.1,2 Although there is little mention of LGBTQI parents in breastfeeding literature, the author has heard positive firsthand accounts of breastfeeding support from individual LGBTQ parents who also note the absence of culturally competent breastfeeding resources, the lack of representation of nonheteronormative families (in areas such as intake forms and images representing parents and families), as well as a lack of specific information and research for their specific breastfeeding or chestfeeding concerns or difficulties, leaving these parents to do their own research for the information required. The lactation profession has shown interest in LGBTQ issues and a desire to be inclusive through changes in policy,12 recognition of women as partners and coparents,13,14 an increase in LGBTQ inclusive breastfeeding materials and provider education,15-18 as well as discussion of LGBTQ inclusion at an institutional level.19 Much of the research, resources, and commentary on lactation and the LGBTQI community have come from LGBTQI providers and parents themselves, yet the contribution of members of this community may be limited due to fear of disclosure; LGBTQI providers and parents may not be “out” (express publicly their sexual or affection orientation or family composition) or may live in “stealth” (not disclose their transgender status) by choice or out of fear of discrimination. The author has had, as well as received personal communications from other LGBTQ lactation providers who report, negative experiences such as unsolicited comments and openly expressed provider opinions on LGBTQI people as parents, and judgment on conception, feeding decisions, and the imaginary “gay lifestyle,” which are harmful and unfounded. Whereas many parenting and breastfeeding challenges are common to heterosexual and same-sex or queer families, the LGBTQI community have specific parenting and infant feeding concerns, such as co-nursing and induced lactation; chestfeeding, breastfeeding, nursing, or feeding (preferred terms may vary) after chest reduction (top-surgery in transgender men); breastfeeding after breast augmentation (transgender women); the use of testosterone while chestfeeding; and pregnancy and lactation’s effects on gender dysphoria (which “occurs when an individual feels discomfort due to parts of their body that do not match their gender identity”).15 LGBTQI parents are also at risk of mental health issues, due to minority stress and social stigma.20 Fear of the implications and repercussions of disclosure, the legal difficulties involved in validating family composition, health disparities, institutional discrimination, and lack of social, family, and professional support are factors that can increase the difficulties intrinsic to the transition to parenthood. Research into health outcomes of the LGBTQI community indicate lower physical and mental health outcomes2,7 of youth and adult members of this community, but also the
effects of social stigma on the children of same-sex attracted parents.21 Public health research may not include information on sexual identity and gender identity. Health concerns of lesbian and bisexual women include multiple risk factors for breast and reproductive cancers, such as nulliparity, alcohol consumption, smoking, obesity, and stress,2,22,23 yet accurate data on specific concerns, such as the presumed prevalence and incidence of breast cancer in the lesbian and bisexual women’s community, are lacking due to the type of demographic data collected by cancer agencies.23 There is also limited published literature on breast cancer and the transgender population.24 Not breastfeeding is known to be a risk factor in these cancers, but there has been little research done on the breastfeeding rates of lesbian and bisexual women and transgender men and women. The recent Australian Study of Child Health in Same-Sex Families (ACHESS)21 found high breastfeeding rates, similar to those of the general population within their cohort, which was limited to a group of parents with an above-average income and education who may well have had fewer barriers to health care access and infant feeding support, along with the ability to access private lactation care. Although breastfeeding is known to be fundamental for the infant’s short- and long-term health and an important factor in the health of the lactating parent or parents, and breastfeeding objectives emphasize the role of breastfeeding in improving population health,25 the United States’ Surgeon General’s Call to Action to Support Breastfeeding26 does not mention nonheteronormative families in any way. Advocacy for LGBTQI inclusion in public health research focusing on breastfeeding may need to come from the profession itself. The United States’ Healthy People 2020 Objectives27 have called for LGBT parenting issues throughout the life course to be evaluated and addressed in the 2010-2020 decade. Since breastfeeding is known to be an important factor in the health of infants and the lactating parent or parents, improving access to breastfeeding support, individuating barriers to and the efficacy of that support, and studying LGBTQI parents and breastfeeding rates should therefore be considered priorities within the field of lactation. LGBTQI parents and their families should not be considered a “separate chapter” in breastfeeding literature; LGBTQI parents have the same lactation and family adjustment challenges as the heterosexual mothers currently served by mainstream breastfeeding support, as well as unique challenges (currently under- or un-researched). Increasing LGBTQI awareness and competency within the breastfeeding field and the use of inclusive nongendered language in intake forms and parent literature are immediate ways of increasing access to breastfeeding support for LGBTQI families. LGBTQI health and lactation providers have unique insights into the complexities of the issues faced by LGBTQI families. Therefore, they should be consulted and involved in discussions of the institutional barriers within this field as well as supported as key researchers and education providers
Downloaded from jhl.sagepub.com at CHINESE UNIV HONG KONG LIB on November 16, 2015
28
Journal of Human Lactation 31(1)
for the development and implementation of culturally competent resources and policies. Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author received no financial support for the research, authorship, and/or publication of this article.
