The results of a unique national survey: "to identify and define service needs for lesbians and to provide data to begin to make the system accountable for meeting those needs" have recently been published in
the USA in a 131-page "Final Report of the National lesbian Health Care Survey," by Judith Bradford and Caitlin Ryan. (1) The following are a selection of the findings (2):

- The fact that lesbians generally do not attend family planning clinics means that they are less likely to be screened for breast and cervical cancer and therefore more likely to acquire it.

- The common assumption that all women with AIDS are heterosexual and the lack of a specific category of lesbians under national statistics suggests that the cases of lesbians with AIDS may be under-reported, thus creating a false sense of security for lesbians.

- Unscreened semen for artificial insemination presented a risk to lesbians. Other reproductive health issues included legal accesss to fertility services (geared towards the married couple), prenatal care,
child development issues and childbirth,and the stress of being a lesbian parent.

- Chalmydia, genital warts and herpes have been found among lesbians in San Francisco.

- Invisibility of lesbians in chronic illness situations results in lesser quality care than other women recieve.

- lesbians are more likely to be poor and dependent on public services and therefore more likely to be ill.

- There are few services of any sort for older or very old lesbians. Research in this area needs to be done.

- There are several aspects relating to domestic violence in the lesbian community:

. a lack of awareness of physical abuse by women to other women;

. there is severe criticism of lesbians who batter other women; this, as well as the low self-esteem of both batterers and battered, may result in further denial and continuation of the abuse;

. some battered women's shelters have had anti-lesbian policies, arguing that sexual and/or affectional expression is inappropriate in such settings which results in poor access to these services for

- The commonest place for lesbians to meet are bars and private clubs where drinking is imporant and often associated with sexuality. In addition, low self-esteem, internalised homophobia and public discrimination make lesbians want to escape from harsh realities. Alcoholism and substance abuse are seen not only as diseases but also as personal and community consequences of lesbian oppression. Although lesbians participate in Alcoholics Anonymous programmes the programmes are not
orientated to the needs of lesbians.

The findings showed that the most common health problem experienced by lesbians in the past had been a long period of depression or sadness. In fact, the survey indicates that mental health problems and stress related illnesses are what most distinguishes lesbian health from that of the female population as a whole. It also suggests that these problems are largely societally induced. (3) Twenty-one percent of the
participants had thought about suicide and 18% had actually attempted it at some time in their lives. These figures are comparable to suicide rates among doctors, long recognised as one of the most high stress groups in society. The authors call for greater education and understanding of Lesbianism among health care providers, and conclude:

"Key research implications relate to the effects of discrimination, physical and sexual abuse and substance abuse, and the interactions among them, on the need for mental health services and the training of providers; the impact of outness/closetedness on mental health and access to non-discriminatory and informed services; and the positive effects of acceptance and integration of lesbian identity."

As far as I am aware there has been no similar research conducted anywhere else in the world.(4) In "Something to Tell You," London Gay Teenage Group, 1984, 19% of the respondents of a survey which included 400 lesbian and gay teenagers had attempted suicide because of their sexuality (equal proportions of lesbians and gay men). In a pilot study Lesbian Information Service carried out in Leicester in late 1987/early 1988, regarding the needs for a lesbian Hostel, 86% of the participants had suffered from depression and 43% had attempted suicide. A cursory look at what is happening in the USA and The Netherlands serves to further illustrate the need for effective research and action in Britain.


Books concerning lesbian health issues show that lesbians in the USA have been addressing lesbian needs for many years, for example:

- "Lesbian Health Matters," Santa Cruz Women's Health Collective, 1979;

- "Out from Under: Sober Dykes and Our Friends," ed. Jean Swallow,

- "Naming the Violence: Speaking Out Against Lesbian Battering," ed.
Kerry Lobel, 1986;

- "Lesbian Couples," D. Meritee Clunis and G. Dorsey Green, 1988, Seal

There are health institutions in the USA which not only cater for the health needs of lesbians but also conduct research. For example, the Lyon-Martin Clinic in San Francisco (women-only) as well as a national network of Feminist Women's Health Centres.

There are also lesbian officers within state and local health departments. The National Lesbian and Gay Health Foundation, which conducted the national lesbian Health Care Survey, presented the results at the
second International Lesbian and Gay Health Conference and AIDS Forum which was held in July 1988. Many major cities in the USA have a variety of institutions which openly provide services to the lesbian
community. Individual and collective psychologial and emotional issues are identified by lesbians at various community agencies, e.g. the Women's Institute for Mental Health. At the same time, many support groups, workshops, conferences and demonstrations are openly prepared for and attended by lesbians, and cover a variety of health topics including breast cancer, AIDS, disability, aging, lesbian battering, incest, reproductive rights, substance abuse, etc.

The Netherlands

There are two organisations which are wholly concerned with lesbian mental healthcare: the Schorer Stichting in Amsterdam and 'Iris' in Arnhem. The former is one of the national mental health care organisations subsidised by the Dutch government whilst 'Iris' is not subsidised and works for Arnhem and the surrounding areas.

Many of the 70 independent women's mental healthcare projects make special efforts directed at lesbians, both as individuals and in group therapy. 'Vrouwenleergangen', a training centre for mental healthcare
workers, run courses on lesbian mental healthcare for both lesbian and non-lesbian healthcare workers.

Rotterdam Council employs two half-time workers (one woman, one man) to the city's health service department with a task to work on a better integration and towards a greater acceptance of homosexuality in society via the social welfare organisations and institutions, which also includes support of local gay organisations.

