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American College of Nurse Midwives urges quality care for trans and gender variant people

January 17, 2013

Anyone else feel like it really is a tide that is turning these days? The American College of Nurse Midwives issued a statement in support of working towards quality, competent care for trans and gender non-conforming people. Woo-hoo! While it may seem like this is a no-brainer, it’s actually a big step in the right direction for ensuring that trans people can find medical care that doesn’t try to pathologize trans identity, and hopefully someday with providers who understand the needs of trans folks.

From the statement, issued in December of 2012:

It is the position of ACNM that midwives:

  • Exhibit respect for patients with nonconforming gender identities and do not pathologize differences in gender identity or expression;
  • Provide care in a manner that affirms patients’ gender identities and reduces the distress of gender dysphoria or refer to knowledgeable colleagues;
  • Become knowledgeable about the health care needs of transsexual, transgender, and gender nonconforming people, including the benefits and risks of gender affirming treatment options;
  • Match treatment approaches to the specific needs of patients, particularly their goals for gender expression and need for relief from gender dysphoria;
  • Have resources available to support and advocate for patients within their families and communities (schools, workplaces, and other settings).

That all sounds great to me. It’s actually a really fabulous statement, much more comprehensive and far-reaching than the one issued by the American College of Obstetricians and Gynecologists last year. It addresses the need for education about transgender issues in midwifery education, and even the fact that it enumerates the different identities: transgender, transsexual, gender variant, gender non-conforming, is a big step that I haven’t seen many other medical bodies take.

This is my favorite part:

As many as half of gender variant individuals report having to educate their health care providers about their health care needs, but gender variant people do not by default have unique or complicated health issues. Most members of this community require the same primary, mental, and sexual health care that all individuals need. The most important thing all midwives can do to improve the health care outcomes of gender variant individuals is to use their skills to provide care that is welcoming and accessible.

Amen to that. I would say the same thing for doulas.

It’s really incredible to witness the strides being made, while still acknowledging the serious barriers and often really challenging conditions that trans people face in the United States. A longform journalistic article I wrote for Political Research Associates was recently published, and in it I explored a new ad campaign run by the DC government that tries to address discrimination against transgender people by promoting trans respect and awareness. It was a pleasure to interview the many folks involved in working to improve conditions for trans people–it’s clear just how much incredible activism has been happening, primarily led by trans folks themselves. But it was also a reminder of how far we have to go, and how trans and gender variant people face serious discrimination in pretty much every area of life. You can read the article here.

Lastly, another new resource from a group I used to work for, The National Latina Institute for Reproductive Health, about creating health care that is inclusive of trans and gender variant Latin@s.

h/t Claudia Booker for the ACNM link

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Breastfeeding while trans

September 11, 2012

Last week for my column at RH Reality Check* I wrote about Trevor MacDonald, a Canadian trans man and father who made headlines for being rejected as a La Leche League (LLL) leader.

In response LLL is reconsidering their policy that leaders must be breastfeeding women because Trevor, in fact, is breastfeeding his son.

I’ve talked before about how few resources exist about trans pregnancy and parenting, so the positive side of this controversy is that more people know about Trevor, his experience and the resources that exist (some he’s created) about breastfeeding for trans parents.

Trevor, despite having had top surgery, has been able to breastfeed his son using his own milk and an at-breast milk supplementation system  supplemental nursing system which is basically a thin tube that is connected to a bottle but is attached next to the nipple so that the baby can latch on to the nipple and the tube at once. This promotes the bonding that comes along with breastfeeding, but also allows the parent’s milk supply to be stimulated by the baby sucking, along with additional nutrition from the supplemented milk (Trevor has been getting this milk through donations from other breastfeeding folks).

Now I’m not a breastfeeding expert, and I can’t honestly remember much about what was covered on this subject at my doula training, but I’m surprised that this is the first I’ve heard about this. Both the fact that some people can produce breast milk post-top surgery, and that there is a way to supplement with other milk that isn’t a bottle.

I can imagine that the at-breast supplementation system might be tricky to use, and some folks would prefer the ease of the bottle. Related question: can you use the at-breast system if you are supplementing with formula?

