By Ky Walker
Historically, trans people have been subjected to marginalisation and discrimination within sexual and reproductive health care. Even today, trans people are often not included in discussions on midwifery care, and sexual, reproductive, maternal, newborn and adolescent health more broadly. As midwifery care is based on justice, equity and dignity, for the International Day Against Homophobia, Biphobia and Transphobia we are working to dispel some myths and misconceptions surrounding health and midwifery care for trans people.
But before delving into this topic, it’s crucial to define “trans” and “transgender.” According to a 2021 report from the UN High Commissioner for Refugees, these terms encompass a range of identities, including non-binary, gender fluid, and gender non-conforming, all of which denote an internal sense of gender differing from the sex assigned at birth and the gender attributed to the individual by society. For the purposes of this article, when referring to trans men and trans women, we also include those who identify as transfeminine and transmasculine, respectively. There are inclusive terms for those on masculinizing or feminizing paths, regardless of gender identity.
Learn more about this WHO resource about gender and health.
Myth: Trans people don’t need contraceptives as they’re already infertile or subfertile.
Reality: While hormone therapy can affect fertility, this is not necessarily permanent and shouldn’t be treated as a contraceptive. A trans man taking testosterone who has ovaries may still ovulate—even if they aren’t menstruating—meaning they could become pregnant. A trans woman taking oestrogen or testosterone-blockers who has testes may still produce sperm, meaning they could impregnate someone.
Midwives can foster autonomy and enable informed choices on contraception for trans people who don’t want to risk pregnancy, as well as on fertility preservation for those who want it.
Sources:
Todd, N. At risk of pregnancy? Contraception for transgender, nonbinary, gender-diverse, and Two Spirit patients. BC Medical Journal. 2022.
Myth: Trans men can’t become pregnant or give birth.
Reality: Many trans men retain their uterus and ovaries, allowing them to become pregnant and give birth. While testosterone therapy can impact their fertility and ability to become pregnant, that does not mean it is impossible. Trans men who wish to carry a child often face barriers to accessing information and care regarding pregnancy. Others who do not want to be pregnant are not given inclusive guidance on contraception and/or abortion services.
Midwives’ role in providing evidence-based care can alleviate this by providing supportive, nonjudgmental care tailored to the needs of trans men navigating pregnancy and birth.
Sources:
Hoffkling, A., Obedin-Maliver, J. & Sevelius, J. From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers. BMC Pregnancy Childbirth. 2017.
Obedin-Maliver J, Makadon HJ. Transgender men and pregnancy. Obstetric Medicine. 2016.
Myth: Trans people don’t need cervical or breast screenings.
Reality: Many trans men still have cervixes or breast tissue, meaning that they may remain at risk of cervical cancer or breast cancer. Many trans women and transfeminine people who take oestrogen-based hormone therapy develop breast tissue that can heighten their risk of breast cancer. However, trans people are often not included in information about cancer screenings.
Midwives can create a welcoming, inclusive, person-centred environment to ensure that trans people receive necessary preventative care according to local screening guidelines.
Sources:
Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health. 2022.
Sterling J, Garcia MM. Cancer screening in the transgender population: a review of current guidelines, best practices, and a proposed care model. Translational Andrology and Urology. 2020.
Myth: Midwives don’t participate in the care of trans people.
Reality: Trans people, like all people, need access to inclusive sexual and reproductive health care that respects their freedom to make decisions about their bodies and lives. Midwives are well-positioned to offer these essential services.
The continuity of midwife care model places the experiences, expertise, and needs of the individual at the centre through personalised and non-authoritarian care. Midwives can provide care in partnership with trans people, upholding their right to bodily autonomy in a welcoming environment.
Sources:
ICM Philosophy and Model of Midwifery Care. 2024.
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2024-05-16 13:42:35Z
CBMiaWh0dHBzOi8vaW50ZXJuYXRpb25hbG1pZHdpdmVzLm9yZy9taWR3aWZlcnktbXl0aC1idXN0aW5nLXNleHVhbC1hbmQtcmVwcm9kdWN0aXZlLWhlYWx0aC1mb3ItdHJhbnMtcGVvcGxlL9IBAA
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