by Ren Lorio-Dominguez
Everyone deserves pregnancy care that includes them. Transgender and gender non-binary folks often struggle to see themselves represented in healthcare situations, or included in language surrounding birth. They frequently face barriers to care, face discrimination in care, or are unable to access care at all. A large 2015 survey found that a third of the transgender and non-binary respondents had negative experiences with health care workers in the previous year, including harassment, physical violence, or sexual assault. 8% had been outright refused healthcare in the previous 12 months. Those who also had disabilities or were people of color experienced these things at even higher rates. With these abuses happening so frequently, it should be no surprise that 23% reported they had not sought needed healthcare because of fear of mistreatment.1
Non-binary and transgender people need safe places to receive care. Healthcare professionals believing they are LGBTQIA+ friendly is not enough. Using inclusive language tells transgender and non-binary folks that you are aware they get pregnant, have babies, and lactate also. Language alone is also not enough, but it is a big piece of the larger picture. A study found that trans and non-binary people who had access to an inclusive care provider had significantly lower rates of depression and suicidal thoughts than those who did not; 38% when receiving inclusive care compared to 54% of those without.2 In a population that is nine times more likely to attempt suicide than the general population of the United States1, this is crucial.
A good place to start in learning to use inclusive language is letting go of assumptions. Get comfortable asking people what their pronouns are, then use the ones they prefer. Start separating gender and anatomy in your mind. If the specifics of their anatomy are not relevant to the care you are providing, mind your own business. If they are relevant, which they often will be for birthworkers, avoid reflexively attaching gender to body parts. A pregnant person definitely has a uterus, but a woman may or may not, and a person with a uterus may or may not be a woman.
Some anatomical terms have so much baggage with them that some transgender and non-binary folks may feel more comfortable using less loaded alternatives. If you’re unclear, ask what they prefer. One pregnant person may be completely comfortable discussing a baby passing through their “vagina”, while another may shudder at use of that term and prefer “birth canal” or “front hole”. Again, ask not assume. Non-binary and transgender people are individuals with unique experiences and preferences. There is no single correct set of terms preferred by the entire group.
You can make a difference in providing better care for trans and gender non-conforming people. The healthcare community needs to be mindful of the fact that straight, cisgender women are not the only people conceiving, gestating, and birthing children. Queer families exist. You may even be caring for them without knowing. Nearly a third of transgender and non-binary individuals do not disclose their gender to healthcare personnel.1 Everyone deserves compassionate, safe, and inclusive care.
Ren Lorio-Dominguez (they/them/theirs) is an aspiring midwife, two time gestational surrogate, and beginning gardener presently living in the Atlanta area.
1James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.
2Shanna K. Kattari, N. Eugene Walls, Stephanie Rachel Speer & Leonardo Kattari (2016) Exploring the relationship between transgender-inclusive providers and mental health outcomes among transgender/gender variant people, Social Work in Health Care, 55:8,635-650, DOI: 10.1080/00981389.2016.1193099