Clinical Education Experiences of Sexual and Gender Minority Midwifery Students in the United States

Introduction: Diversifying the midwifery workforce is a promising strategy for advancing perinatal health and reducing disparities. Clinical education is essential to midwifery training; yet, the experiences of sexual and gender minority (SGM) midwifery students in these settings remain underexplored. Methods: We conducted a national cross-sectional survey of certified nurse-midwives and certified midwives certified between 2019 and 2024 ( n = 4117) about their clinical education experiences. Six hundred forty respondents completed the survey, with a 16% response rate. Multiple clinical education measures were self-reported: perceived competency, satisfaction with preceptorship, quality of interactions, and experiences of bias, harassment, bullying, or abuse. The primary exposure was SGM identity, defined as identifying as non-heterosexual and/or non-cisgender. Multivariable logistic regression models, adjusted for demographic and training characteristics, assessed the associations between SGM identity and clinical education outcomes. Results: One-fifth of the respondents identified as SGM. Across nearly all measures examined, SGM respondents reported significantly poorer experiences than non-SGM peers. In the descriptive results, they were less likely to report excellent interactions with preceptors (47.5% vs. 63.1%), other midwives (24.6% vs. 46.3%), and physicians (11.0% vs. 21.7%) and were less likely to report no gender- or sexual orientation-related bias (46.6% vs. 80.1%). SGM respondents were also more likely to experience bullying, harassment, or abuse during training. Fully adjusted models showed patterns consistent with these findings. Conclusion: SGM midwifery students experience lower-quality clinical education and higher exposure to bias and mistreatment. Addressing these inequities is critical for building a diverse midwifery workforce and broader efforts to advance perinatal health equity.