Respect Equality

LGBTQ+ Americans face greater health care barriers in rural areas, study finds

“There are a lot of differences between urban and rural populations for a general population, so it stands to reason that there would be a lot of differences between urban and rural LGBTQ individuals,” the study’s lead author said.
A field of corn grows near Ashland, Neb., Tuesday, July 24, 2018. (AP Photo/Nati Harnik)

Story at a glance


  • LGBTQ+ Americans living in rural communities face greater barriers to accessing health care than LGBTQ+ people in urban areas, new research has found.

  • Many physicians in rural communities may be unfamiliar with LGBTQ+ issues and identities and may be unequipped to address unique LGBTQ+ health care concerns. LGBTQ+ patients in rural areas are also more likely to face discrimination based on their sexual orientation or gender identity.

  • Obtaining adequate health care in rural America is not an issue exclusive to the LGBTQ+ community, and individuals living in rural communities are at greater risk for poor health outcomes, the CDC has said.

LGBTQ+ Americans in rural areas face greater barriers to accessing adequate health care, new research has found.

In a study published earlier this year in the Journal of Gay and Lesbian Social Services, researchers and physicians practicing in the Appalachian regions of Pennsylvania, Virginia and West Virginia said LGBTQ+ patients outside of urban centers are more likely to struggle to find medical professionals that are familiar with LGBTQ+ issues or identities, a potential detriment to the health of sexual and gender minorities.

Patients in rural areas are also more likely to face stigma around their sexual orientation or gender identity, according to the study, and many practicing physicians in rural communities are likely to have a worldview that is rooted in “heteronormativity,” or a belief that heterosexuality is the normal or preferred sexual orientation.

Doctors in rural America are also largely unequipped to address unique health challenges faced by members of the LGBTQ+ community, like disproportionate rates of depression and anxiety.


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“Research into sexual and gender minorities is growing quickly, but mainly in large urban centers,” the study’s lead author, Zachary Ramsey of the University of West Virginia, said in a news release.

“There are a lot of differences between urban and rural populations for a general population, so it stands to reason that there would be a lot of differences between urban and rural LGBTQ individuals,” Ramsey said. “Without more studies of LGBTQ rural individuals specifically, these differences will not be known, and policies and rural LGBTQ Center programming can only use an urban population for guidance.”

Ramsey’s findings are consistent with those of similar studies. Research published earlier this month in the journal JAMA Surgery found that most transgender adults seeking gender-affirming surgical care leave their home state to get it — even if it means paying additional out-of-pocket medical expenses. 

Researchers in that study said one driving force could be a lack of health care professionals in places like the South and Midwest — two largely rural regions that are becoming increasingly hostile places for gender-affirming physicians to practice.

A 2020 study found that only 20 states had at least one surgeon capable of providing gender-affirming genital surgery to transgender adults, and most practices were located in the Northeast or the West.

According to the Census Bureau, more than 46 million Americans, or roughly 15 percent of the U.S. population, live in rural communities. Individuals living in rural areas are at greater risk for poor health outcomes, the Centers for Disease Control and Prevention has said, in part because they often have to travel long distances to receive specialty or emergency care.

Overall, just 11 percent of physicians practice in rural communities, according to the Association of American Medical Colleges. Of the more than 7,200 federally designated health professional shortage areas, roughly 60 percent are in rural areas.

“Bringing more providers into rural areas would be a great benefit,” Ramsey said, “not only to the individuals who have to drive a few hours to see an endocrinologist for hormones, but to the general population that can sometimes struggle to find appropriate services.”