Homoparenting as a public health issue: a scoping review

Gomes, Romeu; Toma, Tereza Setsuko; Silva, Jessica De Lucca Da; Domene, Fernando Meirinho; Silva, Adriano da

doi:10.11606/s1518-8787.2023057005447

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Sumário

Review • Rev. Saúde Pública 57 • 2023 • https://doi.org/10.11606/s1518-8787.2023057005447 copy

Homoparenting as a public health issue: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To map global scientific production on homoparenting in the field of collective health or public health.

METHODS

In terms of methodological procedures, a scoping review was carried out, guided by the following question: What are the aspects addressed in global scientific production regarding homoparental families in the field of collective or public health? The searches were carried out in seven sources of scientific literature, including 58 studies, involving scientific articles and dissertations. The analytical treatment given to the studies, most of which were qualitative, followed the content analysis technique in the thematic modality.

RESULTS

The results indicate that the perceptions of homosexuals and professionals about the care provided and health services in general was the topic addressed by the largest number of studies (n = 31), followed by heteronormative context of health services (n = 26); disclosure of sexual orientation (n = 20); fertilization (n = 14); educational information and actions (n = 5).

CONCLUSION

Although the issue of same-sex parenthood has been discussed in some health sectors, there is awareness that it is necessary to rely on a consolidated basis through numerous studies when discussing this issue. It is concluded that, among other aspects, the scope of this review is not sufficiently problematized within the scope of health professionals’ training and performance.

