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Journal of Lesbian Studies Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wjls20
The Effects of Coming Out on Relationships and Health Miriam Saphira & Marewa Glover Published online: 12 Oct 2008.
To cite this article: Miriam Saphira & Marewa Glover (2001) The Effects of Coming Out on Relationships and Health, Journal of Lesbian Studies, 5:1-2, 183-194, DOI: 10.1300/J155v05n01_12 To link to this article: http://dx.doi.org/10.1300/J155v05n01_12
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The Effects of Coming Out on Relationships and Health Miriam Saphira Marewa Glover
SUMMARY. This study set out to ascertain how open lesbians were about their sexual orientation, using a snowball sample of lesbians in New Zealand. The research looked at how disclosure impacted on lesbian sexual behaviour, self assessed health status, relationships and use of health services. The questions were part of a large survey modelled on a North Health Study (Parr, Whittaker, and Jackson, 1998) which included the SF-36 survey instrument. A standardized set of questions and calculated scoring were used to measure the self-assessed health of respondents (Ware et al., 1993). The 795 return results were compared with a sample of women from Northern New Zealand and a sample of lesbians from the New Zealand Census. The respondents were coded into three groups according to their degree of openness: those who were out to everybody, those who were out to all but one person of significance, and those who were out to a few. Lesbians who were not open to their doctors were more likely to have reported being closeted to employers and parents, to smoke more, to drink more alcohol, to have less sex, and to earn less money. Respondents who labeled themselves gay reported that they were not so open. Of the 77% that were out to their health professional, 5% had received a negative response. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: Website: E 2001 by The Haworth Press, Inc. All rights reserved.]
KEYWORDS. Lesbians, coming out, health, labels, New Zealand, relationships, stress
[Haworth co-indexing entry note]: ‘‘The Effects of Coming Out on Relationships and Health.’’ Saphira, Miriam, and Marewa Glover. Co-published simultaneously in Journal of Lesbian Studies (Harrington Park Press, an imprint of The Haworth Press, Inc.) Vol. 5, No. 1/2, 2001, pp. 183-194; and: Lesbian Studies in Aotearoa/New Zealand (ed: Alison J. Laurie) Harrington Park Press, an imprint of The Haworth Press, Inc., 2001, pp. 183-194. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-342-9678, 9:00 a.m. - 5:00 p.m. (EST). E-mail address: [email protected]].
E 2001 by The Haworth Press, Inc. All rights reserved.
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INTRODUCTION Women are presumed to be heterosexual unless they demonstrate otherwise (Ponse, 1978). Hooker (1957) called this ‘‘heterosexual ethnocentricity.’’ In this context, lesbian identity has to be developed privately against a stream of heterosexual propaganda (Welch, 1995). Lesbians vary in how public they are about their sexual orientation, and coming out has been referred to as a process that varies over time (Saphira, 1990). Every time a lesbian meets someone new, she has to make a choice as to whether she discloses her orientation, is neutral, or uses a variety of strategies to make her orientation appear ambiguous or heterosexual (Atmore, 1990). It has been suggested that non-disclosure may be adaptive for some individuals (Hetherington and Orzeck, 1989), and there has been little evidence to support that being open to everybody is beneficial to the individual. After the passing of the New Zealand Human Rights Act in 1993, there was an assumption that homophobia would disappear and everyone would be open. Five years later, there has been a suggestion that lesbians are still hidden at work and are becoming less out rather than more open (Ananamu, 1998). In a 1992 New Zealand/Aotearoa discrimination survey, Rankine et al. (1997) (and see this volume) found that 29% of 261 participants were out at work to employers and work-mates. In another New Zealand/Aotearoa study, Welch (1995) found that women who were not open about their orientation scored poorly on four social network scales. Most of the lesbians in her sample of 548 were out to most of their friends and families, but only 28% were totally open (16% saying they were not out at all) in their place of education. The Welch study also looked at the ease with which respondents accepted their sexuality; while 19% found it difficult, only 0.5% could not accept their sexuality. Using the General Health Questionnaire, Welch found that although there were higher scores for the lesbian respondents, indicating poorer mental health, there was no correlation between the scores and the level of the respondents’ outness. A literature review suggested that social pressures, such as stigma, cause unique stresses for lesbians and contribute to poor mental health (Welch, 1995). There has been no information available on the degree of public openness and relationship characteristics of lesbians in New Zealand/ Aotearoa. This study aimed to assess the willingness of lesbians to disclose their sexual preference to their health professionals, employ-
