Are Chinese sexual minority youth at a disadvantage in accessibility to sexual and reproductive health services? Findings from a national survey

Background: Little is known about the accessibility to general sexual and reproductive health (SRH) services among sexual and gender minority communities in China, where gender- and sexuality-related stigma and discrimination remains high. The aim of this study is to investigate the accessibility to SRH services among Chinese sexual minority youths (SMY) aged 15–24 years old. Methods This cross-sectional study utilizes data on 54,580 youths from the 2019–2020 National College Student Survey on Sexual and Reproductive Health, conducted across 31 provinces in mainland China. Multivariable logistic regression modelling was conducted to assess the accessibility to SRH services among Chinese youth with different self-reported sexual orientation. Results A total of 77.6% of respondents self-identified as heterosexual, while 2.8% identified as lesbian or gay, and 9.0% as bisexual. Accessibility to free condoms at formal health services (OR 1.62, 95% CI: 1.32–1.99) and medical treatment (OR 1.83, 95% CI: 1.26–2.63) were significantly higher among gay men compared to heterosexual men. Gay men (OR 1.38, 95% CI: 1.13–1.68) and bisexual men (OR 1.33, 95% CI: 1.03–1.71) were more likely to use condom at first sexual intercourse compared to heterosexual men. However, the associations were reversed among female respondents. Conclusions Although SMY reported higher SRH services utilization compared to their heterosexual counterparts, the accessibility to SRH services remains low among Chinese youths. Policymakers should focus on improving the accessibility to SMY-friendly SRH services among Chinese youths.