By Giana Simonelli, Licensed Associate Counselor
Wholehearted Healing Collective
When Invalidation Becomes Internalized
Sam is a 32-year-old cisgender woman in a same-gender marriage who identifies as the non-gestational parent in her family building process. Sam describes feeling invisible during prenatal appointments and excluded from decision-making processes, leading her to question her own validity as the second parent to her child.
“I’m not really the ‘parent’ anyway. That’s how the doctors at the OB treat me. I’m not biologically involved, so I’m just the ‘support person’”.
These experiences reflect structural and interpersonal invalidation within reproductive healthcare settings and appear to have contributed to internalized beliefs regarding Sam’s legitimacy as a parent. Sam’s story is just one example.
Having your sperm donor referred to as the “real dad”, being asked “who’s mom and who’s dad?” as a gay couple, lack of resources and clear medical guidance as a transgender man wanting to be the gestational carrier, the list goes on. These instances in isolation may sound small from the outside looking in, but they have a big impact on the mental health of LGBTQ+ people.
Why This Conversation Matters
LGBTQ+ individuals and couples face substantial barriers in accessing inclusive and comprehensive reproductive care, shaped by heteronormative policies, systemic inequities, and cisnormativity. Discriminatory experiences for LGBTQ+ people encountered during fertility-related care have been associated with elevated rates of:
- Depression
- Anxiety
- Suicidality
- Psychological distress
It should not be the norm to feel invisible and invalidated in the medical space, especially when it relates to family building and fertility-related care.
Reproductive Care x Mental Health Care
The intersection of reproductive healthcare inequities and mental health distress among LGBTQ+ populations remains under-examined within counseling and mental health literature. LGBTQ+ people encounter both shared and unique challenges when pursuing reproductive healthcare, including decision fatigue, grief following failed fertility cycles, legal concerns, identity and belonging, and minority stress.
In this context, fertility-related care refers to the medical, psychological, and institutional processes involved in family building, including conception, pregnancy, and assisted reproductive technologies such as In vitro Fertilization (IVF).
These stressors frequently intersect with mental health concerns that present within counseling settings, underscoring the relevance of reproductive inequities to counselor assessment, intervention, and advocacy.
Structural Barriers LGBTQ+ Families Face
According to the most recent policy map, 32 states do not require private insurers to provide fertility coverage, and approximately 53% of LGBTQ+ adults reside in states without mandated fertility coverage. Only six states require private insurers to provide fertility coverage with explicitly LGBTQ+-inclusive language.
Exclusionary practices within healthcare settings further contribute to negative reproductive care experiences for the LGBTQ+ population. These practices include:
- Misgendering patients, intentionally or unintentionally
- Use of birth-assigned names (also known as dead names)
- Reliance on cis-normative and heteronormative knowledge
- Non-inclusive intake forms and documentation
These practices have been associated with reluctance to engage in reproductive care and avoidance of services, contributing to delays in access to treatment.
What Healing Can Look Like
From an Acceptance and Commitment Therapy (ACT) framework, counseling may focus on helping clients notice and accept emotional responses related to invalidation without over-identifying with self-critical narratives.
Cognitive Behavioral Therapy (CBT) interventions may assist clients in identifying and restructuring maladaptive cognitions reinforced by systemic exclusion and provider bias.
Narrative therapy can further support clients in externalizing the problem and reconstructing personal narratives that affirm diverse pathways to family building.
Why This Matters Beyond the Therapy Room
Reproductive justice emphasizes the human right to bodily autonomy, to have children, to not have children, and to parent children in safe and sustainable communities. Barriers that restrict LGBTQ+ peoples’ ability to access fertility treatment or be recognized as parents represent systemic denials of reproductive justice. Addressing structural barriers to LGBTQ+ reproductive autonomy is essential to advancing ethical, inclusive, and comprehensive mental health care.
“Fertility-related care and family building are not a one-size-fits-all, regardless of your gender or sexuality. When we try to squeeze LGBTQ+ people into the boxes built on the foundation of heteronormative assumptions, it is not only a disservice but an injustice.” – Giana Simonelli, Licensed Associate Counselor
All clinical examples shared in this post are fictional and intended solely for educational reflection. They are not drawn from real clients or cases.