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ers, and parents and to assess whether being out made any difference to sexual relationships and health issues. METHOD The Lesbian Health Questionnaire was modeled on a North Health Study (Kelsall and Jackson, 1997), which included the SF-36 survey instrument, a standardized set of questions, and calculated scoring to measure the self-assessed health of respondents (Ware et al., 1993). The higher the score, the better the health for a particular dimension of health. Questions around identity and outness were used from previous New Zealand lesbian research (Rankine et al., 1997; Welch, 1995; Machen, 1998). Outness was recorded as out to all significant people, out to all but one significant person, and not out to many people. The Lesbian Health Survey was approved by the North Health Ethical Committee. SAMPLING The Lesbian Health Questionnaire was distributed and collected over six months through a variety of sporting, newsletter, social, and cultural groups. This method of snowball sampling makes it difficult to reach lesbians who are not involved in the various lesbian social activities or those who do not subscribe to newsletters or are isolated or closeted. A total of 2,703 questionnaires were distributed and 795 were returned, a rate of 29%. The Welch (1995) return rate was 44%. The poorer return rate could be due to the large range of facilities where the questionnaire was placed; for example, the poorest return was at a late-night bar where 100 forms were given out as lesbians were leaving, but only nine completed forms were returned. RESULTS There were 41% of all respondents and 49% of Maori respondents who were out to everybody (28% Welch). The ethnicity of respon-
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dents was compared with the 3,627 lesbians who lived with a partner and chose to state that they were a couple in the 1996 Census (Byrne and Hyman, 1998). There was an overrepresentation of respondents who identified as Pakeha (New Zealanders of European origins)--86%, compared with the 73% of lesbians and 62% of the general population in the 1996 Census identifying as Pakeha (Byrne and Hyman, 1998). Maori (8%) were underrepresented (compared with 18% of lesbians, and 14% of the population in the 1996 Census (Byrne and Hyman, 1998). There was a lower representation of Pacific Islands lesbians (2%) than the 5% in the 1996 Census. More Maori respondents were out than Paheka, but the numbers for other ethnicities were too small for comparison (see Table 1). Despite the limitations with the snowball sampling technique, this sample would seem to be reasonably consistent with that identified by previous research in the New Zealand/Aotearoa lesbian community. Respondents stated whether they were out to parents (83%, Maori 55%), their workmates (84%, Maori 100%), doctors (77%, Maori 73%), and employers (68%, Maori 65%). The proportion out to employers is higher than the 29% out in the 1992 discrimination survey (Rankine et al., 1997). This suggests that there may be an increase in openness since 1993. In addition, 46% (Maori 45%) were out to solicitors, but some may not have had a solicitor and thus answered in the negative. TABLE 1. Ethnicity and Being Out ethnic Out
Data
Pakeha
Maori
Pacific
Asian/
Other
To All
Number
281
32
5
3
8
329
%
41%
49%
38%
33%
33%
42%
To Most
Number
140
12
4
6
162
%
21%
18%
31%
25%
20%
Indian
To a Few
0%
Grand Total
Number
260
22
4
6
10
302
%
38%
33%
31%
67%
42%
38%
Total
681
66
13
9
24
793
Total %
100.00
100.00
100.00
100.00
100.00
100.00
%
%
%
%
%
%
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Most of the respondents identified as lesbian, dyke, gay, or takataapui (Maori for lesbian, gay, and transgender people). Twenty-five women (3%) said they did not like labels of sexual orientation and preferred gender or ethnic labels, and one woman said she was heterosexual. Those that identified as takataapui were the most frequently out to everybody, and those that identified as gay were less out (see Table 2). Over half of the respondents were between 30 and 50 years old, and this was the same across all ethnicities. There were 82% under 50 years old, which is similar to the 84% of lesbian couples in the 1996 Census data (Byrne and Hyman, 1998). Younger respondents (38%) and older respondents (24%) were less out than those in the 30-50 age group (44%). Respondents lived throughout New Zealand, with 40% living in the greater Auckland area (33% Byrne and Hyman, 1998; 19% Welch, 1995). Those who lived in the South Island (42%), the greater Auckland area (40%), and the North Island provincial areas (39%) were less out than respondents in Wellington (50%). One third, 33%, were living on less than $NZ20,000 a year (20% Parr, Whittaker, and Jackson, 1998, but they counted household income) and were receiving some government assistance. The median TABLE 2. Identity and Outness identity Out
Data
lesbian
gay
takataapui
bisexual
other
Grand Total
Out to All
Number
278
20
13
7
12
330
%
42.90%
29.41%
59.09%
23.33%
46.15%
41.56%
Out to Most
Number
136
10
3
9
4
162
%
20.99%
14.71%
13.64%
30.00%
15.38%
20.40%
Out to a Few
Number
234
38
6
14
10
302
%
36.11%
55.88%
27.27%
46.67%
38.46%
38.04%
Total
648
68
22
30
26
794
Total %
100.00
100.00
100.00
100.00
100.00
100.00
%
%
%
%
%
%
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income per year was $35,000 ($26,630 median Byrne and Hyman, 1998). Those on a low income tended to be less out, but there was no difference between those that owned their homes and those who did not. Seventy-one percent of respondents owned their own home (69% Byrne and Hyman, 1998), but less than half the Maori lesbians (41%) owned homes. More university graduates were out to families, workmates, and health professionals than those who had only been to secondary school. Education levels were high, with 36% university graduates (15% Parr, Whittaker, and Jackson, 1999), but lower than in other New Zealand lesbian studies (40% Welch, 1995; 39% Rankine et al., 1997), and 19% had other tertiary qualifications (11% Parr, Whittaker, and Jackson, 1998; 29% Welch, 1995; 29% Rankine et al., 1997). OUTNESS AND RELATIONSHIPS There were 436 respondents (78% of those in a relationship, or 55% of the total sample) who lived together (49% Welch, 1995). Of the total sample of respondents, 71% were in a steady relationship at the time of filling out the questionnaire, and 17% had been together for over ten years. Those not in a relationship (29%) and those in a relationship and having sex less often tended to be less out (see Table 3). Frequency of sex was also related to more outness (more than TABLE 3. Out and Sexual Activity frequency Out
Data
2 14
40
90
147
34
325
%
26%
32%
48%
47%
33%
42%
21
40