Homosexuality; Family; Sexual and Gender Minorities; Health; Review

Author	Study design	Study population	Age ( years)	Race/color/ethnicity	Country where it was held	Financing	Conflict of interest
Albuquerque et al. ¹⁵15.Albuquerque GA, Belém JM, Cavalcante Nunes JF, Leite MF. Quirino GS. Planejamento reprodutivo em casais homossexuais na estratégia saúde da família. Rev APS. 2018 Jan;21(1):104-11. https://doi.org/10.34019/1809-8363.2018.v21.15639 https://doi.org/10.34019/1809-8363.2018....	Qualitative	Health professionals (Family Health Strategy nurses)	24–39, mean 30.3	Not shown	Brazil (Juazeiro do Norte, Ceará)	Not shown	Not shown
Andersen et al. ¹⁶16.Andersen AE, Moberg C, Bengtsson Tops A, Garmy P. Lesbian, gay and bisexual parents’ experiences of nurses’ attitudes in child health care-A qualitative study. J Clin Nurs. 2017 Dec;26(23-24):5065-71. https://doi.org/10.1111/jocn.14006 https://doi.org/10.1111/jocn.14006...	Qualitative	Lesbian, gay, or bisexual	33–49	Not shown	Sweden	Received no specific grant from any funding agency in the public, commercial or non-profit sectors	Declare that there is no conflict
Brennan and Sell ¹⁷17.Brennan R, Sell RL. The effect of language on lesbian nonbirth mothers. J Obstet Gynecol Neonatal Nurs. 2014;43(4):531-8. https://doi.org/10.1111/1552-6909.12471 https://doi.org/10.1111/1552-6909.12471...	Qualitative	Lesbians and queers	27–44, mean 34	19 (95%) identified themselves as white	USA	Declare that there are no relevant financial relationships	Declare that there is no conflict
Carvalho et al. ¹⁸18.Carvalho PG, Cabral CD, Ferguson L, Gruskin S, Diniz CS. ‘We are not infertile’: challenges and limitations faced by women in same-sex relationships when seeking conception services in São Paulo, Brazil. Cult Health Sex. 2019 Nov;21(11):1257-72. https://doi.org/10.1080/13691058.2018.1556343 https://doi.org/10.1080/13691058.2018.15...	Qualitative	Lesbians	27–43, mean 34	11 self-identified as white, 4 as mixed/brown, and 1 as black	Brazil (São Paulo and cities in the metropolitan region)	Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes)	Declare that there is no conflict
Chapman et al. ¹⁹19.Chapman R, Wardrop J, Freeman P, Zappia T, Watkins R, Shields L. A descriptive study of the experiences of lesbian, gay and transgender parents accessing health services for their children. J Clin Nurs. 2012a Apr;21(7-8):1128-35. https://doi.org/10.1111/j.1365-2702.2011.03939.x https://doi.org/10.1111/j.1365-2702.2011...	Qualitative	Lesbians, gay men, and transgenders	Not shown	Not shown	Australia	Nurses Memorial Trust of Western Australia and Channel 7 Telethon	Declare that there is no conflict
Chapman et al. ²⁰20.Chapman R, Wardrop J, Zappia T, Watkins R, Shields L. The experiences of Australian lesbian couples becoming parents: deciding, searching and birthing. J Clin Nurs. 2012b Jul;21(13-14):1878-85. https://doi.org/10.1111/j.1365-2702.2011.04007.x https://doi.org/10.1111/j.1365-2702.2011...	Qualitative	Lesbians	35–52	Not shown	Australia	Nurses Memorial Trust of Western Australia and Channel 7 Telethon	Declare that there is no conflict
Chapman et al. ²¹21.Chapman R, Watkins R, Zappia T, Combs S, Shields L. Second-level hospital health professionals’ attitudes to lesbian, gay, bisexual and transgender parents seeking health for their children. J Clin Nurs. 2012c Mar;21(5-6):880-7. https://doi.org/10.1111/j.1365-2702.2011.03938.x https://doi.org/10.1111/j.1365-2702.2011...	Cross-sectional	Healthcare professionals (nurses and doctors)	27–48, mean 31.1 (doctors)	Caucasians: nurses (88.2%); doctors (61.1%)	Australia	Nurses Memorial Trust of Western Australia and Channel 7 Telethon	Declare that there is no conflict
			23–64, mean 40 (nurses)	Yellow : nurses (7.4%); doctors (33.3%)
				Others: nurses (4.4%); doctors (5.6%)
Dahl and Malterud ²⁴24.Dahl B, Malterud K. Neither father nor biological mother. A qualitative study about lesbian co-mothers’ maternity care experiences. Sex Reprod Healthc. 2015 Oct;6(3):169-73. https://doi.org/10.1016/j.srhc.2015.02.002 https://doi.org/10.1016/j.srhc.2015.02.0...	Qualitative	Lesbians	30–52	Not shown	Norway	The Norwegian Women’s Public Health Association	Declare that there is no conflict
Dibley ²⁵25.Dibley L. Experiences of lesbian parents in the UK: interactions with midwives. Evid Based Midwifery. 2009 Jan;7:94-100.	Qualitative	Lesbians	Not shown	Not shown	UK	Not shown	Not shown
Engström et al. ²⁷27.Appelgren Engström H, Häggström-Nordin E, Borneskog C, Almqvist AL. Mothers in same-sex relationships-Striving for equal parenthood: a grounded theory study. J Clin Nurs. 2019 Oct;28(19-20):3700-9. https://doi.org/10.1111/jocn.14971 https://doi.org/10.1111/jocn.14971...	Qualitative	Lesbians	25–42, mean 34	Not shown	Sweden	Not shown	Declare that there is no conflict
