by Dr. Aliena (Ali) Davis, DC
This article initially appeared in Vol. 1, Issue 1 (Winter 2020) of The Birth Mag and is now being made available online to improve accessibility.
Someone you know is LGBTQIA+, possibly even someone you love.
If you’ve been in practice for any length of time, chances are you have LGBTQIA+ clients.
Even if you don’t know which ones they are.
Even if you practice in a small rural town.
Even if you think your practice serves a “different” niche of clientele.
This article is a very basic guide to shifting your practice to be more inclusive to LGBTQIA+ clients.
1. Let’s start with the basics: what does LGBTQIA+ stand for?
This is one acronym that is often used to represent the community – many folks have different preferences on acronyms. I recommend that as you learn more on this topic you hear people’s perspectives about the acronyms they prefer.
For purposes of this article, we will be using LGBTQIA+ which stands for Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual (+ because there are nearly unlimited identities within and outside of these categories that deserve to be acknowledged.)
2. Expand your terminology.
This is a very simple, efficient, and impactful way to practice inclusivity and communicate to your clients that you are working to be inclusive, and it costs nothing except time and effort.
Some examples of expanding your terminology include:
- Do not assume the gender of a client’s partner(s)…or that they have a partner…or that they have only one partner. For example, instead of asking a pregnant person “Will your husband be joining you during our consultation?” You might ask “Will you be bringing any partners or support people with you to our consultation?”
- In your discussions of pregnant and birthing people in general (such as on websites, blogs, and social media) replace “pregnant woman” with “pregnant person” or “pregnant client,” replace “mom and dad” with “parents,” replace “husband/wife” with “partner” or “spouse”.
- In your discussions of babies/children/newborns in general (such as on websites, blogs, and social media) replace “he/she” with “they”. Additionally, if your profession is closely tied to this discussion (looking at our fabulous ultrasound techs), briefly addressing the difference between sex and gender can be a great way to help empower parents to protect their future children from nonconsensual, medically unnecessary genital and gonadal surgeries that many Intersex children are subjected to.
- Add pronouns to your intake forms, and practice using them.
3. Learn about health disparities and intersectionality.
I recently had a conversation with someone who posed a fascinating question: “does every birthworker need to be inclusive [to LGBTQIA+ people]?”
My answer is yes. As mentioned above, LGBTQIA+ people exist everywhere.
We always have, and we always will. In fact, if you work in an area where you believe this work is inapplicable to your practice, that’s a sign that it’s even more essential that you be inclusive because what that signifies is a lack of visibility and safety for the LGBTQIA+ people who ARE occupying that space.
LGBTQIA+ people face higher rates of various physical and mental health struggles, and as a healthcare provider, being attuned to that risk is essential. When you encounter an LGBTQIA+ client who has a condition that needs to be comanaged with a specialist, who in your referral network is a safe provider to whom you can refer that client? A place where their gender identity and pronouns will be respected? Where they can converse openly and freely about their partner(s) without fear? These are the things that providers need to be considering when coordinating care for these clients.
Additionally, learn about intersectionality for the sake of your clients. People rarely bring only one identity with them into our offices, and we need to be aware of how their experience living in their identities of race, gender, class, ability, and other identities may shape their healthcare needs.
4. Never “out” a client.
This should go without saying, but unfortunately, it still happens.
NEVER “out” a client or patient (reveal their sexual orientation or gender identity without the person’s express permission).
First, this is dangerous and can get people killed. (This is not an exaggeration. I’m writing this article on Trans Day of Remembrance 2019 and the final count is over 300 Trans people who have been killed in the last 12 months. Hate crimes are real and still happening.)
Second, if you’re a profession that’s bound by HIPAA, you shouldn’t be sharing this information anyway.
5. Learn about HIV and AIDS, but probably not for the reason you’re thinking.
This question almost always arises during discussions on LGBTQIA+ healthcare.
Sadly, there are still so many misconceptions about this topic that it honestly deserves it’s own article, but I’m going to discuss a couple of key points here.
First, HIV/AIDS is not just an LGBTQIA+ issue. People who are not part of this community also contract HIV, and someone being LGBTQIA+ is NOT synonymous with HIV positive.
I have heard too many stories of students in my own profession refusing to care for patients because they assumed they were HIV positive simply based on their sexual orientation or assumed sexual orientation. This is wildly inaccurate and unnecessarily stigmatizing.
Second, HIV and AIDS are different. They are not synonymous. HIV (Human Immunodeficiency Virus) is the virus that a person contracts. AIDS (Acquired Immunodeficiency Syndrome) is the syndrome that the HIV virus can cause after a long period of infection.
Third, there are medications that can help people who have HIV live healthy lives and even achieve undetectable viral loads, and even prevent infection after exposure to the virus. There is also ongoing research to develop vaccines to prevent infection as well as on possible treatments to eliminate the virus.
Lastly, quite a few healthcare providers still ask “what special precautions do I need to take when working with HIV positive patients/clients?” The answer is that you should be practicing universal precautions with every single patient/client in all clinical interactions – regardless of a patient’s HIV status.
This means that you don’t need to wear gloves when caring for an HIV positive patient if the situation would not otherwise call for wearing gloves or other PPE (looking at you, fellow chiropractors…).mDoing so is unnecessary and stigmatizing.
6. Always work to expand your knowledge and understanding.
Some great resources from which to learn include this publication as well as various books and social media outlets. This article was just a very brief introduction to this topic and is by no means comprehensive.
Here are a few places to start:
Intersex & Genderqueer Recognition Project
(http://www.intersexrecognition.org)
The Trevor Project
(https://www.thetrevorproject.org)
Book: Contesting Intersex
Book: The Body Keeps the Score
Book: White Fragility
Aliena (Ali) Davis, DC – Birth Worker. Author. Activist. [She/They]
