The Imperative for Transgender and Gender Nonbinary Inclusion

Moseson, Heidi; Zazanis, Noah; Goldberg, Eli; Fix, Laura; Durden, Mary; Stoeffler, Ari; Hastings, Jen; Cudlitz, Lyndon; Lesser-Lee, Bori; Letcher, Laz; Reyes, Aneidys; Obedin‐Maliver, Juno

doi:10.1097/aog.0000000000003816

Cited by 143 publications

(124 citation statements)

References 27 publications

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“…It might be interpreted in different ways depending on what "sex" means to a given participant; this could include sexual activity that leads to pregnancy and sexual activity that cannot lead to pregnancy (e.g., sex between two cisgender women where no sperm is released in or near a vagina). These question design shortcomings could lead participants to [1] skip questions that seem irrelevant to their personal experiences; [2] answer a question differently than intended due to different definitions between participants and study investigators; or [3] drop out of a study that does not allow them to accurately convey their experiences or that reflects fundamental misunderstandings about their lives. Taken together, these situations could lead to more missing data, more response misclassification, or both.…”

Section: Plos Onementioning

confidence: 99%

“…The ways in which we conduct research have implications for data quality and inferential value. [1] The quality and completeness of participant-reported information is intimately related to participants' direct experience. [2][3][4] Participant experience, in turn, is influenced by whether participants feel respected, confident in and trusting of the study investigators, and invested in the study topic.…”

Section: Introductionmentioning

confidence: 99%

“…Much sexual and reproductive health (SRH) research has made assumptions about the gender identity and sexual orientation of research participants and their sexual partners that raise concerns about data quality. [3-5, 14, 15] These problematic assumptions include: [1] research participants described as "women" explicitly include only cisgender women, thereby ignoring transgender women and nonbinary people; [2] the sexual and/or romantic partners of "women" are only cisgender men (and not cisgender women, transgender men, transgender women, nonbinary people, and/or those of another gender identity); and [3] sexual activity is assumed to refer only to sex that could lead to pregnancy or specific presentations of sexually-transmitted infections, ignoring other forms of sex that people have. Examples of these assumptions are easily found in widely used demographic, public health, and SRH surveys, both nationally and internationally.…”

Section: Introductionmentioning

confidence: 99%

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Development of an affirming and customizable electronic survey of sexual and reproductive health experiences for transgender and gender nonbinary people

et al. 2020

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To address pervasive measurement biases in sexual and reproductive health (SRH) research, our interdisciplinary team created an affirming, customizable electronic survey to measure experiences with contraceptive use, pregnancy, and abortion for transgender and gender nonbinary people assigned female or intersex at birth and cisgender sexual minority women. Between May 2018 and April 2019, we developed a questionnaire with 328 items across 10 domains including gender identity; language used for sexual and reproductive anatomy and events; gender affirmation process history; sexual orientation and sexual activity; contraceptive use and preferences; pregnancy history and desires; abortion history and preferences; priorities for sexual and reproductive health care; family building experiences; and sociodemographic characteristics. Recognizing that the words people use for their sexual and reproductive anatomy can vary, we programmed the survey to allow participants to input the words they use to describe their bodies, and then used those customized words to replace traditional medical terms throughout the survey. This process-oriented paper aims to describe the rationale for and collaborative development of an affirming, customizable survey of the SRH needs and experiences of sexual and gender minorities, and to

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Section: Plos Onementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Development of an affirming and customizable electronic survey of sexual and reproductive health experiences for transgender and gender nonbinary people

et al. 2020

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“…Trans* people may avoid healthcare facilities due to history of trauma as well as clinicians’ lack of understanding of their health concerns. 26 Trans* people report the need for more supportive resources and to educate their clinicians on their reproductive health. 26 , 27…”

Section: Reflective Casesmentioning

confidence: 99%

“… 26 Trans* people report the need for more supportive resources and to educate their clinicians on their reproductive health. 26 , 27…”

Section: Reflective Casesmentioning

confidence: 99%

True Choice in Reproductive Care: Using Cultural Humility and Explanatory Models to Support Reproductive Justice in Primary Care

2020

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Reproductive justice is the human right to maintain personal bodily autonomy, have children, not have children, and to parent children in safe and sustainable communities. Historically, marginalized individuals have experienced reproductive oppression in multiple forms. This oppression continues in modern times through health policy and patient-clinician communication. To combat this, the framework of reproductive justice outlines four key actions: analyzing power systems, addressing intersecting oppressions, centering the most marginalized, and joining together across issues and identities. Primary care clinicians have a unique role and responsibility to carry out these four key actions in order to provide patient centered reproductive care. To translate reproductive justice into clinical practice, clinicians care can use reflective practice, the framework of cultural humility, and the concepts from the explanatory model of illness.