Erlandsson et al. ²⁸28.Erlandsson K, Linder H, Häggström-Nordin E. Experiences of gay women during their partner’s pregnancy and childbirth. Br J Midwifery. 2010 Feb;18(2):99-103. https://doi.org/10.12968/bjom.2010.18.2.46407 https://doi.org/10.12968/bjom.2010.18.2....	Qualitative	Lesbians	26–48	Not shown	Sweden	Not shown	Not shown
Fantus ²⁹29.Fantus S. Experiences of gestational surrogacy for gay men in Canada. Cult Health Sex. 2021 Oct;23(10):1361-74. https://doi.org/10.1080/13691058.2020.1784464 https://doi.org/10.1080/13691058.2020.17...	Qualitative	Gays and gestational surrogates (surrogacy)	Mean 39 (gay parents)	Gay parents: white: n = 13 (87%); yellow: n = 2 (13%)	Canada	Not shown	They declared that there was no conflict
	Qualitative	Gays and gestational surrogates (surrogacy)	Mean 34 (gestational surrogates)	Gestational surrogates: white: n = 5 (83%); Aboriginal: n = 1 (17%)	Canada	Not shown	They declared that there was no conflict
Goldberg et al. ³⁰30.Goldberg L, Harbin A, Campbell S. Queering the birthing space: phenomenological interpretations of the relationships between lesbian couples and perinatal nurses in the context of birthing care. Sexualities. 2011 Apr;14(2):173-92. https://doi.org/10.1177/1363460711399028 https://doi.org/10.1177/1363460711399028...	Qualitative	Health professionals (perinatal nurses) and lesbians	30–40 (lesbian)	Not shown	Canada	Nova Scotia Health Research Foundation (NSHRF), in partnership with the Canadian Nurses Foundation Nursing Care Partnership Program	Not shown
	Qualitative	Health professionals (perinatal nurses) and lesbians	20–50 (nurses)	Not shown	Canada		Not shown
Hayman et al. ³³33.Hayman B, Wilkes L, Halcomb EJ, Jackson D. Marginalised mothers: lesbian women negotiating heteronormative healthcare services. Contemp Nurse. 2013 Apr;44(1):120-7. https://doi.org/10.5172/conu.2013.44.1.120 https://doi.org/10.5172/conu.2013.44.1.1...	Qualitative	Lesbians	28–58, mean 39.8	Not shown	Australia	Not shown	Not shown
Hayman et al. ³⁴34.Hayman B, Wilkes L, Halcomb E, Jackson D. Lesbian women choosing motherhood: the journey to conception. J GLBT Fam Stud. 2015 May;11(4):395-409. https://doi.org/10.1080/1550428X.2014.921801. https://doi.org/10.1080/1550428X.2014.92...	Qualitative	Lesbians	28–58, mean 39.8	Not shown	Australia	Not shown	Not shown
Hayman and Wilkes ³⁵35.Hayman B, Wilkes L. De novo families: lesbian motherhood. J Homosex. 2017;64(5):577-91. https://doi.org/10.1080/00918369.2016.1194119 https://doi.org/10.1080/00918369.2016.11...	Qualitative	Lesbians	28–58, mean 39.8	Participants identified their cultural background as Australian (n = 21); Anglo-Australian (n = 2); Scottish-Australian (n = 2); Lebanese-Australian (n = 1); Maori-African-American-Australian (n = 1); Italian (n = 1); Dutch (n = 1); and Filipino (n = 1)	Australia	Not shown	Not shown
Juntareal and Spatz ³⁷37.Juntereal NA, Spatz DL. Breastfeeding experiences of same-sex mothers. Birth. 2020 Mar;47(1):21-8. https://doi.org/10.1111/birt.12470 https://doi.org/10.1111/birt.12470...	Mixed	Lesbians	26–50, mean 34.5	White/Caucasian: n = 68 (100%).	USA	University of Pennsylvania, School of Nursing Student Grant	Declare that there is no conflict
				Black/African American: n = 2 (3%)
				Hispanic/Latino: n = 1 (1%).
				*Some interviewees selected more than one option
Kerppola et al. ³⁹39.Kerppola J, Halme N, Perälä ML, Maija-Pietilä A. Parental empowerment: lesbian, gay, bisexual, trans or queer parents’ perceptions of maternity and child healthcare. Int J Nurs Pract. 2019 Oct;25(5):e12755. https://doi.org/10.1111/ijn.12755 https://doi.org/10.1111/ijn.12755...	Qualitative	Lesbian, gay, bisexual, trans, or queer	Not shown	All participants were white and Finnish-speaking; some had an immigrant background	Finland	The authors did not receive financial support for the research	Declare no conflict
	Qualitative	Lesbian, gay, bisexual, trans, or queer	Inclusion criteria: parents at least 18 years of age		Finland		Declare no conflict
Klittmark et al. ⁴¹41.Klittmark S, Garzón M, Andersson E, Wells MB. LGBTQ competence wanted: LGBTQ parents’ experiences of reproductive health care in Sweden. Scand J Caring Sci. 2019 Jun;33(2):417-26. https://doi.org/10.1111/scs.12639 https://doi.org/10.1111/scs.12639...	Qualitative cross-sectional	Lesbian, gay, bisexual, trans, non-binary, and queer.	30–45	Whites	Sweden	Stiftelsen Einar Belven	Not shown
Larsson and Dykes ⁴²42.Larsson AK, Dykes AK. Care during pregnancy and childbirth in Sweden: perspectives of lesbian women. Midwifery. 2009 Dec;25(6):682-90. https://doi.org/10.1016/j.midw.2007.10.004 https://doi.org/10.1016/j.midw.2007.10.0...	Qualitative	Lesbians	Not shown	Not shown	Sweden	Not shown	Not shown