References 1. Harvey VL, Housel TH, eds. Health Care Disparities and the LGBT Population. Plymouth, UK: Lexington Books; 2014. 2. Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: Board on the Health of Select Populations, Institute of Medicine of The National Academies; 2011. 3. Kitzinger C. Heteronormativity in action: reproducing the heterosexual nuclear family in after-hours medical calls. Soc Probl. 2005;52(4):477-498. 4. Serrano J. Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity. Emeryville, CA: Seal Press; 2007. 5. Bauer GR, Hammond R, Travers R, Kaay M, Hohenadel KM, Boyce M. “I don’t think this is theoretical; this is our lives”: how erasure impacts health care for transgender people. J Assoc Nurses AIDS Care. 2009;20(5):348-361. 6. Barker M. 57 Genders (and none for me)? Reflections on the new Facebook gender categories. Rewriting the rules [blog]. http://rewritingtherules.wordpress.com/2014/02/15/57-genders-and-none-for-me-reflections-on-the-new-facebookgender-categories/. Published February 15, 2014. Accessed September 16, 2014. 7. Leonard W, Pitts M, Mitchell A, et al. Private Lives 2: The Second National Survey of the Health and Wellbeing of Gay, Lesbian, Bisexual and Transgender (GLBT) Australians. Melbourne: La Trobe University, The Australian Research Centre in Sex, Health & Society; 2012. 8. Hagen B, Paz Galupo M. Trans* individuals’ experiences of gendered language with health care providers: recommendations for practitioners. Int J Transgend. 2014;15(1):16-34. 9. Bjorkman M, Malterud K. Lesbian women’s experiences with health care: a qualitative study. Scand J Prim Health Care. 2009;27(4):238-243. 10. Rosenstreich G, Comfort J, Martin P. Primary health care and equity: the case of lesbian, gay, bisexual, trans and intersex Australians. Aust J Prim Health. 2011;17(4):302-308. 11. Barker M, Richards C, Jones R, et al. The Bisexuality Report. Milton Keynes, UK: Open University, Centre for Citizenship,
Identities, and Governance and Faculty of Health and Social Care; 2014. 12. West D. LLLI updates breastfeeding counsellor eligibility criteria [press release]. http://www.llli.org/llli_updates_breastfeeding_counsellor_eligibility_criteria_21_april_2014. Published April 21, 2014. Accessed September 17, 2014. 13. Wiessinger D, West D, Pitman T. The Womanly Art of Breastfeeding. 8th ed. London, UK: Pinter & Martin Ltd; 2010. 14. Farrow A. When two women share parenting. Breastfeeding Today. 2014;23:16-18. 15. MacDonald T. Tips for transgender breastfeeders and their lactation educators. http://www.milkjunkies.net/2012/03/tips-fortransgender-breastfeeders-and.html. Published May 5, 2012. Accessed September 17, 2014. 16. Simpson J. LGBTQ parents and lactation—an exploration in LGBTQ culture. GOLD Lactation Online Conference; May 8, 2014. http://www.goldlactation.com/conference/presentations/78 17. MacDonald T. How health care providers and other birth workers can support trans* clients through pregnancy, birth, and infant feeding. YoniFest, Québec; August 2, 2014. 18. Dobrich C. Lesbian couples and breastfeeding. Liquid Gold, Australian Breastfeeding Association National Conference, Melbourne; August 3, 2014. 19. Carothers C. 2014 Lactation summit: addressing inequities within the lactation consultant profession. Clinical Lactation. 2014;5(3):86-89. 20. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674-697. 21. Crouch SR, Waters E, McNair R, Power J, Davis E. Parentreported measures of child health and wellbeing in same-sex parent families: a cross-sectional survey. BMC Public Health. 2014;14:635. 22. Meads C, Moore D. Breast cancer in lesbians and bisexual women: systematic review of incidence, prevalence and risk studies. BMC Public Health. 2013;13(1):1. 23. Cochran SD, Mays VM. Risk of breast cancer mortality among women cohabiting with same sex partners: findings from the National Health Interview Survey, 1997-2003. J Womens Health. 2012;21(5):528-533. 24. Pattison ST, McLaren BR. Triple negative breast cancer in a male-to-female transsexual. Intern Med J. 2013;43(2): 203-205. 25. Centers for Disease Control and Prevention. Breastfeeding report card: United States/2014. http://www.cdc.gov/breastfeeding/ pdf/2014breastfeedingreportcard.pdf. Accessed September 29, 2014. 26. US Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Rockville, MD: US Dept of Health and Human Services; 2011. 27. US Department of Health and Human Services. Healthy People 2020: Lesbian, Gay, Bisexual, and Transgender Health. Rockville, MD: US Dept of Health and Human Services; 2010.