30
49
19
159
38%
32%
16%
16%
18%
20%
20
44
66
114
50
294
36%
35%
35%
37%
49%
38%
To All
To Most % To a Few %
3
4
5
6
Grand Total
Total
55
124
186
310
103
778
Total %
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
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TABLE 4. SF-36 and Outness SF-36 (lower score = worse health)
Out to All
Out to Most
Out to a Few
Physical
85.63
87.07
81.35
Recent function
74.49
76.85
66.03
Pain
70.82
72.11
64.45
General
73.69
71.59
68.22
Vital
58.64
57.81
53.01
Social
75.76
76.39
70.68
Emotional
69.83
66.67
67.33
Mental
71.83
71.91
69.66
monthly 48%; less than monthly 34%). Those who first had sex with a woman when they were younger were more out (under 21 years 43%; 21-30 years 46%) than those who were over 30 (34%). Nineteen percent lived alone (21% Welch, 1995), and only 32% were out to everybody. Over a third (38%) had given birth at some time (Maori 48%), and 25% lived with children (27% Welch, 1995; 29% Byrne and Hyman, 1998). Compared with the total, more Maori lesbian respondents lived with children, and fewer Pacific Islands lesbian respondents did so. There was no difference in outness between those who had given birth or were living with children and those who had not or were not. Of those that had contact with children, less than half (47%) were out to their children, but 65% of Maori respondents had told their children. In 1983, in a sample of 70 lesbian mothers in New Zealand, 69% had talked about their orientation to their children (Saphira, 1984). COMING OUT TO HEALTH PROFESSIONALS Of those who had seen a doctor, 77% were out to their general practitioner, 74% to their naturopath, and 95% to their counsellor. Nearly three-quarters of Maori lesbians (73%) were out to their doctor. There were 20 respondents (5%) who were not out to their counsel-
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lor. Five identified as lesbian, one as gay, three as bisexual, and one as other. This raises the question of how a lesbian could get a quality service from a counsellor without being open about her orientation or developing orientation. Similarly, in the Welch sample, 7% were not out to their counsellor. Of those who had seen a medical specialist, only 44% were out to the specialist. If the women were out to their general practitioner, they were more likely to be out to other health professionals, but not necessarily to their parents, and this was the same for Maori lesbians and takataapui. The lesbian respondents tended to be less out to physiotherapists (36%, Maori 31%) and medical insurers (25%, Maori 75%). Consultation with lesbian health workers throughout the research period indicated that there was still resistance from some lesbians (some of whom worked in health related businesses) to being out to health professionals. These lesbians appeared to view their body as made up of disparate body parts, and they did not believe in the relationship between stress and illness. They were more reluctant to acknowledge that stress resulted from being in the closet and found it stressful to come out (Tuck, 1991). This is an area worthy of further study. HEALTH PROFESSIONALS’ RESPONSE TO OUTNESS This study found a reported 85% positive response by health professionals to outness and a 5% negative response. It was not clear how long ago some of these responses may have occurred, but the age of some respondents was young enough to mean that the response was recent. The comments included: ‘‘I don’t think he heard me as later he asked if full intercourse was painful’’--lesbian in her thirties. ‘‘My doctor does not think I am gay, that it is just a phase’’--lesbian in her twenties. ‘‘Since shifting to a small town I have had a negative response from an older GP’’--disabled thirty year old lesbian. ‘‘She told me it was my life and my decision and then went on to talk about her husband and her honeymoon’’--young, recently out lesbian.
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A number of the respondents stressed how careful they were in choosing who they told about their sexual orientation. They took extra trouble to ask others about suitable professionals, and, in the larger centres, they often chose health professionals who were lesbian, for example: ‘‘My GP and Counsellor were both very accepting and supportive that’s why I chose to tell them’’--lesbian in her thirties. HEALTH AND OUTNESS Degree of outness and the average SF-36 scores indicated lower healthscores for those who were least out Those out to everybody scored highest on most factors, but not on pain, social function, and recent physical function. This would suggest that health is a complex matter, and lesbian health may be influenced by degree of outness among a myriad of other factors. ILLNESS, INJURY, AND OUTNESS Lesbians in the health part of this survey had a higher rate of injury than a random sample of Northern Region New Zealand women (Saphira and Glover, 2000). It was suggested that lesbians may feel distracted due to discrimination (Sargent, 1999). Those that had suffered an injury in the past 12 months were less out (35%) than those who had not (45%). On the other hand, after coming out, lesbians have said they have felt exposed, embarrassed, and on display, which may account for the smaller difference than if accidents were due to maintaining their closetedness (Robertson, 1992). These stresses could lead to more use of alcohol, but more lesbians who were not out drank weekly (57%) than those who were out (42%). Over half the respondents who smoked tobacco were not out (60%), but this is similar for those who did not smoke (57%), whereas cannabis smokers were more likely to be out (50%) than non-cannabis users (41%). It has been previously reported that the lesbians in this sample delayed going to a health professional when they were ill or injured, but being out or not out did not influence how they sought health care. More of those who had not been unwell or injured in the last 12 months were out (48%) than those who had been unwell or injured (40%).
