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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Transgender Day of Remembrance

November 20, 2012

Today is Transgender Day of Remembrance, where those transgender people who have passed on, whether due to violence, discrimination or suicide are remembered and honored.

Last week was also Transgender Awareness Week, organized by Fenway Health in Massachusetts.

I’ve been working for weeks now on a long article about the transgender community, so I’ve been knee deep in interviews and research about transgender people in the United States.

It’s depressing, to say the least. Experiences of discrimination are frighteningly widespread. Health disparities abound. Violence is a common fact of life.

But there is also much resilience, much hope, much strength in the transgender community. There is much knowledge that the arc of history bends towards justice, and that the transgender struggle lives in all of us who understand how ideas of gender limit all of us.

I wrote about discrimination and transgender health disparities last week at RH Reality Check, which you can read here. The discrimination that transgender people face impacts their health in serious ways, and when race is factored in, the disparities are even greater.

But on this day of solemnity and remembrance, let us also remember perseverance and strength. For every person who has passed on, there are many more who are thriving and surviving.

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New column: Preparing for the trans baby boom

June 20, 2012

My latest column for RH Reality Check was published this week. An excerpt:

This shift in attention toward the issues facing trans and gender non-conforming pregnancy is indicative of a bigger shift overall — more and more trans and gender non-conforming people are giving birth. As Pati Garcia, a Los Angeles doula and midwife-in-training put it during our panel: “We’re on the cusp on a trans baby boom.”

Trans health as an overall field is still in its nascency. Our understanding of hormone therapies, gender reassignment surgeries, and much more is still being developed, so it’s no surprise that the field of pregnancy and parenting for trans people is also new and developing.

Within the needs of trans people in pregnancy and birth is the challenge of addressing what seems like an obvious connection: between pregnancy and femaleness. Trans people are often neglected in the arena of pregnancy and birth because of the strongly-held notion that only female-identified people experience pregnancy and birth. While not all trans people, whether they were assigned female at birth or not, can experience pregnancy (because of infertility or hysterectomy), some can and do, prompting the need for our pregnancy and birth providers to accommodate.

It’s not easy, as it’s a process that is intensely gendered. Everything from maternity clothes to the language of health care providers carries the assumption that the pregnant person identifies as female (and often that the other parent identifies as male). Language is an obvious barrier from the get-go: maternal health, pregnant women, all of the language associated with pregnancy and birth is gendered. From body parts to actors, all is coded in a way that would make a pregnant person who is not identified as a female feel uncomfortable.

Read the whole article here.

It was inspired by my panel at the Philadelphia Trans Health Conference, so big props to Pati Garcia (aka Chula Doula), Ryan Pryor, Abigail Fletcher and Lucia Leandro Gimeno, my co-panelists. It was an amazing conversation about trans and gender non-conforming centered midwifery and doula care. And the room was full! I love how many more people are focusing on these intersections, because there is much work to be done.


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