Downloaded from jhl.sagepub.com at CHINESE UNIV HONG KONG LIB on November 16, 2015
research-article2014
JHLXXX10.1177/0890334414554928Journal of Human LactationFarrow
Commentary
Lactation Support and the LGBTQI Community
Journal of Human Lactation 2015, Vol. 31(1) 26–28 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0890334414554928 jhl.sagepub.com
Alice Farrow1 Keywords barriers, bisexual, breastfeeding, chestfeeding, cisnormative, disclosure, discrimination, gay, gender identity, health disparities, heteronormative, intersex, lactation support, lesbian, queer, questioning, sexual orientation, support, transgender Although it is recognized that diverse members of the lesbian, gay, bisexual, transgender, queer, questioning, and intersex (LGBTQI) community face significant barriers to accessing appropriate health care,1,2 very little has been written and little research has been done on access to lactation support for this community. Heteronormative and cisnormative assumptions are predominant in the language (including images) in mainstream breastfeeding literature and the language used by providers. This would appear to be a significant barrier to accessing lactation support by LGBTQI parents, as well as limiting the adequacy of that support, forming a barrier to a positive working environment for LGBTQI providers who are vital to the process of change toward LGBTQI inclusion in the field. Heteronormativity is “the mundane production of heterosexuality as the normal, natural, taken-for-granted sexuality,” which leads to social exclusion or marginalization of nonheterosexuals.3 Heteronormativity can easily be seen in breastfeeding literature and practice as the assumption that families are made up of a man, a woman, and a child or children. Cisnormativity is the assumption that everyone is cisgender or cissexual (ie, “people who are not transsexual and who have only ever experienced their subconscious and physical sexes as being aligned”).4 Cisnormativity is manifested in institutional erasure and practices that “exclude or ignore the possibility of providing service to trans clients,”5 such as the predominant use, within the lactation profession, of female gendered language when referring to breastfeeding parents. Each letter of the acronym LGBTQI represents a diverse group of people with different needs and issues. Readers may be familiar with other variations of this acronym in the form of LGB, LGBT, or LGBTQ. The author has chosen the form LGBTQI (as it encompasses the diverse acronyms used in the studies referenced) when speaking of the community generally, and abbreviated forms of this acronym when referring to a smaller grouping of identities. The letters contained in LGBTQI do not represent all gender identities and sexual or affection orientations, knowledge of which is in rapid evolution, especially within popular culture; social media has recently recognized this by allowing account holders to
identify in dozens of ways6 or to not identify at all. Acronyms, therefore, can be problematic and limiting as descriptors of this community and should be held under scrutiny for their accuracy and usefulness. Advocacy and research have visibly focused on the white Caucasian lesbian and gay communities, which are not representative of LGBTQI people worldwide. English language terms and acronyms are not inclusive of the terms used in other cultures such as the Native American Two Spirit people and the Indian Hjira. Sexual orientation and gender are only 1 facet of an intersectional identity, and some LGBTQI people belong to more than 1 minority group and therefore are subject to intersectional