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CONCLUSION Overall, there were more lesbians who were not out in all areas of their lives than were open about their sexual orientation. There was less openness among those who were on lower incomes, receiving government assistance, older, and/or not in a relationship. Those living together were more open, suggesting that the immediate support of each other may go some way to countering the feeling of exposure that has been reported (Robertson, 1992). Those living alone and those not in relationships were less likely to be out in all spheres of their lives. Degrees of outness are complex, and it is difficult to examine these issues in quantitative research. Public and private selves are not mutually exclusive, as was demonstrated in the television show episode where Ellen ‘‘came out’’ as a screen character (Yescavage and Alexander, 1999). There has been little study of the attitudes of health professionals towards lesbians. In this study, about three-quarters of the respondents were out to their general practitioner or naturopath, and 5% had experienced a negative response. Some recent research has looked at discourses which are prejudiced against lesbians and gay men, such as submissions opposing sexual orientation anti-discrimination changes to the Human Rights legislation (McCreanor, 1994). This study concluded that there was still a sector of society who were prejudiced against New Zealand lesbians. If these discriminatory beliefs are widely recognised, it may affect the degree to which lesbians are open about their sexual identity. Since the Human Rights Act 1993, lesbians in this survey have become more out than those in previous studies. It may be that the interrelated factors of attitudes of health professionals, and lesbian attitudes towards health, discrimination, stress, and difficulty with being out to professionals, contribute to the seemingly poorer health of lesbians. Creating a safe practice within medical environments would seem essential to enabling lesbians to feel comfortable in being open about their orientation and in availing themselves of comprehensive care. Only 5% of doctors were considered to be negative towards their patients’ sexual orientation, but this may be partly due to the lesbian’s careful selection of her health professional. The lesbian respondents stressed how carefully they chose health professionals to tell about
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their sexual orientation. After one negative response, one lesbian chose not to come out to her current health professional. The health system does not appear to service the unique needs of lesbians. More anti-discrimination information is needed in the various health professions to ensure safe practice. More education on gay and lesbian issues for all professionals may address these factors and may also decrease lesbians’ anxiety around choosing professionals, making it easier for lesbians to come out. This study does show that more then half the lesbian respondents were not open about their sexual orientation to professionals, significant family members, and workmates. Dialogue needs to be established in order to reduce and eliminate this problem. Major research studies involving thousands of women should give the opportunity for lesbians to be open about their sexuality in order to allow a better analysis of their needs. A lesbian orientation involves far more than sexual behaviour and includes complex social and cultural referents (Saphira, 1990; Tuck, 1991). To improve our knowledge about public health for lesbians, we need more in-depth research and inclusion in other studies. REFERENCES Ananamu (1998). Tamaki Makaurau Lesbian Newsletter, Auckland. Atmore, Chris (1990). ‘‘Everything isn’t for everybody’’: Some experiences of being lesbian in the work place, Deparment of Sociology and Social Work Working Papers No 5, Victoria University of Wellington. Byrne, Judith, and Hyman, Prue (1998). What the 1996 Census tells us about lesbians, Paper presented to the New Zealand Women’s Studies Conference, Palmerston North. Hetherington, C. and Orzeck, A. (1989). Career counselling and life planning with lesbian women, Journal of Counselling and Development 68, pp. 52-56. Hooker, Evelyn (1957). The adjustment of the male homosexual, Journal of Projective Techniques 21(1), pp. 18-33. Kelsall, Lisa and Jackson, Gary (1997). Preliminary Report on the North Health Survey 1996. Unpublished report. Machen, Maryclare (1999). The silencing of lesbian domestic abuse. Unpublished MA (Psychology) thesis, University of Auckland. McCreanor, Tim (1996). ‘‘Why strengthen the city wall when the enemy has poisoned the well’’: An essay of anti-homosexual discourse in New Zealand, Journal of Homosexuality 31(4), 75-105. Parr, Angelique, Whittaker, Robyn, and Jackson, Gary (1999). The Northern Region Health Survey 1996/9, Auckland: Health Funding Authority Northern Office.
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Ponse, Barbara (1978). Identities in the Lesbian World: The Social Construction of Self, Connecticut: Greenwood Press. Rankine, Jenny (1997). The Great Late Lesbian and Bisexual Women’s Discrimination Survey, Auckland: Rankine. Robertson (1992). Lesbians as an invisible minority in the health services area, Health Care for Women International 13, pp. 155-163. Saphira, Miriam (1990). Children’s understanding of sexual orientation, unpublished PhD (Psychology) thesis, University of Auckland. Saphira, Miriam (1984). Amazon Mothers, Auckland: Papers Inc. Sargent, Michael (1999). Personal communication reported in Saphira M.E. and Glover M., National Lesbian Health Survey, Auckland: Papers Inc. Tuck, Wendy (1991). Women’s sexual orientation: A study of diversity. Unpublished MA (Psychology) thesis, University of Waikato. Ware, John, Snow, Kristin, Kosinski, Mark, and Gandek, Barbara (1993). SF-36 Health Survey: Manual and Interpretation Guide, Boston: The Health Institute. Welch, Sarah, (1995). Lesbian mental health. Unpublished BMSc thesis, Dunedin: University of Otago. Yescavage, Karen and Alexander, Jonathon (1999). ‘‘What do you call a lesbian who has only slept with men? Answer: Ellen Morgan’’: Deconstructing the lesbian identity of Ellen Morgan, Journal of Lesbian Studies 3(3), pp. 21-26.
