Abortion experiences and preferences of transgender, nonbinary, and gender-expansive people in the United States

Abstract

Background Transgender, nonbinary, and gender-expansive (TGE) people who were assigned female or intersex at birth experience pregnancy and have abortions. No data have been published on individual abortion experiences or preferences of this understudied population. Objective(s) To fill existing evidence gaps on the abortion experiences and preferences of TGE people in the United States to inform policies and practices to improve access to and quality of abortion care for this population. Study Design In 2019, we recruited TGE people assigned female or intersex at birth and aged 18 years and older from across the United States to participate in an online survey about sexual and reproductive health recruited through The PRIDE Study and online postings. We descriptively analyzed closed- and open-ended survey responses related to pregnancy history, abortion experiences, preferences for abortion method, recommendations to improve abortion care for TGE people, and respondent sociodemographic characteristics. Results The majority of the 1,694 respondents were less than 30 years of age. Respondents represented multiple gender identities and sexual orientations and resided across all four United States Census Regions. Overall, 210 (12%) respondents had ever been pregnant; these 210 reported 421 total pregnancies, of which 92 (22%) ended in abortion. For respondents’ most recent abortion, 41 (61%) were surgical, 23 (34%) were medication, and 3 (4.5%) used another method (primarily herbal). Most recent abortions took place at or before nine weeks gestation (n=41, 61%). If they were to need an abortion today, respondents preferred medication abortion to surgical abortion three to one (n=703 versus n=217), but 514 (30%) respondents did not know which method they would prefer. Reasons for medication abortion preference among the 703 respondents included a belief that it is the least invasive method (n=553, 79%) and the most private method (n=388, 55%). To improve accessibility and quality of abortion care for TGE patients, respondents most frequently recommended that abortion clinics adopt gender-neutral or gender-affirming intake forms, that providers utilize gender-neutral language, and that greater privacy be incorporated into the clinic. Conclusion(s) These data contribute significantly to the evidence base on individual experiences of and preferences for abortion care for TGE people. Findings can be used to adapt abortion care to better include and affirm the experiences of this underserved population.

Easing of Regulatory Barriers to Telemedicine Abortion in Response to COVID-19

“…This is certainly true of abortion, as people living in poverty and those who face systematic discrimination by governments lack access to contraception and are more likely to experience unwanted pregnancy and seek abortion, even under unsafe conditions. Abortion is needed by people who face stigma, stereotyping, and discrimination in other aspects of their lives—predominately women, as well as transgender, non-binary, and gender-expansive individuals ( 8 ). Globally, rates of unintended pregnancy are higher in poorer countries, and researchers have identified an inverse relationship between unintended pregnancy and income ( 9 ).…”

“I’ll just deal with this on my own”: a qualitative exploration of experiences with self-managed abortion in the United States

“…This study concluded that 7% (95% CI: 5.5–8.4%) of self-identified women in the US will attempt SMA at some point in their lives [ 8 ]. The prevalence of SMA may be even higher in certain subgroups of the populations; a recent study exploring abortion attempts without clinical supervision among transgender, nonbinary, and gender-expansive people in the US found that 36% and 19% of ever-pregnant study participants reported considering and attempting SMA, respectively [ 9 ]. Evidence suggests that SMA occurs across the US in both states with restrictive and supportive abortion policy landscapes [ 8 , 10 ].…”

“…They include fear of abortion stigma, a preference for privacy and autonomy, receiving recommendations for informal methods from family or friends, and logistical challenges to accessing facility-based care such as lack of transport or funds [ 2 , 10 , 13 , 14 ]. People who are young, less knowledgeable about abortion legality, and/or identify as transgender, nonbinary, or gender-expansive are some of those shown to be particularly interested in SMA [ 2 , 9 , 15 ]. For the latter group, concerns about accessing facility-based care may be related to intimate partner violence, refusals of care from providers, and barriers to insurance coverage tied to gender markers [ 9 ].…”

“…People who are young, less knowledgeable about abortion legality, and/or identify as transgender, nonbinary, or gender-expansive are some of those shown to be particularly interested in SMA [ 2 , 9 , 15 ]. For the latter group, concerns about accessing facility-based care may be related to intimate partner violence, refusals of care from providers, and barriers to insurance coverage tied to gender markers [ 9 ].…”

“It’s a walk of shame”: Experiences of unintended pregnancy and abortion among sexual- and gender-minoritized females in urban India

“…24 Self-management through the use of medication, or in some cases use of herbs, was also perceived to be less invasive and to offer more privacy than clinicbased abortion. 25 This may be particularly salient in settings that do not have competency in transgender or gender-inclusive health care. 28 Research with SGMF in India has documented how stigma related to sexual and/or gender identity affects some aspects of reproductive health and sexual autonomy, including family formation, intimate and family relationship support, and access to contraception.…”