While I’m not glad that Trevor was rejected as a LLL leader (and I hope they will come around and see that anyone who is breastfeeding should be welcome) I am glad that his story has brought attention and resources to the question of breastfeeding while trans.

For more information, visit his blog or join the facebook group he created for trans parents and allies.

I’d also love to hear from folks, doulas or otherwise, who have experience working with trans parents who chose to breastfeed. Other resources? Tips? Leave them in comments or email me (radicaldoulaATgmail) and I’ll post more later on.

Update: Trevor sent along the link to this fabulous post with tips for breastfeeding for trans folks.

*Transgender is misspelled in the title of the column, which was an error made by the Editor. I’ve contacted them to ask them to fix it, but have not heard back.


ACOG issues statement urging OB-GYNs to treat transgender patients

November 30, 2011

This may just be the only time I praise ACOG. I’m not a huge fan of the way they treat midwifery care and home birth, but this is good news for trans health. From my post at Feministing:

The American College of Obstetrics and Gynecology has come out with a new statement for their members: it’s time to prepare to work with transgender patients.

“To address the significant health care disparities of transgender individuals and to improve their access to care, ob-gyns should prepare to provide routine treatment and screening or refer them to other physicians, according to The American College of Obstetricians and Gynecologists (The College). In a Committee Opinion published today, The College also states its opposition to gender identity discrimination and supports both public and private health insurance coverage for gender identity disorder treatment.”

Their statement specifically addresses the gynecological needs of transgender men, who may still require cervical and breast cancer screenings, as well as other gynecological (and even obstetric) care.

“We need to make our offices settings that treat all patients with respect,” said Dr. Buyers. The College offers ob-gyns suggestions on how to create an office environment that is welcoming to transgender patients. For instance, asking patients their preferred name and pronoun, posting non-discrimination policies, ensuring confidentiality, and offering sensitivity training for staff are all steps that signal acceptance and let patients know that they will be treated with dignity. “We want the transgender community to know that we, as ob-gyns, care about their health.”

I hope that their members follow this important advice.

While not a widely addressed topic, folks in the birth activist community are starting to address the needs of trans and gender non-conforming people in health care. The fact that ACOG has gotten on board shows just how far we’ve come. The advice ACOG provides for their members applies to us as doulas as well, and we’d go far by simply implementing some of their recommendations also.


Creating Change 2009

January 31, 2009

I’ve been at the National Gay and Lesbian Task Force’s annual conference, Creating Change.

I’ve posted a few blogs from the workshops over at Feministing. Go check them out, there were some great conversations about gender identity.

The State of the Movement

Embracing Two SpiritTraditions

Butch Re(defined)


Transgender Day of Remembrance

November 20, 2008

I like what Bear said:

It’s Trans Day Of Remembrance. We lost thirty this year. Mostly transwomen and transfeminine spectrum people, mostly women of color, mostly savagely beaten or stabbed for being too challenging to understand, assimilate, classify.

For the first time the NYT wrote about the murder of a transwoman of color in a way that suggests that her death is to be taken seriously, and did so before a well-meaning white non-trans person made a film about it. But it is hard to understand this as progress.

I’ve seen a variety of kinds of vigils and memorials for TDOR, but the one that is most vivid for me is one I saw at Wells College, a few years ago. The students there wrote the names of each of the trans dead on a slice of paper that they taped to the back of a dining hall chair. Suddenly it became clear that in the seven years (I think) since count had been kept, a huge hall’s worth of transpeople had been killed. Sitting in the chairs was emotionally intense, and if you were quiet you could hear the chatter of the ghosts, making friends. I sat in Rita Hester’s chair, and missed her.

Please take a moment, even if it’s just a breath right now, to remember. If you’re the praying kind, a prayer couldn’t hurt. If you’re the doing kind, tell someone else it’s Transgender Day of Remembrance, and what that means. If you’re the giving kind, make a donation to National Center For Transgender Equality – they can always use it. If you’re the writing kind, write about who you have lost, or found, and post or publish it if you’re able. And whatever other kind you are, please also be the kind who interrupts transphobia. Because it’s killing us, you see? It’s killing us.