discrimination. Members of the LGBTQI community experience acceptance and equality diversely according to culture, religion, country or region of residence, sex, gender, and sexual or affection orientation. Health research shows that LGBTQI people have limited access to health care due to factors such as poverty, homelessness, gender-specific care and services, ineligibility for health insurance coverage due to marriage discrimination laws, fear of violence, refusal of care, substandard care without consideration of noncisgender heteronormative needs, and derogatory or moralistic comments from providers.1,2 Transgender health care is problematized by the implication that transsexualism is a disorder.1 Resultant reluctance to seek care, including routine checks and specialist referrals due to the stress of disclosure of sexual orientation and/or gender identity to health care providers, widens gaps in health disparity for this community.2,7 Studies have found that all members of the LGBTQ community are affected by heteronormative and gendered language and invisibility,5,8-10 but transgender and bisexual individuals experience more invisibility and erasure within society and the health care system than other members of the LGBT community,2,5,11 1
The Open University, Milton Keynes, UK
Date submitted: August 4, 2014; Date accepted: September 19, 2014. Corresponding Author: Alice Farrow, Via Francesco Catel 25, 00152 Rome, Italy. Email: [email protected]
Downloaded from jhl.sagepub.com at CHINESE UNIV HONG KONG LIB on November 16, 2015
27
Farrow and transgender people are particularly affected by institutional barriers such as gender-specific health insurance coverage and care.1,2 Although there is little mention of LGBTQI parents in breastfeeding literature, the author has heard positive firsthand accounts of breastfeeding support from individual LGBTQ parents who also note the absence of culturally competent breastfeeding resources, the lack of representation of nonheteronormative families (in areas such as intake forms and images representing parents and families), as well as a lack of specific information and research for their specific breastfeeding or chestfeeding concerns or difficulties, leaving these parents to do their own research for the information required. The lactation profession has shown interest in LGBTQ issues and a desire to be inclusive through changes in policy,12 recognition of women as partners and coparents,13,14 an increase in LGBTQ inclusive breastfeeding materials and provider education,15-18 as well as discussion of LGBTQ inclusion at an institutional level.19 Much of the research, resources, and commentary on lactation and the LGBTQI community have come from LGBTQI providers and parents themselves, yet the contribution of members of this community may be limited due to fear of disclosure; LGBTQI providers and parents may not be “out” (express publicly their sexual or affection orientation or family composition) or may live in “stealth” (not disclose their transgender status) by choice or out of fear of discrimination. The author has had, as well as received personal communications from other LGBTQ lactation providers who report, negative experiences such as unsolicited comments and openly expressed provider opinions on LGBTQI people as parents, and judgment on conception, feeding decisions, and the imaginary “gay lifestyle,” which are harmful and unfounded. Whereas many parenting and breastfeeding challenges are common to heterosexual and same-sex or queer families, the LGBTQI community have specific parenting and infant feeding concerns, such as co-nursing and induced lactation; chestfeeding, breastfeeding, nursing, or feeding (preferred terms may vary) after chest reduction (top-surgery in transgender men); breastfeeding after breast augmentation (transgender women); the use of testosterone while chestfeeding; and pregnancy and lactation’s effects on gender dysphoria (which “occurs when an individual feels discomfort due to parts of their body that do not match their gender identity”).15 LGBTQI parents are also at risk of mental health issues, due to minority stress and social stigma.20 Fear of the implications and repercussions of disclosure, the legal difficulties involved in validating family composition, health disparities, institutional discrimination, and lack of social, family, and professional support are factors that can increase the difficulties intrinsic to the transition to parenthood. Research into health outcomes of the LGBTQI community indicate lower physical and mental health outcomes2,7 of youth and adult members of this community, but also the