'Homosexuality, Which Homosexuality?" An International Conference held in Amsterdam in December 1987.

Participants at this international conference produced a variety of papers for and about lesbians, a number of which were specifically concerned with lesbian health issues:

. "Lesbian Mental Healthcare Methods", Marleen Heeman;

. "New Research Issues in Lesbian Health", Nancy Shaw;

. "Lesbians and AIDS", Diane Richardson;

. "Therapeutic Work with Lesbian Couples", Coby Langenkamp;

. "Educating Health Care Workers: How Special are lesbians and gay men?" Nicoline Tamsona;

. "Lesbian Relationships, Closeness and Autonomy", Karlein Schreurs;

. "Lesbian Motherhood", Maaike de Klerck;

. "Lesbianism: The inevitable struggle between freedom and security", Astrid de Vreese; and others.


The few organisations that exist, the lack of research and publications about lesbian health issues confirms that there is no real acknowledgement, especially by the medical profession, of lesbian health matters in this country.

As far as I am aware, there are no British books on lesbian health issues. There were few British papers presented at the conference, 'Homosexuality, Which Homosexuality.' There are a some organisations
being established in Britain. For example, three lesbians and Alcohol Groups: in London, Birmingham and Manchester; a national network of lesbian Therapists as well as a lesbians in Health Care Network; and the Women's Therapy Centre in London run two workshops for lesbians. There has also been a series of lesbian Health workshops, in London. L.I.S. ran a Lesbian Health Workshop at a Women's Health Day in Stoke-on-Trent and have set up a Lesbians with Agoraphobia Network. There
maybe other groups in existence but they are not known to me. I understand that there is shortly to be a national conference for lesbians working in Women's Aid in Britain - perhaps they will develop
work around lesbian battering.

What Kind of Environment Encourages a lesbian Health Care Movement?

In her article on "New Research Issues in Lesbian Health", Nancy Shaw asserts that there are two main sources concerning the emergence of new ideas and research topics about lesbian health in the USA: new
biological challenges and social change. It is the latter, however, that Shaw argues is the key to issue identification and research in lesbian health. "The emergence of a lesbian community as a self-defined
set of individuals who claim an identity and who are not adequately described only as a population participating in certain behaviours, has had enormous consequences for the identification of lesbian health issues. ...Similarly, there are innumberable support groups for lesbians with health concerns experienced by the broader community: substance abuse, alcoholism, incest, rape, etc. As a gender analysis of these issues has spread through society, lesbians have applied that analysis to themselves. They have also explored explanations and recovery strategies that go beyond both medicine and gender to sexual orientation. The idea that lesbians experience health problems in a manner different from non-lesbians, (e.g. differently from heterosexual women) is a hypothesis which could be tested in the context of a variety of issues."

How Can We Develop a Lesbian Health Care Movement in Britain?

In order to develop a Lesbian Health Care Movement in Britain we must acknowledge that lesbians are a separate political group of women. Lesbians are made invisible and oppressed by the state. Lesbians are
further ignored and marginalised by both the Gay and Women's Liberation Movements, and in particular, local authority (labour) women's projects and women's units. Julia Penelope says:

"As women, specifically as the most despised women, we have no identity, no tradition, no history. We have to begin to create our own traditions and, in order to do this, we have to separate ourselves from gay men and their activities. We have been the small, subordinate subclassification of homosexuality for too long. We have to discover our meaning of being a lesbian ..."(5)

The Women's Liberation Movement have refused to face up to lesbian oppression as the most concentrated form of women's oppression. It is significant that whilst lesbians have always been at the forefront of the Women's Liberation Movement we have continued to deny our own oppression. We have been refused visible access to women's projects because we would "put 'ordinary' (read straight) women off." Now it is Section 28 (we'll lose our funding) which is being used to both justify anti-Lesbianism and to insist on our political location within the Gay Movement rather than within the Women's Movement, thereby separating us once and for all from women.

Lesbians do have special health care needs which are largely societally induced. We must acknowledge this. We must also support what initiatives there are, and encourage new projects, for example, a national survey on Lesbian Health Care Needs in Britain. I believe that the results would be startling given that we do not have the support networks and projects that exist in America and elsewhere.

Sources: "Lesbian Mental Healthcare, Methods", Marleen Heeman, 1987; "Hag Rag," Sep/Oct 1988, U.S.A.; "Something to Tell You," L Trenchard & H Warren, London Gay Teenage Group, 1984; "Lesbian Network," 1988, Australia; "Lesbians and Housing in Leicester," L.I.S., 1988;

(1) Copies can be obtained from the National lesbian & Gay Health Foundation, PO Box 65472, Washington, D.C. 20035, USA.

(2) "New Research Issues in lesbian Health," Nancy Shaw, 1987, presented at the conference "Homosexuality, Which Homosexuality?"

(3) The findings show that over 75% of the respondents had had mental health counselling. The most common reasons for counselling were depression, problems with a lover, family, anxiety, personal growth,
loneliness and being lesbians.

(4) The government in Australia are currently conducting research into the health needs of women to develop a National Policy on Women's Health. They identified specific groups of women who might have
different needs but neglected to include lesbians.

(5) "Lesbian Separatism: The Linguistic and Social Sources of Separatist Politics," 1974 and published recently by Onlywomen Press in "For Lesbians Only, A Separatist Anthology," edited by Sarah Lucia
Hoagland and Julia Penelope, 1988.

© Jan Bridget 1989