Trans People Get Abortions, Too

"There's a natural similarity between reproductive rights and transgender rights," said Mercedes Sanchez, director of development and community education at Cedar River Clinics in Washington state. "It's all about autonomy, bodily autonomy, and being able to make the choices for ourselves." Sanchez sees the fight for reproductive rights and transgender rights as intertwined. And, in fact, they are.

It is essential for healthcare providers to be aware of intersections of oppression from race, socioeconomic status, sex assigned at birth and current gender status, so patients can feel safe and included in medical spaces. To state that abortion services are cis people's health concern excludes trans and nonbinary people's experiences.

Sanchez explained that some people believe trans and nonbinary folks receive special care.

"But it's not true," she said. "It's just the same healthcare you use for everyone else but just coming at it in a more respectful and inclusive way."

Sanchez's experience speaks to how pervasive cisnormativity—assuming all patients are cisgender—in medical and healthcare spaces can be. Such injustices prevent practitioners and staff from creating inclusive spaces and actually harm and injure trans and genderqueer patients.

A 2020 Guttmacher Institute study on abortions reported that about 530 trans and nonbinary people had abortions in 2017, many of which were performed at clinics that did not have transgender-specific care. In addition to exclusive services, dangerous setbacks, including state abortion bans in the wake of the Supreme Court's ruling on Dobbs v. Jackson Women's Health Organization, will harm not only cis women but also trans men and nonbinary people. All marginalized communities will feel the ripple effect of this monumental decision that overturned federal abortion rights in the United States.

According to the Guttmacher report, only 23 percent of abortion clinics in the United States even provide transgender-inclusive or specific care. Cedar River has worked to increase that number by supporting other clinics in expanding their understanding, education and services with the Transgender Healthcare Toolkit.

Alex transitioned a year ago, and in the past 12 months, every time he has gone into a healthcare facility, he has been met with "Cause of T." "Nauseous? Cause of T. Headache? Cause of T. Anything is always cause of T."

His frustrations surrounding basic primary care are constantly high because he feels his lifelong documented problems are ignored and lumped into testosterone assumptions.

Studies by A.J. Lowik, a British Columbia social researcher, back this up. Lowik's research tracks trans and nonbinary people's experiences accessing reproductive healthcare. The work has largely shown that trans people experience emotional, physical, psychological and health-related consequences of extensive undue labor when engaging with medical health systems.

Lowik utilizes this knowledge to train reproductive healthcare providers who want to provide better, more inclusive services for trans and nonbinary people. For Lowik, the starting place is language.

"It's about precision," Lowik said. "Inclusive neutral language is pregnant person, birthing person; whatever language is being used is about inclusion, but it's also about precision. Even among women, you're not talking about women, you're talking about a particular subset of women who are pregnant or who are menstruating. So it actually is more precise to use this neutral language."

"Not all women get pregnant," Lowik said. "And yet the language of women gets used as if that is kind of universally to be applied."

Natalie Hinchcliffe, a family doctor in Ohio, has spent her career working to integrate LGBTQ-specific care with gender-affirming care into an abortion space. Many clinics providing sexual healthcare have long lacked inclusive ways of operating, from failure to provide PEP or PrEP to how they do STI testing.

She pointed out this cis-centering, from a public health perspective, is concerning because providers can misdiagnose, such as, as Alex experienced, blaming hormone therapy. Failure to correctly identify the cause of health problems can perpetuate disease. Creating a gendered binary or women-only space is harmful to patients, Hinchcliffe explained.

"These are real people that have already come into your clinic and will continue to come into your clinic; yes, in smaller numbers potentially, just based on how many people identify a diverse gender that's different than their sex assigned at birth," she said. "But that doesn't make their experience any less important and from the perspective of intersectional feminism."

Cis-hetero women who advocate for reproductive justice and rights should be aware of trans and gender-expansive experiences within healthcare, medical systems and reproductive movement spaces, in order to become better allies and advocates.

"It has always been my view that we need to stop being on the defensive and start being on the offense," Sanchez said. "I think we need to push, like not just answering their arguments, but pushing what we want. For example, with the Biden administration, they had a campaign promise to abolish the Hyde Amendment, which prohibits federal funding for abortion. And we're still waiting, so come on."

Hinchcliffe advocated for broad attention to the gender binary: seeing where it exists and saying something in a polite and kind way, as in: Tell me more about that. I really want to understand where you're coming from. I feel different but I'm curious to understand what makes you think that or what is your experience with that then?

While this work begins with language for Lowik, it doesn't end there.

"Let's not get distracted by a conversation about language," Lowik said. "So if you are a person who is seeing that language conversation kind of go off the rails, I would interrupt it and be like, 'Hey, actually, trans people exist and they need access to care.' And that's all there is to it."