Lee et al. ⁴⁴44.Lee E, Taylor J, Raitt F. ‘It’s not me, it’s them’: How lesbian women make sense of negative experiences of maternity care: a hermeneutic study. J Adv Nurs. 2011 May;67(5):982-90. https://doi.org/10.1111/j.1365-2648.2010.05548.x https://doi.org/10.1111/j.1365-2648.2010...	Qualitative	Lesbians	Not shown	Not shown	Scotland	Has not received a grant from any funding agency in the public, commercial or non-profit sectors	Declare that there is no conflict
Malmquist and Nelson ⁴⁶46.Malmquist A, Nelson KZ. Efforts to maintain a “just great” story: lesbian parents’ talk about encounters with professionals in fertility clinics and maternal and child healthcare services. Fem Psychol. 2014 May;24(1):56-73. https://doi.org/10.1177/0959353513487532 https://doi.org/10.1177/0959353513487532...	Qualitative	Lesbians	Mean 36	Not shown	Sweden	Not shown	Not shown
McNair et al. ⁴⁸48.McNair R, Brown R, Perlesz A, Lindsay J, De Vaus D, Pitts M. Lesbian parents negotiating the health care system in Australia. Health Care Women Int. 2008 Feb;29(2):91-114. https://doi.org/10.1080/07399330701827094 https://doi.org/10.1080/0739933070182709...	Qualitative	Lesbians	29–62 (mothers)	Families of Anglo-Australian origins (n = 11); with Australian Aboriginal origins (n = 2); that contained members from southern Europe (n = 2); with northern European origins (n = 3); with Eastern European origins (n = 3); of Asian origin (n = 2); of Latin origin (n = 1)	Australia	Australian Research Council and Victorian Association of Family Therapists	Not shown
	Qualitative	Lesbians	4–34 (children)		Australia		Not shown
Mikhailovich et al. ⁴⁹49.Mikhailovich K, Martin S, Lawton S. Lesbian and gay parents: their experiences of children’s health care in Australia. Int J Sex Gend Stud. 2001;6(3):181-91. https://doi.org/10.1023/A:1011586417276 https://doi.org/10.1023/A:1011586417276...	Cross-sectional	Lesbians and gay men	Mean 38	Not shown	Australia	University of Canberra	Declare that there is no conflict
Nicol et al. ⁵⁰50.Nicol P, Chapman R, Watkins R, Young J, Shields L. Tertiary paediatric hospital health professionals’ attitudes to lesbian, gay, bisexual and transgender parents seeking health care for their children. J Clin Nurs. 2013 Dec;22(23-24):3396-405. https://doi.org/10.1111/jocn.12372 https://doi.org/10.1111/jocn.12372...	Cross-sectional	Health professionals in a pediatric tertiary hospital (nurses; doctors; other professions and employees)	Similar mean ages for nurses (37.1), physicians (35.9), and other healthcare professionals and other staff (37.4)	Caucasian: n = 178 (88.1%)	Australia	Nurses Memorial Trust of Western Australia	Declare that there is no conflict
	Cross-sectional			Others: n = 24 (11.9%)	Australia	Nurses Memorial Trust of Western Australia	Declare that there is no conflict
Nimbi et al. ⁵¹51.Nimbi FM, Viozzi E, Tripodi F, Simonelli C, Baiocco R. Could educational programs in sexology have an influence on attitudes towards same-sex marriage and parenting? Sexologies. 2020;29(3):e77-83. https://doi.org/10.1016/j.sexol.2020.01.001 https://doi.org/10.1016/j.sexol.2020.01....	Quantitative	Health professionals	Mean 34.54 (Sexology Educational Programs Group);	Not shown	Italy	Not shown	Declare that there is no conflict
	Quantitative	Health professionals	Mean 30 (Group without Educational Programs in Sexology)	Not shown	Italy	Not shown	Declare that there is no conflict
O’Neill et al. ⁵³53.O’Neill KR, Hame HP, Dixon R. Perspectives from Lesbian women: their experiences with healthcare professionals when transitioning to planned parenthood. Divers Equal Health Care. 2013 Dec;10(4):213-22.	Qualitative	Lesbians	Mid 30s–mid 40s	All women identified as being of European descent	New Zealand	Te Pou, New Zealand National Mental Health Research Center	Declare that there is no conflict
Obem ⁵⁴54.Obem MK. A (in)visibilidade de famílias homoafetivas durante atendimentos nos serviços de saúde. Rio Grande do Sul [dissertation]. Santa Maria: Universidade Federal de Santa Maria; 2018.	Qualitative (master’s thesis)	Lesbians and gay men	23–54	Not shown	Brazil (Rio Grande do Sul)	Capes	Not shown
Perrin and Kulkin ⁵⁵55.Perrin EC, Kulkin H. Pediatric care for children whose parents are gay or lesbian. Pediatrics. 1996 May;97(5):629-35. https://doi.org/10.1542/peds.97.5.629 https://doi.org/10.1542/peds.97.5.629...	Qualitative	Lesbians and gay men	Not shown	White: n = 435 (94%)	USA	Joseph P. Healey Endowment Grant Award, 1993 to 1995	Not shown
				Hispanic: n = 11 (2%)
				Black: n = 6 (1%)
				Other/unknown: n = 15 (3%)
Renaud ⁵⁶56.Renaud MT. We are mothers too: childbearing experiences of lesbian families. J Obstet Gynecol Neonatal Nurs. 2007;36(2):190-9. https://doi.org/10.1111/j.1552-6909.2007.00136.x https://doi.org/10.1111/j.1552-6909.2007...	Qualitative and critical ethnography	Lesbians	20–40	Of the interviewees, Caucasian (n = 18), Hispanic (n = 2); and “woman of color,” as identified in the research (n = 1)	USA	Not shown	Not shown
				Support group participants: included “women of color”
				Focus group: all were Caucasian