effects of social stigma on the children of same-sex attracted parents.21 Public health research may not include information on sexual identity and gender identity. Health concerns of lesbian and bisexual women include multiple risk factors for breast and reproductive cancers, such as nulliparity, alcohol consumption, smoking, obesity, and stress,2,22,23 yet accurate data on specific concerns, such as the presumed prevalence and incidence of breast cancer in the lesbian and bisexual women’s community, are lacking due to the type of demographic data collected by cancer agencies.23 There is also limited published literature on breast cancer and the transgender population.24 Not breastfeeding is known to be a risk factor in these cancers, but there has been little research done on the breastfeeding rates of lesbian and bisexual women and transgender men and women. The recent Australian Study of Child Health in Same-Sex Families (ACHESS)21 found high breastfeeding rates, similar to those of the general population within their cohort, which was limited to a group of parents with an above-average income and education who may well have had fewer barriers to health care access and infant feeding support, along with the ability to access private lactation care. Although breastfeeding is known to be fundamental for the infant’s short- and long-term health and an important factor in the health of the lactating parent or parents, and breastfeeding objectives emphasize the role of breastfeeding in improving population health,25 the United States’ Surgeon General’s Call to Action to Support Breastfeeding26 does not mention nonheteronormative families in any way. Advocacy for LGBTQI inclusion in public health research focusing on breastfeeding may need to come from the profession itself. The United States’ Healthy People 2020 Objectives27 have called for LGBT parenting issues throughout the life course to be evaluated and addressed in the 2010-2020 decade. Since breastfeeding is known to be an important factor in the health of infants and the lactating parent or parents, improving access to breastfeeding support, individuating barriers to and the efficacy of that support, and studying LGBTQI parents and breastfeeding rates should therefore be considered priorities within the field of lactation. LGBTQI parents and their families should not be considered a “separate chapter” in breastfeeding literature; LGBTQI parents have the same lactation and family adjustment challenges as the heterosexual mothers currently served by mainstream breastfeeding support, as well as unique challenges (currently under- or un-researched). Increasing LGBTQI awareness and competency within the breastfeeding field and the use of inclusive nongendered language in intake forms and parent literature are immediate ways of increasing access to breastfeeding support for LGBTQI families. LGBTQI health and lactation providers have unique insights into the complexities of the issues faced by LGBTQI families. Therefore, they should be consulted and involved in discussions of the institutional barriers within this field as well as supported as key researchers and education providers
Downloaded from jhl.sagepub.com at CHINESE UNIV HONG KONG LIB on November 16, 2015
28
Journal of Human Lactation 31(1)
for the development and implementation of culturally competent resources and policies. Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author received no financial support for the research, authorship, and/or publication of this article.