Journal of Lesbian Studies Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wjls20
The Effects of Coming Out on Relationships and Health Miriam Saphira & Marewa Glover Published online: 12 Oct 2008.
To cite this article: Miriam Saphira & Marewa Glover (2001) The Effects of Coming Out on Relationships and Health, Journal of Lesbian Studies, 5:1-2, 183-194, DOI: 10.1300/J155v05n01_12 To link to this article: http://dx.doi.org/10.1300/J155v05n01_12
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan,
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sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
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The Effects of Coming Out on Relationships and Health Miriam Saphira Marewa Glover
SUMMARY. This study set out to ascertain how open lesbians were about their sexual orientation, using a snowball sample of lesbians in New Zealand. The research looked at how disclosure impacted on lesbian sexual behaviour, self assessed health status, relationships and use of health services. The questions were part of a large survey modelled on a North Health Study (Parr, Whittaker, and Jackson, 1998) which included the SF-36 survey instrument. A standardized set of questions and calculated scoring were used to measure the self-assessed health of respondents (Ware et al., 1993). The 795 return results were compared with a sample of women from Northern New Zealand and a sample of lesbians from the New Zealand Census. The respondents were coded into three groups according to their degree of openness: those who were out to everybody, those who were out to all but one person of significance, and those who were out to a few. Lesbians who were not open to their doctors were more likely to have reported being closeted to employers and parents, to smoke more, to drink more alcohol, to have less sex, and to earn less money. Respondents who labeled themselves gay reported that they were not so open. Of the 77% that were out to their health professional, 5% had received a negative response. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: Website: E 2001 by The Haworth Press, Inc. All rights reserved.]
KEYWORDS. Lesbians, coming out, health, labels, New Zealand, relationships, stress
[Haworth co-indexing entry note]: ‘‘The Effects of Coming Out on Relationships and Health.’’ Saphira, Miriam, and Marewa Glover. Co-published simultaneously in Journal of Lesbian Studies (Harrington Park Press, an imprint of The Haworth Press, Inc.) Vol. 5, No. 1/2, 2001, pp. 183-194; and: Lesbian Studies in Aotearoa/New Zealand (ed: Alison J. Laurie) Harrington Park Press, an imprint of The Haworth Press, Inc., 2001, pp. 183-194. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-342-9678, 9:00 a.m. - 5:00 p.m. (EST). E-mail address: [email protected]].
E 2001 by The Haworth Press, Inc. All rights reserved.
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INTRODUCTION Women are presumed to be heterosexual unless they demonstrate otherwise (Ponse, 1978). Hooker (1957) called this ‘‘heterosexual ethnocentricity.’’ In this context, lesbian identity has to be developed privately against a stream of heterosexual propaganda (Welch, 1995). Lesbians vary in how public they are about their sexual orientation, and coming out has been referred to as a process that varies over time (Saphira, 1990). Every time a lesbian meets someone new, she has to make a choice as to whether she discloses her orientation, is neutral, or uses a variety of strategies to make her orientation appear ambiguous or heterosexual (Atmore, 1990). It has been suggested that non-disclosure may be adaptive for some individuals (Hetherington and Orzeck, 1989), and there has been little evidence to support that being open to everybody is beneficial to the individual. After the passing of the New Zealand Human Rights Act in 1993, there was an assumption that homophobia would disappear and everyone would be open. Five years later, there has been a suggestion that lesbians are still hidden at work and are becoming less out rather than more open (Ananamu, 1998). In a 1992 New Zealand/Aotearoa discrimination survey, Rankine et al. (1997) (and see this volume) found that 29% of 261 participants were out at work to employers and work-mates. In another New Zealand/Aotearoa study, Welch (1995) found that women who were not open about their orientation scored poorly on four social network scales. Most of the lesbians in her sample of 548 were out to most of their friends and families, but only 28% were totally open (16% saying they were not out at all) in their place of education. The Welch study also looked at the ease with which respondents accepted their sexuality; while 19% found it difficult, only 0.5% could not accept their sexuality. Using the General Health Questionnaire, Welch found that although there were higher scores for the lesbian respondents, indicating poorer mental health, there was no correlation between the scores and the level of the respondents’ outness. A literature review suggested that social pressures, such as stigma, cause unique stresses for lesbians and contribute to poor mental health (Welch, 1995). There has been no information available on the degree of public openness and relationship characteristics of lesbians in New Zealand/ Aotearoa. This study aimed to assess the willingness of lesbians to disclose their sexual preference to their health professionals, employ-
