The way we (specifically cisgender people, both in and out of the medical field) conceptualize sexual and reproductive health often further marginalizes transgender and gender non-conforming individuals. This is a result of the way we use exclusive language, the way we think inside the binary, and the way we prioritize how things have historically happened over how they can and should be done going forward.
Trans people deserve visibility and acceptance. They also deserve reproductive healthcare that is safe, comfortable, and affirming.
How do trans experiences in reproductive healthcare differ from cisgender experiences?
In a 2021 article for Frontiers in Reproductive Health, the authors talk about a tendency among healthcare professionals to think of SRH (sexual and reproductive health) in terms of “women’s health” and “men’s health” services. This can lead to an array of problematic and damaging practices, including misgendering (which puts an emotional strain on the patient) and transphobia in a clinical setting.
“Awareness and visibility of transgender individuals have exponentially increased over recent years,” the article says, “however, [gender non-conforming people] face unique barriers.” These include “discrimination, lack of clinician knowledge, health system obstacles…social stigma, harassment, and rejection.”
Andrew Townsend, the Health Promotion Officer at Action Canada (Canada’s Planned Parenthood), says these experiences have a significant impact on trans people and their access to care in Canada.
“It really just colours the entire experience that trans people have within the healthcare system,” he tells us.
Townsend says that trans people sometimes see clinicians who have never treated a trans person before, and the patient will find themselves advocating for their own care while also educating the clinician. This is undoubtedly an exhausting process, and, as with all those who face medical stigma, it can cause significant anxiety. This may lead a patient to avoid doctor’s visits altogether, which in turn leads to poorer health outcomes.
Why do trans people face so much stigma in reproductive healthcare settings?
Trans people face oppressive and ignorant attitudes in all facets of life, and healthcare is no exception. Systemic issues, a lack of education on trans lives and rights, and blatant transphobia are all barriers to adequate healthcare among trans individuals.
In the previously mentioned article from Frontiers in Reproductive Health, the authors write the following:
“Structural inequities embedded within the healthcare system can limit access to healthcare for transgender people. Many transgender individuals lack health insurance, which may be partially due to the higher prevalence of unemployment and poverty faced by these individuals.”
In addition to social injustice, a lack of medical school training on issues specific to trans people means doctors often aren’t equipped to provide adequate care to people of all genders.
For example, the Frontiers article says “Transgender males who have internal and external female anatomy will need standard SRH care such as contraception counseling, reproductive health education, breast and gynecological cancer screenings, STI testing, and menstrual management. However, it is important for OB-GYNs to understand the various options for hormonal and surgical gender affirmation, as these interventions impact the SRH needs and considerations of the trans individuals”.
Unfortunately, many doctors aren’t trained to treat these nuanced situations.
While medical education plays a huge role in the struggles trans people face within healthcare settings, the general population also needs to be taught about trans experiences, so we understand the full impacts, so transphobia is no longer seen as an acceptable standpoint. Anti-trans agendas are more than differences of opinion, they are dangerous infringements on basic human rights.
How do we make changes to our spaces to prioritize safety and inclusivity?
In November 2022, the government of Canada announced that $3.8 million in funding would be given to Trans Care BC to support a project “to help address barriers to sexual and reproductive health care encountered by TTNB (Two-Spirit, trans and non-binary) people due to discrimination and a lack of provider knowledge.”
Trans Care BC’s project aims to improve care through education, both for health care providers and TTNB people in BC. They will focus on three areas: sexual health promotion and harm reduction, sexual desire, function, fertility and perinatal care, and gender-affirming post-operative care.
Minister of Health Jean Yves Duclos says the following about the initiative: “People of all genders and identities deserve to be their true, authentic self and have access to the care and services that they need to lead a happy and healthy life. As Two-Spirit, trans, and non-binary people in Canada continue to disproportionately experience poorer health outcomes caused by stigma and discrimination, organizations like Trans Care BC are doing important work to find solutions. Together with organizations such as Trans Care BC, we are committed to improving access to sexual and reproductive health services and address the barriers to gender-affirming care.”
While funding like this is a step forward, it’s important that the momentum continues and that we insist on improving our education systems so trans people feel safe and affirmed while accessing care.
This means improving the way we use language (“women’s health” and “men’s health” should be referred to as sexual and reproductive health, for example.) It also means more research needs to be done in relation to trans people and their reproductive health. OB-GYNs and other clinicians need to be fully aware of the consequences of inadequate care and the importance of inclusive care, both in language and in action.
People of all genders who want to start a family, or who are taking care of their reproductive health in other ways, have a right to know all their options, and to feel unburdened and at ease when advocating for themselves.