Rondahl et al. ⁵⁷57.Röndahl G, Bruhner E, Lindhe J. Heteronormative communication with lesbian families in antenatal care, childbirth and postnatal care. J Adv Nurs. 2009 Nov;65(11):2337-44. https://doi.org/10.1111/j.1365-2648.2009.05092.x https://doi.org/10.1111/j.1365-2648.2009...	Qualitative	Lesbians	30–46	Not shown	Sweden	Uppsala University Hospital and Linkoping University, ISV/HAV	Declare that there is no conflict
Ross et al. ⁵⁸58.Ross LE, Steele LS, Epstein R. Lesbian and bisexual women’s recommendations for improving the provision of assisted reproductive technology services. Fertil Steril. 2006 Sep;86(3):735-8. https://doi.org/10.1016/j.fertnstert.2006.01.049 https://doi.org/10.1016/j.fertnstert.200...	Qualitative	Lesbians or bisexuals	Not shown	Not shown	Canada	Lesbian and Gay Community Appeal Foundation of Toronto. Lori E. Ross is supported by a Career Scientist Award from the Ontario Ministry of Health and Long-Term Care and the Ontario Women’s Health Council. Leah Steele is supported as an academic researcher by the Department of Family Medicine, St. Michael’s Hospital, University of Toronto and the Health Systems Research and Consultancy Unit at the Center for Addiction and Mental Health, Toronto, Ontario, Canada; and, as a career scientist, by the Ontario Ministry of Health and Long-Term Care	Not shown
Rozental and Malmquist ⁵⁹59.Rozental A, Malmquist A. Vulnerability and acceptance: lesbian women’s family-making through assisted reproduction in Swedish Public Health Care. J GLBT Fam Stud. 2015 Mar;11(2):127-50. https://doi.org/10.1080/1550428X.2014.891088 https://doi.org/10.1080/1550428X.2014.89...	Qualitative	Lesbians	26–45	Not shown	Sweden	Swedish Council for Working Life and Social Research	Not shown
Silva ⁶¹61.Silva DA. Enfim mães! Da experiência da reprodução assistida à experiência da maternidade lésbica [dissertation]. Rio de Janeiro: Universidade do Estado do Rio de Janeiro; 2013.	Qualitative (master’s thesis)	Healthcare professionals and Lesbians	26–46 (lesbians)	Not shown	Brazil (states of Rio de Janeiro and São Paulo)	Not shown	Not shown
	Qualitative (master’s thesis)	Healthcare professionals and Lesbians	29–60 (health professionals)	Not shown	Brazil (states of Rio de Janeiro and São Paulo)	Not shown	Not shown
Spidsberg ⁶⁴64.Spidsberg BD. Vulnerable and Strong: lesbian women encountering maternity care. J Adv Nurs. 2007 Dec;60(5):478-86. https://doi.org/10.1111/j.1365-2648.2007.04439.x https://doi.org/10.1111/j.1365-2648.2007...	Qualitative hermeneutic phenomenological	Lesbians	Not shown	Not shown	Norway	Not shown	Not shown
Spidsberg and Sørlie ⁶⁵65.Spidsberg BD, Sørlie V. An expression of love: midwives’ experiences in the encounter with lesbian women and their partners. J Adv Nurs. 2012 Apr;68(4):796-805. https://doi.org/10.1111/j.1365-2648.2011.05780.x https://doi.org/10.1111/j.1365-2648.2011...	Qualitative	Health professionals (midwives)	30–59, mean 50	Not shown	Norway	The Norwegian Women’s Public Health Association	Declare that there is no conflict
Stewart ⁶⁶66.Stewart M. Lesbian parents talk about their birth experiences. Br J Midwifery. 1999 Feb;7(2):96-101. https://doi.org/10.12968/bjom.1999.7.2.8377 https://doi.org/10.12968/bjom.1999.7.2.8...	Qualitative	Lesbians	Not shown	White (100%)	UK	Not shown	Not shown
Doussa et al. ⁶⁷67.Doussa H, Power J, McNair R, Brown R, Schofield M, Perlesz A, et al. Building healthcare workers’ confidence to work with same-sex parented families. Health Promot Int. 2016 Jun;31(2):459-69. https://doi.org/10.1093/heapro/dav010 https://doi.org/10.1093/heapro/dav010...	Qualitative	Lesbians and gay men; health and wellness service providers	Not shown	Not shown	Australia	Australian Research Council Linkage Grant, with financial support from the Victorian Health Promotion Foundation (VicHealth), Relationships Australia (National and Victoria), ACON (formerly the AIDS Council of NSW), and in-kind support from Gay and Lesbian Health Victoria and the Queensland Association for Healthy Communities	Declared that there was no conflict
Wilton and Kaufmann ⁷¹71.Wilton T, Kaufmann T. Lesbian mothers’ experiences of maternity care in the UK. Midwifery. 2001 Sep;17(3):203-11. https://doi.org/10.1054/midw.2001.0261 https://doi.org/10.1054/midw.2001.0261...	Mixed	Lesbians	All except one were over 30 years old	White: n = 45 (100%)	UK	Not shown	Not shown
Wojnar and Katzenmeyer ⁷²72.Wojnar DM, Katzenmeyer A. Experiences of preconception, pregnancy, and new motherhood for lesbian nonbiological mothers. J Obstet Gynecol Neonatal Nurs. 2014;43(1):50-60. https://doi.org/10.1111/1552-6909.12270 https://doi.org/10.1111/1552-6909.12270...	Qualitative phenomenological descriptive	Lesbians	28–48, mean 37.2	White (n = 20), African American (n = 2), mixed ethnicity (n = 2)	Various communities in the Pacific Northwest	No relevant financing relationship	Declare that there is no conflict