LGBT related hate crimes on the rise in DC

September 18, 2008
There are many things about the queer community in DC that are really positive. It’s a close knit community, people are really welcoming, there is a very visible LGBT presence across the city. There are lots of bars and clubs for gay men and there a few for lesbian women as well. Unfortunately, there are some huge downsides to being part of this community as well.

LGBT related hate crimes have been on the rise in the district lately. There have been at least three incidents in the last few weeks, involving young gay men being brutally beaten while out in the streets. We’re not talking about people who were out really late at night, or even walking alone. One of the most recent victims, Tony Randolph Hunter, died yesterday from his injuries. It hasn’t been confirmed that these incidents were hate crimes, but it’s probable.

I know that my friends and I are pretty scared. I would say that I’m quite visibly queer, and that makes me feel like a target. Nationally, around 16% of hate crimes are LGBT related. In DC, it’s 60%.

It’s such a complicated issue. Crime in DC is pretty severe–it ranks in the top five nationally in terms of crime rates. A lot of my friends have been mugged, it’s a common occurrence. One of the reasons that might explain the disparity in hate crimes rates is the Gay and Lesbian Liasion Unit of the DC police department. So reporting in DC might be better than in other cities, where crimes that could be considered LGBT related hate crimes are not reported. Also, the visibility of the community might contribute to the rate. Poverty is also pretty serious in DC, as well as racial tensions. It’s a majority African-American city, and the gay community is overwhelmingly white. The gentrification issues I mentioned earlier also probably have an impact.

If you happen to be in DC, a group has arisen to try and address these recent crimes. The next meeting is on Monday, I know I will be there.

Cross-posted on Feministing


Trans or Gender Non-Conforming? Take this survey

September 12, 2008

The National Gay and Lesbian Task Force just launched a new national survey on Transgender Discrimination.

I just went to a briefing a few days ago on Capitol Hill hosted by the National LGBT Health Coalition about how little data we have nationally about LGBT people. Why? Because federal surveys refuse to include questions about sexual orientation and gender identity. Without data, we have no way of knowing what the disparities are and no way of asking for funding to address them. Huge problem.

One way organizations get around this data issue is by creating their own surveys like this one.

“This is an absolutely critical national effort. We urge all transgender and gender non-conforming people to take the survey to help guide us in making better laws and policies that will improve the quality of life for all transgender people. We need everyone’s voice in this, everyone’s participation.”
– Mara Keisling, Executive Director, National Center for Transgender Equality

In the wake of one of the most violent years on record of assaults on transgender people, the National Center for Transgender Equality (NCTE) and the National Gay and Lesbian Task Force have teamed up on a comprehensive national survey to collect data on discrimination against transgender people in housing, employment, public accommodations, healthcare, education, family life and criminal justice.

To date, in 2008, several young gender non-conforming people of color have been murdered, including California junior high school student Lawrence King, who was shot in public during the school day. King’s murder, and the murders of Simmie Williams in South Carolina and Angie Zapata in Greeley, Colorado come in a year in which we are still working to include transgender provisions in a federal bill to protect lesbian, gay and bisexual workers from discrimination in employment.

So if you identify as trans or gender non-conforming please take the survey today!

Crossposted at feministing


Southern Comfort

August 15, 2008

I saw this documentary, Southern Comfort, a few months ago and have been meaning to post about it ever since. It was a really touching story, and an interesting look into the life of a few transgender people living in the Deep South. The focus of the movie is a trans man, Robert Eads. It’s about his story and battle with ovarian cancer (which he eventually succumbs to) and the people in his life, including his partner, Lola, pictured here.

What makes Robert’s story particularly remarkable is that he had tried to get a hysterectomy during his transition, but his doctors refused. The procedure would have saved his life, as he eventually was diagnosed with ovarian cancer. His other friends in the film also talk about the transphobia they faced in receiving necessary medical care. It’s a serious issue, and not just for trans people living in the rural south.