References 1. Harvey VL, Housel TH, eds. Health Care Disparities and the LGBT Population. Plymouth, UK: Lexington Books; 2014. 2. Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: Board on the Health of Select Populations, Institute of Medicine of The National Academies; 2011. 3. Kitzinger C. Heteronormativity in action: reproducing the heterosexual nuclear family in after-hours medical calls. Soc Probl. 2005;52(4):477-498. 4. Serrano J. Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity. Emeryville, CA: Seal Press; 2007. 5. Bauer GR, Hammond R, Travers R, Kaay M, Hohenadel KM, Boyce M. “I don’t think this is theoretical; this is our lives”: how erasure impacts health care for transgender people. J Assoc Nurses AIDS Care. 2009;20(5):348-361. 6. Barker M. 57 Genders (and none for me)? Reflections on the new Facebook gender categories. Rewriting the rules [blog]. http://rewritingtherules.wordpress.com/2014/02/15/57-genders-and-none-for-me-reflections-on-the-new-facebookgender-categories/. Published February 15, 2014. Accessed September 16, 2014. 7. Leonard W, Pitts M, Mitchell A, et al. Private Lives 2: The Second National Survey of the Health and Wellbeing of Gay, Lesbian, Bisexual and Transgender (GLBT) Australians. Melbourne: La Trobe University, The Australian Research Centre in Sex, Health & Society; 2012. 8. Hagen B, Paz Galupo M. Trans* individuals’ experiences of gendered language with health care providers: recommendations for practitioners. Int J Transgend. 2014;15(1):16-34. 9. Bjorkman M, Malterud K. Lesbian women’s experiences with health care: a qualitative study. Scand J Prim Health Care. 2009;27(4):238-243. 10. Rosenstreich G, Comfort J, Martin P. Primary health care and equity: the case of lesbian, gay, bisexual, trans and intersex Australians. Aust J Prim Health. 2011;17(4):302-308. 11. Barker M, Richards C, Jones R, et al. The Bisexuality Report. Milton Keynes, UK: Open University, Centre for Citizenship,
Identities, and Governance and Faculty of Health and Social Care; 2014. 12. West D. LLLI updates breastfeeding counsellor eligibility criteria [press release]. http://www.llli.org/llli_updates_breastfeeding_counsellor_eligibility_criteria_21_april_2014. Published April 21, 2014. Accessed September 17, 2014. 13. Wiessinger D, West D, Pitman T. The Womanly Art of Breastfeeding. 8th ed. London, UK: Pinter & Martin Ltd; 2010. 14. Farrow A. When two women share parenting. Breastfeeding Today. 2014;23:16-18. 15. MacDonald T. Tips for transgender breastfeeders and their lactation educators. http://www.milkjunkies.net/2012/03/tips-fortransgender-breastfeeders-and.html. Published May 5, 2012. Accessed September 17, 2014. 16. Simpson J. LGBTQ parents and lactation—an exploration in LGBTQ culture. GOLD Lactation Online Conference; May 8, 2014. http://www.goldlactation.com/conference/presentations/78 17. MacDonald T. How health care providers and other birth workers can support trans* clients through pregnancy, birth, and infant feeding. YoniFest, Québec; August 2, 2014. 18. Dobrich C. Lesbian couples and breastfeeding. Liquid Gold, Australian Breastfeeding Association National Conference, Melbourne; August 3, 2014. 19. Carothers C. 2014 Lactation summit: addressing inequities within the lactation consultant profession. Clinical Lactation. 2014;5(3):86-89. 20. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674-697. 21. Crouch SR, Waters E, McNair R, Power J, Davis E. Parentreported measures of child health and wellbeing in same-sex parent families: a cross-sectional survey. BMC Public Health. 2014;14:635. 22. Meads C, Moore D. Breast cancer in lesbians and bisexual women: systematic review of incidence, prevalence and risk studies. BMC Public Health. 2013;13(1):1. 23. Cochran SD, Mays VM. Risk of breast cancer mortality among women cohabiting with same sex partners: findings from the National Health Interview Survey, 1997-2003. J Womens Health. 2012;21(5):528-533. 24. Pattison ST, McLaren BR. Triple negative breast cancer in a male-to-female transsexual. Intern Med J. 2013;43(2): 203-205. 25. Centers for Disease Control and Prevention. Breastfeeding report card: United States/2014. http://www.cdc.gov/breastfeeding/ pdf/2014breastfeedingreportcard.pdf. Accessed September 29, 2014. 26. US Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Rockville, MD: US Dept of Health and Human Services; 2011. 27. US Department of Health and Human Services. Healthy People 2020: Lesbian, Gay, Bisexual, and Transgender Health. Rockville, MD: US Dept of Health and Human Services; 2010.
Downloaded from jhl.sagepub.com at CHINESE UNIV HONG KONG LIB on November 16, 2015