Author	Type of review	Design of primary studies	Study population	Financing	Conflict of interest
Chapman et al. ²²22.Chapman R, Zappia T, Shields L. An essay about health professionals’ attitudes to lesbian, gay, bisexual and transgender parents seeking healthcare for their children. Scand J Caring Sci. 2012 d Jun;26(2):333-9. https://doi.org/10.1111/j.1471-6712.2011.00938.x https://doi.org/10.1111/j.1471-6712.2011...	Descriptive essay	Not shown	Health professionals	Nurses Memorial Trust of Western Australia; Channel 7 Telethon	Not shown
Dahl et al. ²³23.Dahl B, Fylkesnes AM, Sørlie V, Malterud K. Lesbian women’s experiences with healthcare providers in the birthing context: a meta-ethnography. Midwifery. 2013 Jun;29(6):674-81. https://doi.org/10.1016/j.midw.2012.06.008 https://doi.org/10.1016/j.midw.2012.06.0...	Metaethnography	13 empirical qualitative studies	Lesbian women	The Norwegian Women’s Public Health Association	Declare that there is no conflict
Eliason ²⁶26.Eliason MJ. Lesbian and gay family issues. J Fam Nurs. 1996 Feb;2(1):10-29. https://doi.org/10.1177/107484079600200102 https://doi.org/10.1177/1074840796002001...	Narrative review	Not shown	Lesbian and gay families; family nurses	Not shown	Not shown
Gregg ³¹31.Gregg I. The health care experiences of lesbian women becoming mothers. Nurs Womens Health. 2018 Feb;22(1):40-50. https://doi.org/10.1016/j.nwh.2017.12.003 https://doi.org/10.1016/j.nwh.2017.12.00...	Review	10 qualitative studies	Lesbian women and healthcare professionals	There were no relevant financial relationships	Declare that there is no conflict
Hammond ³²32.Hammond C. Exploring same sex couples’ experiences of maternity care. Br J Midwifery. 2014;22(7):495-500. https://doi.org/10.12968/bjom.2014.22.7.495 https://doi.org/10.12968/bjom.2014.22.7....	Literature review	13 studies (does not provide design)	Lesbian mothers	Not shown	Not shown
Imaz ³⁶36.Imaz E. Same-sex parenting, assisted reproduction and gender asymmetry: reflecting on the differential effects of legislation on gay and lesbian family formation in Spain. Reprod Biomed Soc Online. 2017 Feb;4:5-12. https://doi.org/10.1016/j.rbms.2017.01.002 https://doi.org/10.1016/j.rbms.2017.01.0...	Essay with an anthropological approach	Assisted Human Reproduction Act	Gay and lesbian same-sex couples and families	Not shown	Reports no conflicts of financial or commercial interest
Kelsall-Knight ³⁸38.Kelsall-Knight L. Experiences of LGBT parents when accessing healthcare for their children: a literature review. Nurs Child Young People. 2021 May;33(3):17-24. https://doi.org/10.7748/ncyp.2021.e1346 https://doi.org/10.7748/ncyp.2021.e1346...	Literature review	Qualitative studies (n = 7); mixed methods (n = 1); quantitative studies, with a qualitative aspect (n = 2)	LGBT parents	Not shown	Declare that there is no conflict
Klein et al. ⁴⁰40.Klein DA, Malcolm NM, Berry-Bibee EN, Paradise SL, Coulter JS, Keglovitz Baker K, et al. Quality primary care and family planning services for LGBT clients: a comprehensive review of clinical guidelines. LGBT Health. 2018 Apr;5(3):153-70. https://doi.org/10.1089/lgbt.2017.0213 https://doi.org/10.1089/lgbt.2017.0213...	Review of clinical guidelines	17 clinical guidelines	LGBT	US Office of Population Affairs and Atlas Research	One of the researchers reports being on the advisory boards of Gilead Sciences, Inc. and Merck
Lee ⁴³43.Lee E. Lesbian users of maternity services: appropriate care. Br J Midwifery. 2004 Jun;12(6):353-8. https://doi.org/10.12968/bjom.2004.12.6.13132 https://doi.org/10.12968/bjom.2004.12.6....	Literature review	Not shown	lesbian mothers	Not shown	Not shown
Lucio and Araújo ⁴⁵45.Lucio FPS, Araújo EC. A maternidade de mães lésbicas na perspectiva da enfermagem: revisão integrativa. Rev Eletrônica Enferm. 2017;19:1-11. https://doi.org/10.5216/ree.v19.40304 https://doi.org/10.5216/ree.v19.40304...	Integrative review	5 descriptive studies with a qualitative approach	Lesbian women	Not shown	Not shown
McManus et al. ⁴⁷47.McManus AJ, Hunter LP, Renn H. Lesbian experiences and needs during childbirth: guidance for health care providers. J Obstet Gynecol Neonatal Nurs. 2006;35(1):13-23. https://doi.org/10.1111/j.1552-6909.2006.00008.x https://doi.org/10.1111/j.1552-6909.2006...	Literature review	15 articles (do not inform design)	Lesbian couples	Not shown	Not shown
Norton et al. ⁵²52.Norton W, Hudson N, Culley L. Gay men seeking surrogacy to achieve parenthood. Reprod Biomed Online. 2013 Sep;27(3):271-9. https://doi.org/10.1016/j.rbmo.2013.03.016 https://doi.org/10.1016/j.rbmo.2013.03.0...	Documentary narrative review	Documents	Gay men who want to be fathers	Not shown	Declare that there is no conflict
Shields et al. ⁶⁰60.Shields L, Zappia T, Blackwood D, Watkins R, Wardrop J, Chapman R. Lesbian, gay, bisexual, and transgender parents seeking health care for their children: a systematic review of the literature. Worldviews Evid Based Nurs. 2012 Dec;9(4):200-9. https://doi.org/10.1111/j.1741-6787.2012.00251.x https://doi.org/10.1111/j.1741-6787.2012...	Systematic review	4 studies (2 quantitative studies with open questions for qualitative analysis and 2 qualitative studies that used semi-structured interviews)	LGBT parents	Nurses Memorial Trust and Channel 7 Telethon	Not shown
Silva et al. ⁶²62.Silva JL, Costa MJ, Távora RC, Valença CN. Planejamento para famílias homoafetivas: releitura da saúde pública brasileira. Rev Bioet. 2019;27(2):276-80. https://doi.org/10.1590/1983-80422019272310 https://doi.org/10.1590/1983-80422019272...	Narrative review	Not shown	Same-sex couples	Not shown	Declare that there is no conflict
Singer ⁶³63.Singer RB. Improving prenatal care for pregnant lesbians. The Free Library. 2012 Oct [cited 2023 Jan 6]. Available from: https://www.thefreelibrary.com/Improvingprenatalcareforpregnantlesbians.-a0334177975 https://www.thefreelibrary.com/Improving...	Narrative review	Not shown	Pregnant lesbians	Not shown	Not shown
Weber ⁶⁸68.Weber S. Parenting, family life, and well-being among sexual minorities: nursing policy and practice implications. Issues Ment Health Nurs. 2008 Jun;29(6):601-18. https://doi.org/10.1080/01612840802048824 https://doi.org/10.1080/0161284080204882...	Narrative review	Not shown	Lesbian and gay parents	Not shown	Not shown
Wells and Lang ⁶⁹69.Wells MB, Lang SN. Supporting same-sex mothers in the Nordic child health field: a systematic literature review and meta-synthesis of the most gender equal countries. J Clin Nurs. 2016 Dec;25(23-24):3469-83. https://doi.org/10.1111/jocn.13340 https://doi.org/10.1111/jocn.13340...	Systematic literature review and metasynthesis	Qualitative interviews (n = 8); qualitative interviews with focus groups (n = 1); cross-sectional (n = 1)	Same-sex mothers; same-sex co-mothers; and midwives	Not shown	Declare that there is no conflict
Werner and Westerståhl ⁷⁰70.Werner C, Westerståhl A. Donor insemination and parenting: concerns and strategies of lesbian couples: a review of international studies. Acta Obstet Gynecol Scand. 2008;87(7):697-701. https://doi.org/10.1080/00016340802011603 https://doi.org/10.1080/0001634080201160...	Review	Reviews (n = 5); interviews (n = 17); others (n = 2)	Lesbian couples	FoU (Research and Development) Södra Älvsborg	Declare that there is no conflict