It’s a great documentary, I highly recommend it. Southern Comfort is also the name of a yearly trans convention that happens in Atlanta, Georgia.


Why Marriage Isn’t My Golden Ticket

June 18, 2008

From the ACLU’s blog, the Blog of Rights Symposium. Thanks to Nancy Goldstein for inviting to participate! In a related vein, I was recently on NPR’s Here and Now with Robin Young also talking about gay marriage. This was particularly fun, as it was me and a log cabin republican. You can listen to the show here, the segment begins five minutes in.

It’s official. Same sex couples can get married in California, as of 5 p.m. PST on Monday. While most people in the GLBT community are celebrating the decision, my excitement was rather muted. While I am touched by the stories of couples getting married after 50 years together, I know that marriage isn’t my golden ticket. Marriage isn’t my golden ticket unless I’m lucky enough (or even want) a long-term monogamous partnership. It isn’t my golden ticket unless I have a job or a partner with healthcare benefits. It isn’t my golden ticket unless I have an inheritance to worry about, or a pension to be concerned with.

Mattilda Bernstein Sycamore, a radical activist and writer has been one very vocal voice of dissent. From her piece at Alternet:

Gay marriage does nothing to address fundamental problems of inequality. What is needed is universal access to basic necessities like housing, health care, food, and the benefits now obtained through citizenship (like the right to stay in this country). Legalized gay marriage means only that certain people in a specific type of long-term, monogamous relationship sanctioned by a state contract might be able to access benefits. While marriage could confer inclusion under a spouse’s health-care policy, it does nothing to provide such a policy. Marriage might ensure hospital visitation rights, but not for anyone without a spouse. Marriage may allow for inheritance rights between spouses, but what if there is nothing to inherit?

While I would not go as far as Mattilda to say that I oppose the CA marriage decision, I agree with her that a movement so focused on marriage is not a movement that represents my activism and interests. She also makes the important point that marriage is not a cure-all. So many problems exist in our society that deserve our attention and it’s upsetting to me to see the majority of the resources of our movement being allocated to marriage-only fights. Social benefits should not only be afforded to those who enter into long-term romantic partnerships. I said as much on a recent segment of NPR’s Here and Now.

Thankfully there are groups and activists who are working for a broader vision of what marriage equality might look like. Queers for Economic Justice put out a Beyond Marriage statement in 2006, with pages of important sign-ons in support of their principles:

The current debate over marriage, same-sex and otherwise, ignores the needs and desires of so many in a nation where household diversity is the demographic norm. We seek to…diversify and democratize partnership and household recognition. We advocate the expansion of existing legal statuses, social services and benefits to support the needs of all our households.

As a queer Latina working in the reproductive justice movement, my vision of social justice focuses on putting the needs of the most marginalized members of our community at the center of our organizing. The current marriage-focused movement fails to do this. Issues like universal health care, immigration reform, comprehensive sex education, ending gender-based discrimination and violence are central to my activism and I would love to see a queer movement that reflected these values as well.


DSMV Controversy

June 5, 2008

I posted about this yesterday over at Feministing, and I wanted to link here in case you didn’t see it. There was some really good conversation in the comments, be sure to check it out.

An exerpt:

The American Psychiatric Association appointed members at the beginning of May to the Committee on Sexual and Gender Identity Disorders for the revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

This committee will be reexamining the DSM-V, which is the manual of mental disorders that controls the diagnosis and treatment of gender and sexual difference. It was a big deal when homosexuality was declassified as a disorder, and some queer and trans activists are calling for gender identity dysphoria to be similarly declassified.

Since then, lots of people have been expressing their concern about two particular appointments: Ray Blanchard and Kenneth Zucker (who has been appointed as chair).

From Rea Carey, Acting Executive Director, National Gay and Lesbian Task Force

We are very concerned about these appointments. Kenneth Zucker and Ray Blanchard are clearly out of step with the occurring shift in how doctors and other health professionals think about transgender people and gender variance. It is extremely disappointing and disturbing that the APA appears to be failing in keeping up with the times when it comes to serving the needs of transgender adults and gender-variant children.

Read the rest of the post over at Feministing.


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