From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers

BMC Pregnancy and Childbirth

Research

Jae Sevelius¹  Juno Obedin-Maliver²  Alexis Hoffkling³ 

[1] Center for Excellence in Transgender Health, University of California San Francisco, 550 16th Street, 94158, San Francisco, CA, USA;Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 550 16th Street, 94158, San Francisco, CA, USA;Department of General Internal Medicine, San Francisco Department of Veterans Affairs, 4150 Clement Street, Building 18, 111A1, 94142, San Francisco, CA, USA;School of Medicine, University of California San Francisco, 2926 Otis St., 94703, Berkeley, CA, USA;

关键词: Transgender;    Pregnancy;    Stigma;    Transsexual;    Female-to-male;    Reproduction;    Lactation;   

DOI  :  10.1186/s12884-017-1491-5

来源: Springer

【 摘 要 】

BackgroundSome transgender men retain their uterus, get pregnant, and give birth. However, societal attitudes about gender have erected barriers to openly being pregnant and giving birth as a transgender man. Little research exists regarding transgender men’s reproductive needs. Anecdotal observations suggest that social change and increasing empowerment of transgender men may result in increasing frequency and openness about pregnancy and birth. Specific needs around conception, pregnancy, and newborn care may arise from transphobia, exogenous testosterone exposure, or from having had (or desiring) gender-affirming surgery. We undertook a qualitative study to understand the needs of transgender men who had given birth.MethodsWe interviewed 10 transgender men who had been recruited for a recently published online cross-sectional survey of individuals (n = 41). Subjects had given birth while identifying as male. Interviews were recorded, transcribed, and systematically coded. Analysis used a priori and emergent codes to identify central themes and develop a framework for understanding participant experiences.ResultsParticipants reported diverse experiences and values on issues including prioritization and sequencing of transition versus reproduction, empowerment in healthcare, desire for external affirmation of their gender and/or pregnancy, access to social supports, and degree of outness as male, transgender, or pregnant. We identified structural barriers that disempowered participants and describe healthcare components that felt safe and empowering. We describe how patients’ strategies, and providers’ behaviors, affected empowerment. Anticipatory guidance from providers was central in promoting security and empowerment for these individuals as patients.ConclusionsRecognizing diverse experiences has implications in supporting future patients through promoting patient-centered care and increasing the experiential legibility. Institutional erasure creates barriers to transgender men getting routine perinatal care. Identifying this erasure helps shape recommendations for how providers and clinics can provide appropriate care. Specific information regarding reproduction can be helpful to patients. We provide recommendations for providers’ anticipatory guidance during the pre-transition, pre-conception, prenatal, and postpartum periods. Ways to support and bring visibility to the experience of transgender men are identified. Improving clinical visibility and affirming gender will likely enhance patient experience and may support patient-centered perinatal healthcare services.

【 授权许可】

CC BY   
© The Author(s). 2017