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Disparities in Mistreatment During Childbirth

Liu,

Underhill,

Aubey

et al. 2024

JAMA Netw Open

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ImportanceLack of respectful maternity care may be a key factor associated with disparities in maternal health. However, mistreatment during childbirth has not been widely documented in the US.ObjectivesTo estimate the prevalence of mistreatment by health care professionals during childbirth among a representative multistate sample and to identify patient characteristics associated with mistreatment experiences.Design, Setting, and ParticipantsThis cross-sectional study used representative survey data collected from respondents to the 2020 Pregnancy Risk and Monitoring System in 6 states and New York City who had a live birth in 2020 and participated in the Postpartum Assessment of Health Survey at 12 to 14 months’ post partum. Data were collected from January 1, 2021, to March 31, 2022.ExposuresDemographic, social, clinical, and birth characteristics that have been associated with patients’ health care experiences.Main Outcomes and MeasuresAny mistreatment during childbirth, as measured by the Mistreatment by Care Providers in Childbirth scale, a validated measure of self-reported experiences of 8 types of mistreatment. Survey-weighted rates of any mistreatment and each mistreatment indicator were estimated, and survey-weighted logistic regression models estimated odds ratios (ORs) and 95% CIs.ResultsThe sample included 4458 postpartum individuals representative of 552 045 people who had live births in 2020 in 7 jurisdictions. The mean (SD) age was 29.9 (5.7) years, 2556 (54.4%) identified as White, and 2836 (58.8%) were commercially insured. More than 1 in 8 individuals (13.4% [95% CI, 11.8%-15.1%]) reported experiencing mistreatment during childbirth. The most common type of mistreatment was being “ignored, refused request for help, or failed to respond in a timely manner” (7.6%; 95% CI, 6.5%-8.9%). Factors associated with experiencing mistreatment included being lesbian, gay, bisexual, transgender, queer identifying (unadjusted OR [UOR], 2.3; 95% CI, 1.4-3.8), Medicaid insured (UOR, 1.4; 95% CI, 1.1-1.8), unmarried (UOR, 0.8; 95% CI, 0.6-1.0), or obese before pregnancy (UOR, 1.3; 95% CI, 1.0-1.7); having an unplanned cesarean birth (UOR, 1.6; 95% CI, 1.2-2.2), a history of substance use disorder (UOR, 2.6; 95% CI, 1.3-5.1), experienced intimate partner or family violence (UOR, 2.3; 95% CI, 1.3-4.2), mood disorder (UOR, 1.5; 95% CI, 1.1-2.2), or giving birth during the COVID-19 public health emergency (UOR, 1.5; 95% CI, 1.1-2.0). Associations of mistreatment with race and ethnicity, age, educational level, rural or urban geography, immigration status, and household income were ambiguous.Conclusions and RelevanceThis cross-sectional study of individuals who had a live birth in 2020 in 6 states and New York City found that mistreatment during childbirth was common. There is a need for patient-centered, multifaceted interventions to address structural health system factors associated with negative childbirth experiences.

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The Imperative for Transgender and Gender Nonbinary Inclusion

Abstract: Personal or nonessential information may be redacted at the editor's discretion.

Cited by 143 publications

References 27 publications

Development of an affirming and customizable electronic survey of sexual and reproductive health experiences for transgender and gender nonbinary people

Development of an affirming and customizable electronic survey of sexual and reproductive health experiences for transgender and gender nonbinary people

True Choice in Reproductive Care: Using Cultural Humility and Explanatory Models to Support Reproductive Justice in Primary Care

Disparities in Mistreatment During Childbirth

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