We, Too, Have Children: Inclusive Pediatric Care for Black LGBTQIA+ Families

Black pediatric patients in the United States experience disproportionate harm from systemic racism in health care. Black LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender Queer, Intersex, Asexual, with the "+" representing additional sexual orientations and gender identities) parents and caregivers, as primary navigators of care for their children, may also encounter homophobia, transphobia, and heteronormative bias. These intersecting biases can shape clinical interactions and influence pediatric care quality yet remain underexamined in health equity research. This study assessed how the intersecting identities of Black LGBTQIA+ caregivers influence their interactions with pediatric clinicians and affect the health care their children receive.

This qualitative study recruited 14 Black LGBTQIA+ parents or caregivers of pediatric patients from 10 families through purposive and snowball sampling. Semistructured interviews were conducted via videoconference in 2023. Data analysis was conducted using a 3-round inductive and deductive thematic coding process to identify barriers to inclusive care and caregiver-informed strategies to advance equity in pediatric settings.

Six themes were identified. Three themes reflect the unique experiences of Black LGBTQIA+ caregivers in pediatric medicine: (1) lack of awareness or experience with same-sex families, (2) proactive caregiver advocacy, and (3) caregiver-perceived impact of clinician representation. The remaining 3 themes offered actionable recommendations for pediatric clinicians: (4) expansion of clinician understanding of caregiver roles, (5) adaptive communication practices, and (6) inclusive caregiver support.

The intersecting identities of Black LGBTQIA+ caregivers shape pediatric care through systemic barriers and opportunities for better clinician engagement. Inclusive, culturally responsive practices that strengthen family relationships, foster open communication, and recognize all caregivers' roles can build trust, improve outcomes, and advance equity in pediatric care.