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ers, and parents and to assess whether being out made any difference to sexual relationships and health issues. METHOD The Lesbian Health Questionnaire was modeled on a North Health Study (Kelsall and Jackson, 1997), which included the SF-36 survey instrument, a standardized set of questions, and calculated scoring to measure the self-assessed health of respondents (Ware et al., 1993). The higher the score, the better the health for a particular dimension of health. Questions around identity and outness were used from previous New Zealand lesbian research (Rankine et al., 1997; Welch, 1995; Machen, 1998). Outness was recorded as out to all significant people, out to all but one significant person, and not out to many people. The Lesbian Health Survey was approved by the North Health Ethical Committee. SAMPLING The Lesbian Health Questionnaire was distributed and collected over six months through a variety of sporting, newsletter, social, and cultural groups. This method of snowball sampling makes it difficult to reach lesbians who are not involved in the various lesbian social activities or those who do not subscribe to newsletters or are isolated or closeted. A total of 2,703 questionnaires were distributed and 795 were returned, a rate of 29%. The Welch (1995) return rate was 44%. The poorer return rate could be due to the large range of facilities where the questionnaire was placed; for example, the poorest return was at a late-night bar where 100 forms were given out as lesbians were leaving, but only nine completed forms were returned. RESULTS There were 41% of all respondents and 49% of Maori respondents who were out to everybody (28% Welch). The ethnicity of respon-
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dents was compared with the 3,627 lesbians who lived with a partner and chose to state that they were a couple in the 1996 Census (Byrne and Hyman, 1998). There was an overrepresentation of respondents who identified as Pakeha (New Zealanders of European origins)--86%, compared with the 73% of lesbians and 62% of the general population in the 1996 Census identifying as Pakeha (Byrne and Hyman, 1998). Maori (8%) were underrepresented (compared with 18% of lesbians, and 14% of the population in the 1996 Census (Byrne and Hyman, 1998). There was a lower representation of Pacific Islands lesbians (2%) than the 5% in the 1996 Census. More Maori respondents were out than Paheka, but the numbers for other ethnicities were too small for comparison (see Table 1). Despite the limitations with the snowball sampling technique, this sample would seem to be reasonably consistent with that identified by previous research in the New Zealand/Aotearoa lesbian community. Respondents stated whether they were out to parents (83%, Maori 55%), their workmates (84%, Maori 100%), doctors (77%, Maori 73%), and employers (68%, Maori 65%). The proportion out to employers is higher than the 29% out in the 1992 discrimination survey (Rankine et al., 1997). This suggests that there may be an increase in openness since 1993. In addition, 46% (Maori 45%) were out to solicitors, but some may not have had a solicitor and thus answered in the negative. TABLE 1. Ethnicity and Being Out ethnic Out
Data
Pakeha
Maori
Pacific
Asian/
Other
To All
Number
281
32
5
3
8
329
%
41%
49%
38%
33%
33%
42%
To Most
Number
140
12
4
6
162
%
21%
18%
31%
25%
20%
Indian
To a Few
0%
Grand Total
Number
260
22
4
6
10
302
%
38%
33%
31%
67%
42%
38%
Total
681
66
13
9
24
793
Total %
100.00
100.00
100.00
100.00
100.00
100.00
%
%
%
%
%
%
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Most of the respondents identified as lesbian, dyke, gay, or takataapui (Maori for lesbian, gay, and transgender people). Twenty-five women (3%) said they did not like labels of sexual orientation and preferred gender or ethnic labels, and one woman said she was heterosexual. Those that identified as takataapui were the most frequently out to everybody, and those that identified as gay were less out (see Table 2). Over half of the respondents were between 30 and 50 years old, and this was the same across all ethnicities. There were 82% under 50 years old, which is similar to the 84% of lesbian couples in the 1996 Census data (Byrne and Hyman, 1998). Younger respondents (38%) and older respondents (24%) were less out than those in the 30-50 age group (44%). Respondents lived throughout New Zealand, with 40% living in the greater Auckland area (33% Byrne and Hyman, 1998; 19% Welch, 1995). Those who lived in the South Island (42%), the greater Auckland area (40%), and the North Island provincial areas (39%) were less out than respondents in Wellington (50%). One third, 33%, were living on less than $NZ20,000 a year (20% Parr, Whittaker, and Jackson, 1998, but they counted household income) and were receiving some government assistance. The median TABLE 2. Identity and Outness identity Out
Data
lesbian
gay
takataapui
bisexual
other
Grand Total
Out to All
Number
278
20
13
7
12
330
%
42.90%
29.41%
59.09%
23.33%
46.15%
41.56%
Out to Most
Number
136
10
3
9
4
162
%
20.99%
14.71%
13.64%
30.00%
15.38%
20.40%
Out to a Few
Number
234
38
6
14
10
302
%
36.11%
55.88%
27.27%
46.67%
38.46%
38.04%
Total
648
68
22
30
26
794
Total %
100.00
100.00
100.00
100.00
100.00
100.00
%
%
%
%
%
%
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income per year was $35,000 ($26,630 median Byrne and Hyman, 1998). Those on a low income tended to be less out, but there was no difference between those that owned their homes and those who did not. Seventy-one percent of respondents owned their own home (69% Byrne and Hyman, 1998), but less than half the Maori lesbians (41%) owned homes. More university graduates were out to families, workmates, and health professionals than those who had only been to secondary school. Education levels were high, with 36% university graduates (15% Parr, Whittaker, and Jackson, 1999), but lower than in other New Zealand lesbian studies (40% Welch, 1995; 39% Rankine et al., 1997), and 19% had other tertiary qualifications (11% Parr, Whittaker, and Jackson, 1998; 29% Welch, 1995; 29% Rankine et al., 1997). OUTNESS AND RELATIONSHIPS There were 436 respondents (78% of those in a relationship, or 55% of the total sample) who lived together (49% Welch, 1995). Of the total sample of respondents, 71% were in a steady relationship at the time of filling out the questionnaire, and 17% had been together for over ten years. Those not in a relationship (29%) and those in a relationship and having sex less often tended to be less out (see Table 3). Frequency of sex was also related to more outness (more than TABLE 3. Out and Sexual Activity frequency Out
Data
2 14
40
90
147
34
