Black maternal health in the United States is in crisis. In 2021, Black women were 2.6 times more likely to die during pregnancy and the postpartum period than white women.1 This data is staggering, and the toll of the human suffering—immense lost potential, grieving parents and partners, motherless children—cannot be overstated. However, the data is missing an important distinction: What is happening to Black transgender, gender diverse, and non-binary birthing people when they seek care?2 What are their pregnancy outcomes? And what can we do to positively impact the perinatal health of this population?
While we don’t know the number of Black trans people who die annually in the US from pregnancy- and postpartum-related causes, we do know that this population faces discrimination and violence at a higher rate than white transgender and Black cisgender people.3 This discrimination can and does occur in the healthcare setting. As a result of living within oppressive systems, people who are Black and trans are at higher risk of issues that can complicate pregnancy if not properly addressed, such as HIV and substance use disorder.3 We can make sense of these disparate health risks by viewing them through the lens of intersectionality, a term coined by Dr. Kimberlé Crenshaw, herself a Black woman.4 Intersectionality means that no one is just their gender, or their race, or their sexual orientation, or their income, or their disability status; discrimination and privilege happen along multiple axes. In a society that prizes white, cisgender, heterosexual, male, able-bodied expression, the systems that Black trans people engage with for medical care can do a great deal of harm, both intentionally and accidentally.
But, while the medical system can do harm, there is an increasing number of providers working to ensure that their offices are a safe place for transgender patients. Because trans people have been excluded from the mainstream narrative for so long, these standards of care are still being researched and developed.5,6,7 Here are some things providers can do to ensure the best care for their transgender or non-binary perinatal patients:
- Lead with curiosity and compassion rather than judgment or assumptions. Even innocent assumptions can be harmful to a patient. When you don’t know, ask. This goes for pronouns, preferred vocabulary (i.e., “breastfeeding” vs. “nursing” or “chestfeeding”), sexual orientation, and more. As much as possible, make this the norm in your workplace for all clients and staff.
- Ensure that your patients’ name and pronouns are used at every step of care, from the waiting room to the delivery room.
- Educate yourself on the lived reality of reproductive care for trans individuals. For example, a trans man might need access to birth control, abortion services, or help conceiving. Some trans men menstruate. Learn about the interplay of testosterone hormone therapy and fertility, as well as the effects of stopping testosterone and when to resume the hormone therapy.
- Understand that, while being trans is a joyful experience, our society has left many trans folks with trauma.3 Take steps to make your workplace trauma-informed and reap the benefits for all clients and staff, regardless of gender identity.8
- Recognize and celebrate the diversity of your patients. Just like no two pregnancies are alike among cisgender women, the same is true for transgender and gender diverse patients.
By following these steps, providers can help move us all closer to birth equity. Black trans folks deserve the same thoughtful, quality care as anyone else along their pregnancy journey. The best society is one where there are no disparities, where every birthing parent leads a long, happy, healthy life with their family. Together, we can get there.
If you need gender-informed reproductive care, Metro Trans Umbrella Group has a list of providers here: https://www.stlmetrotrans.org/#medical
If you’re a provider and would like to learn more about how you can follow the recommendations in this article, reach out to BloomNetwork@generatehealthstl.org.
- https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.html
- https://transequality.org/issues/resources/understanding-transgender-people-the-basics
- https://www.thetaskforce.org/wp-content/uploads/2019/07/ntds_full.pdf
- https://www.law.columbia.edu/news/archive/kimberle-crenshaw-intersectionality-more-two-decades-later
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814572/
- https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/03/health-care-for-transgender-and-gender-diverse-individuals
- https://journals.sagepub.com/doi/full/10.1177/08912432221138086
- https://www.awcommunities.org/