Theme	Subthemes
Heteronormative context of health services ^{15–18,21,24,26,29,30,32,34,39–43,48,51,54,56,57,59,65–68,72}	Compromised standard of healthcare of homosexual couples due to the hegemony of heterosexuality
	Inadequate forms and information systems for same-sex couples
	Discrimination against non-biological mothers or fathers
	Controversies about the fact that lesbians are mothers
	Not reducing parenting to blood ties
Disclosure of sexual orientation ^{19,21–25,31,34,38,41,43,47–50,51,52,60,64,65,69,71}	Couples’ positions on non-disclosure because they do not consider it important
	Negative experiences of couples due to disclosure
	Defense of disclosure by couples because it can bring specific attention and demarcate a status to be recognized
	Medical professionals are less likely than nursing professionals to consider that there should be disclosure
Fertilization ¹⁸18.Carvalho PG, Cabral CD, Ferguson L, Gruskin S, Diniz CS. ‘We are not infertile’: challenges and limitations faced by women in same-sex relationships when seeking conception services in São Paulo, Brazil. Cult Health Sex. 2019 Nov;21(11):1257-72. https://doi.org/10.1080/13691058.2018.1556343 https://doi.org/10.1080/13691058.2018.15... ^, ²⁰20.Chapman R, Wardrop J, Zappia T, Watkins R, Shields L. The experiences of Australian lesbian couples becoming parents: deciding, searching and birthing. J Clin Nurs. 2012b Jul;21(13-14):1878-85. https://doi.org/10.1111/j.1365-2702.2011.04007.x https://doi.org/10.1111/j.1365-2702.2011... ^, ²⁵25.Dibley L. Experiences of lesbian parents in the UK: interactions with midwives. Evid Based Midwifery. 2009 Jan;7:94-100. ^, ²⁹29.Fantus S. Experiences of gestational surrogacy for gay men in Canada. Cult Health Sex. 2021 Oct;23(10):1361-74. https://doi.org/10.1080/13691058.2020.1784464 https://doi.org/10.1080/13691058.2020.17... ^, ³⁴34.Hayman B, Wilkes L, Halcomb E, Jackson D. Lesbian women choosing motherhood: the journey to conception. J GLBT Fam Stud. 2015 May;11(4):395-409. https://doi.org/10.1080/1550428X.2014.921801. https://doi.org/10.1080/1550428X.2014.92... ^, ³⁵35.Hayman B, Wilkes L. De novo families: lesbian motherhood. J Homosex. 2017;64(5):577-91. https://doi.org/10.1080/00918369.2016.1194119 https://doi.org/10.1080/00918369.2016.11... ^, ³⁶36.Imaz E. Same-sex parenting, assisted reproduction and gender asymmetry: reflecting on the differential effects of legislation on gay and lesbian family formation in Spain. Reprod Biomed Soc Online. 2017 Feb;4:5-12. https://doi.org/10.1016/j.rbms.2017.01.002 https://doi.org/10.1016/j.rbms.2017.01.0... ^, ⁴⁵45.Lucio FPS, Araújo EC. A maternidade de mães lésbicas na perspectiva da enfermagem: revisão integrativa. Rev Eletrônica Enferm. 2017;19:1-11. https://doi.org/10.5216/ree.v19.40304 https://doi.org/10.5216/ree.v19.40304... ^, ⁴⁷47.McManus AJ, Hunter LP, Renn H. Lesbian experiences and needs during childbirth: guidance for health care providers. J Obstet Gynecol Neonatal Nurs. 2006;35(1):13-23. https://doi.org/10.1111/j.1552-6909.2006.00008.x https://doi.org/10.1111/j.1552-6909.2006... ^, ⁵²52.Norton W, Hudson N, Culley L. Gay men seeking surrogacy to achieve parenthood. Reprod Biomed Online. 2013 Sep;27(3):271-9. https://doi.org/10.1016/j.rbmo.2013.03.016 https://doi.org/10.1016/j.rbmo.2013.03.0... ^, ⁵⁶56.Renaud MT. We are mothers too: childbearing experiences of lesbian families. J Obstet Gynecol Neonatal Nurs. 2007;36(2):190-9. https://doi.org/10.1111/j.1552-6909.2007.00136.x https://doi.org/10.1111/j.1552-6909.2007... ^, ⁵⁸58.Ross LE, Steele LS, Epstein R. Lesbian and bisexual women’s recommendations for improving the provision of assisted reproductive technology services. Fertil Steril. 2006 Sep;86(3):735-8. https://doi.org/10.1016/j.fertnstert.2006.01.049 https://doi.org/10.1016/j.fertnstert.200... ^, ⁵⁹59.Rozental A, Malmquist A. Vulnerability and acceptance: lesbian women’s family-making through assisted reproduction in Swedish Public Health Care. J GLBT Fam Stud. 2015 Mar;11(2):127-50. https://doi.org/10.1080/1550428X.2014.891088 https://doi.org/10.1080/1550428X.2014.89... ^, ⁶²62.Silva JL, Costa MJ, Távora RC, Valença CN. Planejamento para famílias homoafetivas: releitura da saúde pública brasileira. Rev Bioet. 