325
%
26%
32%
48%
47%
33%
42%
21
40
30
49
19
159
38%
32%
16%
16%
18%
20%
20
44
66
114
50
294
36%
35%
35%
37%
49%
38%
To All
To Most % To a Few %
3
4
5
6
Grand Total
Total
55
124
186
310
103
778
Total %
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
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TABLE 4. SF-36 and Outness SF-36 (lower score = worse health)
Out to All
Out to Most
Out to a Few
Physical
85.63
87.07
81.35
Recent function
74.49
76.85
66.03
Pain
70.82
72.11
64.45
General
73.69
71.59
68.22
Vital
58.64
57.81
53.01
Social
75.76
76.39
70.68
Emotional
69.83
66.67
67.33
Mental
71.83
71.91
69.66
monthly 48%; less than monthly 34%). Those who first had sex with a woman when they were younger were more out (under 21 years 43%; 21-30 years 46%) than those who were over 30 (34%). Nineteen percent lived alone (21% Welch, 1995), and only 32% were out to everybody. Over a third (38%) had given birth at some time (Maori 48%), and 25% lived with children (27% Welch, 1995; 29% Byrne and Hyman, 1998). Compared with the total, more Maori lesbian respondents lived with children, and fewer Pacific Islands lesbian respondents did so. There was no difference in outness between those who had given birth or were living with children and those who had not or were not. Of those that had contact with children, less than half (47%) were out to their children, but 65% of Maori respondents had told their children. In 1983, in a sample of 70 lesbian mothers in New Zealand, 69% had talked about their orientation to their children (Saphira, 1984). COMING OUT TO HEALTH PROFESSIONALS Of those who had seen a doctor, 77% were out to their general practitioner, 74% to their naturopath, and 95% to their counsellor. Nearly three-quarters of Maori lesbians (73%) were out to their doctor. There were 20 respondents (5%) who were not out to their counsel-
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lor. Five identified as lesbian, one as gay, three as bisexual, and one as other. This raises the question of how a lesbian could get a quality service from a counsellor without being open about her orientation or developing orientation. Similarly, in the Welch sample, 7% were not out to their counsellor. Of those who had seen a medical specialist, only 44% were out to the specialist. If the women were out to their general practitioner, they were more likely to be out to other health professionals, but not necessarily to their parents, and this was the same for Maori lesbians and takataapui. The lesbian respondents tended to be less out to physiotherapists (36%, Maori 31%) and medical insurers (25%, Maori 75%). Consultation with lesbian health workers throughout the research period indicated that there was still resistance from some lesbians (some of whom worked in health related businesses) to being out to health professionals. These lesbians appeared to view their body as made up of disparate body parts, and they did not believe in the relationship between stress and illness. They were more reluctant to acknowledge that stress resulted from being in the closet and found it stressful to come out (Tuck, 1991). This is an area worthy of further study. HEALTH PROFESSIONALS’ RESPONSE TO OUTNESS This study found a reported 85% positive response by health professionals to outness and a 5% negative response. It was not clear how long ago some of these responses may have occurred, but the age of some respondents was young enough to mean that the response was recent. The comments included: ‘‘I don’t think he heard me as later he asked if full intercourse was painful’’--lesbian in her thirties. ‘‘My doctor does not think I am gay, that it is just a phase’’--lesbian in her twenties. ‘‘Since shifting to a small town I have had a negative response from an older GP’’--disabled thirty year old lesbian. ‘‘She told me it was my life and my decision and then went on to talk about her husband and her honeymoon’’--young, recently out lesbian.
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A number of the respondents stressed how careful they were in choosing who they told about their sexual orientation. They took extra trouble to ask others about suitable professionals, and, in the larger centres, they often chose health professionals who were lesbian, for example: ‘‘My GP and Counsellor were both very accepting and supportive that’s why I chose to tell them’’--lesbian in her thirties. HEALTH AND OUTNESS Degree of outness and the average SF-36 scores indicated lower healthscores for those who were least out Those out to everybody scored highest on most factors, but not on pain, social function, and recent physical function. This would suggest that health is a complex matter, and lesbian health may be influenced by degree of outness among a myriad of other factors. ILLNESS, INJURY, AND OUTNESS Lesbians in the health part of this survey had a higher rate of injury than a random sample of Northern Region New Zealand women (Saphira and Glover, 2000). It was suggested that lesbians may feel distracted due to discrimination (Sargent, 1999). Those that had suffered an injury in the past 12 months were less out (35%) than those who had not (45%). On the other hand, after coming out, lesbians have said they have felt exposed, embarrassed, and on display, which may account for the smaller difference than if accidents were due to maintaining their closetedness (Robertson, 1992). These stresses could lead to more use of alcohol, but more lesbians who were not out drank weekly (57%) than those who were out (42%). Over half the respondents who smoked tobacco were not out (60%), but this is similar for those who did not smoke (57%), whereas cannabis smokers were more likely to be out (50%) than non-cannabis users (41%). It has been previously reported that the lesbians in this sample delayed going to a health professional when they were ill or injured, but being out or not out did not influence how they sought health care. More of those who had not been unwell or injured in the last 12 months were out (48%) than those who had been unwell or injured (40%).
