By Shelby Frye
2021 saw more attacks on reproductive health than any year since Roe v. Wade was decided in 1973, most notably in the restrictive abortion bills from Texas and Ohio. Protests are sweeping across the country, and activists are organizing to protect reproductive rights. However, in a world dominated by binaries, LGBTQIA+ people are often left on the sidelines— and the reproductive justice movement is no exception.
When talking about reproductive rights, it can be easy to slip into the traditional male-female, gay-straight binary we are taught from a young age. Though most trans, nonbinary, bisexual, and other LGBTQIA+ folks have the capacity to get pregnant, they are less likely than cisgender women to have access to reproductive healthcare or be the focus of reproductive health research. If the reproductive justice movement is to effectively fight for bodily autonomy, it’s imperative that we include people of all genders and sexualities, from language to research, to medical care to activism.
Difficulty Accessing Care
Quality reproductive health care is often hard to access for LGBTQIA+ people, sometimes because of outright discrimination. Lambda Legal reports that nearly 56% of gay, lesbian, or bisexual folks have experienced discrimination from a healthcare professional, including physical abuse and denial of medical care. That number jumps to 70% for trans or genderqueer patients. These negative experiences discourage the LGBTQIA+ community from seeking out reproductive care for fear of continued mistreatment.
Even when healthcare professionals are well-intentioned, they often don’t have the cultural awareness or medical knowledge needed to appropriately treat LGBTQIA+ patients. In a 2020 study interviewing nonbinary and trans folks assigned female at birth, interviewees reported doctors who either didn’t know about their specific needs or made assumptions about them, leading to a lack of contraceptive care. Specifically, both doctors and patients knew little about the impacts of testosterone on the ability to get pregnant, incorrectly assuming that people who take testosterone can’t get pregnant.
Apart from substandard care, LGBTQIA+ individuals are also more likely to be uninsured, and thus may struggle to access reproductive health services at all. Even with insurance, providers may deny care based on indicated gender. For instance, because contraceptive coverage for biological males is not covered by insurance, trans men might be denied contraceptive access despite their ability to get pregnant.
This lack of access has serious implications for queer people’s lives. Queer people with the ability to get pregnant are at a higher risk of unintended pregnancy than cisgender, straight people. The pandemic has only widened these disparities, with nearly 50% of queer women reporting difficulty accessing contraceptives or other reproductive health care during the pandemic, compared to 31% of straight women.
Both distrust in the medical establishment and general societal stigma play a role in LGBTQIA+ individuals’ lack of access to contraceptives. Queer people are often left out of the birth control conversation, so much so that they don’t see themselves as needing it. When they do have vaginal sex and seek out contraception, they are less likely to use more effective contraceptives in favor of condoms or other short-term methods. The effects of binary thinking even show up within queer communities, where sex with cisgender men might be seen as not being “actually queer” and prevent people from discussing contraception with their friends. Taking birth control, for instance, can be seen as antithetical to a queer person’s identity, making them less likely to want to take it.
So What Do We Do About It?
There are public policies that can be implemented in legislatures to make the reproductive justice movement more inclusive; for instance, inclusive sex education in schools, which can teach kids about their own bodies and identities from a young age. A May 2021 Call to Action from organizations including the Human Rights Campaign and Planned Parenthood argues that inclusive sex education can increase the use of contraceptives as well as decrease rates of unintended pregnancies, among other positive outcomes.
Efforts to decrease the number of uninsured people in this country and make healthcare more affordable could also increase LGBTQIA+ access to reproductive healthcare. For instance, uninsured rates fell among lesbian, gay, and bisexual people after the passage of the Affordable Care Act in 2016, and while reliable data doesn’t exist for gender identity, it is suggested that this is also true for trans folks.
Other strategies to improve inclusive reproductive healthcare access can also include simple reforms in the healthcare system like additional medical training on inclusive and affirming reproductive counseling for all genders and sexualities, patient education materials that use gender-inclusive language, and center the experiences of queer people, and partnerships with LGBTQIA+ communities. Promoting inclusive practices from providers will make doctors’ offices more comfortable for queer people, enabling greater, and more accurate, contraceptive access and reproductive health care.
While it won’t be easy to combat centuries of binary thinking, these reforms and others like them are imperative in ensuring reproductive health is for all people, not just heterosexual, cisgender women. By including people of all identities, advocates for reproductive rights can truly earn the title “the reproductive justice movement.”