Guest post: Trans access to abortion

A genderqueer person in a hospital gown looking up and receiving a pelvic exam.
Image from The Gender Spectrum Collection

I am super excited to present today’s guest blog. Kelvin Sparks is an intersex trans man whose pronouns are he/him/his, and he runs a brilliant sex blog full of toy reviews and sex-education-y essays. You can also find him on Twitter, where he says clever and insightful sex positive things things – which have recently included the importance of inclusive language around reproductive healthcare. As a cis woman, while I feel helpless about the attack on abortion rights just now, I also recognise my own privilege when it comes to being included in these conversations. Because of this, I reached out to Kelvin to ask if he would write something for me on trans access to abortion. He absolutely didn’t disappoint.

Following the bill signed into Alabama law on the 15th of May, discussion of reproductive rights has taken over social media. While reproductive rights and justice are causes close to my heart, I’ve definitely been avoiding some of the discussions that have sprouted across social media because of the cissexism involved in them.

I understand, historically, why abortion is framed as a “women’s issue” by people who advocate for abortion and reproductive rights, especially given the movement’s origin in the 1960s and 70s. But here, in 2019, reproductive rights advocates not only can do better, but must do better. While abortion restrictions are partly the result of structural misogyny, not everyone impacted by these restrictions is a woman. There are trans men and non-binary people who need abortion access just as much as cisgender women do, and who are impacted just as much by abortion restrictions.

Why Abortion Restrictions Impact Trans People Too

When I bring up the idea that trans people may need to access abortion as much as cisgender women, a lot of cis people are surprised, because they assume that transitioning makes it impossible for AFAB trans people to become pregnant. This is very much not the case.

Firstly, some trans people do not want medical interventions that impact their fertility, such as hysterectomies or genital reconstruction surgeries. Even if they do want them, these procedures are often difficult to access. In the US, metodioplasty can cost up to $60,000 and phalloplasty as much as $150,000. In the UK, while these procedures are available on the NHS, the wait to receive them may be up to a decade. Even accessing a hysterectomy on the NHS requires a referral to a Gender Identity Clinic, with waits for a first clinic appointment often over two years. This leaves many AFAB trans people capable of being pregnant, even if they would prefer otherwise.

While some people believe that going on testosterone hormone replacement therapy always renders transmasculine people sterile, this isn’t the case. There’s very little data on the actual impact of testosterone on fertility, and there have been plenty of cases where trans men on HRT have become pregnant. And again, like with bottom surgery and hysterectomy, there are plenty of AFAB trans people who don’t want this kind of gender affirming medical intervention.

Trans men and non-binary people assigned female at birth do experience unplanned pregnancies.  6% of the 450 AFAB trans people involved in a 2018 study experienced unplanned pregnancies, for example. (For comparison, in the US, 5% of cisgender women of reproductive age experience unplanned pregnancies in a given year)

Trans people are just as able to have unwanted and unplanned pregnancies as cis women are, and we are therefore just as impacted by restrictions on abortion access as cis women are. So called  “heartbeat bills” that restrict abortion, and total abortion bans all impact the lives of transgender people who are not women. However, on top of this, trans people often face barriers to accessing abortion beyond those that cis women do.

Trans Specific Abortion Access Issues

While some of the specific issues that impact trans people’s access to abortion are the result of society’s transphobia in general, others are directly related to the framing of abortion as a “women’s issue”, such as the difficulty of finding trans friendly abortion providers, and potential difficulty with gendered medical insurance policies.

While gender neutralising your language around reproductive healthcare and abortion rights is a good start at making your activism inclusive, activism that wants to be truly trans inclusive should take these extra access issues into account.

For an example of an access issue impacted by society-wide transphobia, take the fact that trans people may face an economic barrier to abortion access into account. In the US, the cost of an abortion may be up to (and in some cases, more than) $950, not including transport, which may need to be out of state. Trans people in the US are more than twice as likely to live in poverty than the general population, making abortions hard to afford for those who don’t have access to national healthcare or insurance, especially if they have to travel out of state to access an abortion.

Another barrier that is trans specific, and related to the focus on abortion as a ‘women’s issue’ is that of gendered healthcare policy. Plenty of AFAB trans people have changed their legal gender marker to either M or X, depending on the options available to them. Insurance companies completing post-payment audits may flag up procedures that ‘do not match’ a male gender marker, such as hysterectomy or abortion procedures, and refuse to pay for them. Issues around access to pap smears and hysterectomies in transmasculine people who have changed their gender marker aren’t uncommon, and only 12 states in the US legislate against this.

Even when trans people are able to access abortions, we still face transphobia in healthcare. In the UK, where healthcare is nationalised, 7% of trans people were refused healthcare because of their trans status in 2018, and a similar amount (8%) from the US report being refused healthcare because of their trans status. Even when we are not refused care, we may be misgendered or harassed by staff members. These kinds of microaggressions can make accessing healthcare even more stressful and difficult for trans people than it is for cis women.

How to Be An Ally to Trans People in Reproductive Rights Activism

Firstly, the absolute minimum is to be gender neutral when talking about abortion access. It’s possible to discuss the misogyny in the ideologies that lead to these kinds of restrictions without implying that all people impacted by abortion restrictions are women (or, indeed, that these restrictions are being pushed only by men and there are no women who are complicit- the Alabama restrictions were signed into law by a woman, and the primary sponsor of the bill is also a woman).

Secondly, campaign for abortion access rights locally. While a lot of the discussion around abortion rights has been US focused, remember that the fight for reproductive rights is a global fight. For example, if you’re in the UK, remember that there are people in our country who do not have access to legal abortion. People in Northern Ireland can face life in prison for having an abortion. Write to your MP about it- there’s an email form here that takes two minutes to fill out. And if you’re based anywhere else outside of the US, look for local battles for abortion rights that need your help.

And thirdly, include trans specific reproductive rights issues in your reproductive rights activism. Join campaigns against mandatory sterilisation for trans people (which at the time of writing, still impacts trans people in 14 European countries, and many more worldwide). Campaign to extend legislation against gendered insurance restrictions beyond the 12 states it currently exists in. Campaign for anti-discrimination laws, so that trans people have some protection against being turned away from reproductive healthcare.

 

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