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CONCLUSION Overall, there were more lesbians who were not out in all areas of their lives than were open about their sexual orientation. There was less openness among those who were on lower incomes, receiving government assistance, older, and/or not in a relationship. Those living together were more open, suggesting that the immediate support of each other may go some way to countering the feeling of exposure that has been reported (Robertson, 1992). Those living alone and those not in relationships were less likely to be out in all spheres of their lives. Degrees of outness are complex, and it is difficult to examine these issues in quantitative research. Public and private selves are not mutually exclusive, as was demonstrated in the television show episode where Ellen ‘‘came out’’ as a screen character (Yescavage and Alexander, 1999). There has been little study of the attitudes of health professionals towards lesbians. In this study, about three-quarters of the respondents were out to their general practitioner or naturopath, and 5% had experienced a negative response. Some recent research has looked at discourses which are prejudiced against lesbians and gay men, such as submissions opposing sexual orientation anti-discrimination changes to the Human Rights legislation (McCreanor, 1994). This study concluded that there was still a sector of society who were prejudiced against New Zealand lesbians. If these discriminatory beliefs are widely recognised, it may affect the degree to which lesbians are open about their sexual identity. Since the Human Rights Act 1993, lesbians in this survey have become more out than those in previous studies. It may be that the interrelated factors of attitudes of health professionals, and lesbian attitudes towards health, discrimination, stress, and difficulty with being out to professionals, contribute to the seemingly poorer health of lesbians. Creating a safe practice within medical environments would seem essential to enabling lesbians to feel comfortable in being open about their orientation and in availing themselves of comprehensive care. Only 5% of doctors were considered to be negative towards their patients’ sexual orientation, but this may be partly due to the lesbian’s careful selection of her health professional. The lesbian respondents stressed how carefully they chose health professionals to tell about
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their sexual orientation. After one negative response, one lesbian chose not to come out to her current health professional. The health system does not appear to service the unique needs of lesbians. More anti-discrimination information is needed in the various health professions to ensure safe practice. More education on gay and lesbian issues for all professionals may address these factors and may also decrease lesbians’ anxiety around choosing professionals, making it easier for lesbians to come out. This study does show that more then half the lesbian respondents were not open about their sexual orientation to professionals, significant family members, and workmates. Dialogue needs to be established in order to reduce and eliminate this problem. Major research studies involving thousands of women should give the opportunity for lesbians to be open about their sexuality in order to allow a better analysis of their needs. A lesbian orientation involves far more than sexual behaviour and includes complex social and cultural referents (Saphira, 1990; Tuck, 1991). To improve our knowledge about public health for lesbians, we need more in-depth research and inclusion in other studies. REFERENCES Ananamu (1998). Tamaki Makaurau Lesbian Newsletter, Auckland. Atmore, Chris (1990). ‘‘Everything isn’t for everybody’’: Some experiences of being lesbian in the work place, Deparment of Sociology and Social Work Working Papers No 5, Victoria University of Wellington. Byrne, Judith, and Hyman, Prue (1998). What the 1996 Census tells us about lesbians, Paper presented to the New Zealand Women’s Studies Conference, Palmerston North. Hetherington, C. and Orzeck, A. (1989). Career counselling and life planning with lesbian women, Journal of Counselling and Development 68, pp. 52-56. Hooker, Evelyn (1957). The adjustment of the male homosexual, Journal of Projective Techniques 21(1), pp. 18-33. Kelsall, Lisa and Jackson, Gary (1997). Preliminary Report on the North Health Survey 1996. Unpublished report. Machen, Maryclare (1999). The silencing of lesbian domestic abuse. Unpublished MA (Psychology) thesis, University of Auckland. McCreanor, Tim (1996). ‘‘Why strengthen the city wall when the enemy has poisoned the well’’: An essay of anti-homosexual discourse in New Zealand, Journal of Homosexuality 31(4), 75-105. Parr, Angelique, Whittaker, Robyn, and Jackson, Gary (1999). The Northern Region Health Survey 1996/9, Auckland: Health Funding Authority Northern Office.
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Ponse, Barbara (1978). Identities in the Lesbian World: The Social Construction of Self, Connecticut: Greenwood Press. Rankine, Jenny (1997). The Great Late Lesbian and Bisexual Women’s Discrimination Survey, Auckland: Rankine. Robertson (1992). Lesbians as an invisible minority in the health services area, Health Care for Women International 13, pp. 155-163. Saphira, Miriam (1990). Children’s understanding of sexual orientation, unpublished PhD (Psychology) thesis, University of Auckland. Saphira, Miriam (1984). Amazon Mothers, Auckland: Papers Inc. Sargent, Michael (1999). Personal communication reported in Saphira M.E. and Glover M., National Lesbian Health Survey, Auckland: Papers Inc. Tuck, Wendy (1991). Women’s sexual orientation: A study of diversity. Unpublished MA (Psychology) thesis, University of Waikato. Ware, John, Snow, Kristin, Kosinski, Mark, and Gandek, Barbara (1993). SF-36 Health Survey: Manual and Interpretation Guide, Boston: The Health Institute. Welch, Sarah, (1995). Lesbian mental health. Unpublished BMSc thesis, Dunedin: University of Otago. Yescavage, Karen and Alexander, Jonathon (1999). ‘‘What do you call a lesbian who has only slept with men? Answer: Ellen Morgan’’: Deconstructing the lesbian identity of Ellen Morgan, Journal of Lesbian Studies 3(3), pp. 21-26.