2019;27(2):276-80. https://doi.org/10.1590/1983-80422019272310 https://doi.org/10.1590/1983-80422019272... ^, ⁷⁰70.Werner C, Westerståhl A. Donor insemination and parenting: concerns and strategies of lesbian couples: a review of international studies. Acta Obstet Gynecol Scand. 2008;87(7):697-701. https://doi.org/10.1080/00016340802011603 https://doi.org/10.1080/0001634080201160...	Legal aspects
	Difficulty of access for homosexual couples
	Methods
	Male peers are more disadvantaged than female peers
	The legality of surrogacy varies in different countries
	Protocols on assisted reproduction do not cater for same-sex couples
	Regulation of in vitro fertilization makes access difficult for lesbians
	Priority for donor insemination techniques
	Prohibition of gay men donating sperm
	Future legal problems with the donor
	Measures for fertility services for homosexual couples
Perceptions of homosexuals and professionals about care provided and health services in general ^{16–19,22,24,25,27,28,30,31–34,37,38,41,44,46,49,50,53–55,59,61,63,64,66–69,71,72}	Satisfactory care
	Unsatisfactory care
	Negative interactions
	Absence of emotional support
	Non-acceptance of non-biological mothers
	Homophobic comments
	Constraints and discrimination
	Lack of benefits for families headed by one or two homosexual adults
	Exclusive approach to the biological father
	Service denied
	Excessive curiosity of professionals
	Symbolic violence
	Service habits disturbed by the presence of homosexual couples
	Inappropriate language directed at homosexuals
	The need for an environment to protect oneself from homophobia
	Misunderstanding by professionals
	Professionals not prepared to care for homosexual couples
Information and educational actions ²⁷27.Appelgren Engström H, Häggström-Nordin E, Borneskog C, Almqvist AL. Mothers in same-sex relationships-Striving for equal parenthood: a grounded theory study. J Clin Nurs. 2019 Oct;28(19-20):3700-9. https://doi.org/10.1111/jocn.14971 https://doi.org/10.1111/jocn.14971... ^, ³²32.Hammond C. Exploring same sex couples’ experiences of maternity care. Br J Midwifery. 2014;22(7):495-500. https://doi.org/10.12968/bjom.2014.22.7.495 https://doi.org/10.12968/bjom.2014.22.7.... ^, ³⁹39.Kerppola J, Halme N, Perälä ML, Maija-Pietilä A. Parental empowerment: lesbian, gay, bisexual, trans or queer parents’ perceptions of maternity and child healthcare. Int J Nurs Pract. 2019 Oct;25(5):e12755. https://doi.org/10.1111/ijn.12755 https://doi.org/10.1111/ijn.12755... ^, ⁴¹41.Klittmark S, Garzón M, Andersson E, Wells MB. LGBTQ competence wanted: LGBTQ parents’ experiences of reproductive health care in Sweden. Scand J Caring Sci. 2019 Jun;33(2):417-26. https://doi.org/10.1111/scs.12639 https://doi.org/10.1111/scs.12639... ^, ⁵¹51.Nimbi FM, Viozzi E, Tripodi F, Simonelli C, Baiocco R. Could educational programs in sexology have an influence on attitudes towards same-sex marriage and parenting? Sexologies. 2020;29(3):e77-83. https://doi.org/10.1016/j.sexol.2020.01.001 https://doi.org/10.1016/j.sexol.2020.01.... ^, ⁷¹71.Wilton T, Kaufmann T. Lesbian mothers’ experiences of maternity care in the UK. Midwifery. 2001 Sep;17(3):203-11. https://doi.org/10.1054/midw.2001.0261 https://doi.org/10.1054/midw.2001.0261...	Positive score for sex education programs
	Insufficient information on induced lactation for non-biological mothers
	Information exclusively heterosexual in nature
	Registration denied in educational group

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[1] Correspondence: Romeu Gomes Fundação Oswaldo Cruz Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira Av. Rui Barbosa, 716 22250-020 Rio de Janeiro, RJ, Brazil E-mail: romeugo@gmail.com