Trans Reproductive Rights

Full access to reproductive rights are a luxury which many transgender people do not have. Through a lack of support and access to fertility preservation technology, trans people are dissuaded from becoming parents. Bias in the medical system, in addition to systemic barriers prevent an equal access to reproductive freedoms.

Terminology

1. Transgender describes someone's gender identity that differs from the gender they were assigned at birth.
2. Cisgender is a word that describes someone who does identify with the gender they were assigned at birth
3. Assigned male/assigned female at birth relates to how an infant is placed in a designated gender category when they are born, based off of their external genitalia. This terminology is more inclusive of different bodies, and thus preferable to terms like "biologically female." It allows for an understanding that everyone is forcibly assigned a gender, and some may choose to reject that.
4. Medical Transition is the process of seeking out medical care in order to change the individual's body to align better with their ideal gender presentation. A trans person may choose to transition socially, yet not medically.
5. Hormone Replacement Therapy (HRT) is an aspect of medical transition. It involves prescribing sex hormones testosterone and estrogen/progesterone to trans patients to give them more masculine/more feminine traits.
6. Misgendering is the act of mistaking the gender of an individual, trans or cis. It is often a painful experience for the subject.
7. While there is a distinction between the terms gender and sex, with gender being understood as the social construct and personal identity, and sex being the biological component, this notion is further complicated when one gains understanding that the binary categories of sex are also constructed.

History

The use of hormones to create feminized/masculinized traits emerged out of the 1920s with the research of Magnus Hirschfeld. Hirschfeld's Institut für Sexualwissenschaft, or Institute of Sexuality as Scientific Study, provided the beginnings of what would come to be known as trans healthcare. In Hirschfeld's institute, scientists researched the effects of sex hormones on the body, and applied that knowledge to the trans patients. Unfortunately, in 1933 with the rise of the Nazi party and right-wing censorship, the institute was burned down and most of the research lost. Thus, most of the knowledge we now have about medical transition are things that have had to be re-learned. Experts estimate that if the Institut für Sexualwissenschaft had not been destroyed, trans-specific healthcare would be decades more advanced than it currently is.

Eugenics

Restrictions imposed on certain populations can prevent or dissuade them from reproducing. In the case of transgender people in the West, it is frequently a combination of lack of financial support, lack of access to affordable reproductive technology, and barring trans people from adopting children which prevents trans people from becoming parents. Because of the nature of hormone replacement therapy, sterilization or reduced fertility is often a side effect. This results in difficulty conceiving, which complicates the process of trans people having biological children. Restrictions placed on who can adopt also hinders the process of trans people becoming parents. In Sweden, France, and other European nations, transgender people are explicitly named as unfit parents and require sterilization to change their legal gender marker, the gender listed on all the government-issued documents.

Reproductive Technologies

Hormone Replacement Therapy

HRT involves adding sex hormones to a body that does not naturally produce it in such high amounts. For a trans woman, this could look like ingesting estrogen pills and antiandrogens in order to gain a more feminized appearance. Side effects of high levels of estrogen in trans women usually include reduced sperm count or infertility. In trans men, high levels of testosterone for several years can cause the ovaries to atrophy, making conception difficult without reproductive assistance. While these side effects can be serious, they are usually not deterrent to trans people who want to pursue medical transition. Ideally, there would be some kind of system in place to provide accessible fertility preservation for trans people who may want children in the future, but at the moment, no such service exists for trans people that is free of cost. To compare HRT to other forms of medical treatment that affect fertility, cancer patients receive much more support in cryopreserving their reproductive tissues before they start radiation therapy. Furthermore, fertility preservation methods are often expensive, with cryopreserving ova running on an average upwards of $6,000. With the disproportionately high poverty levels that most trans people face, this is not a feasible option for most aspiring parents.

Accessing Medical Care

Reproductive healthcare is often gendered, which makes accessing the services difficult for trans individuals. Many fertility care and pre-, ante-, and post-natal care providers assign genders to the bodies of the patients in their care, which can result in transgender patients being misgendered when they are interpreted as a gender they are not. The assumption that all people who give birth are women, and all people who create sperm are men, is harmful, cisnormative, and unfortunately commonplace in the medical field. The medical field is not devoid of bias either. Doctors have the power to prevent trans people from accessing life-changing surgeries or access to hormones. In the reproductive care field, healthcare professionals have a history of denying the gender identities of their patients. In 2015, midwives from across North America signed an open letter expressing their concern that language surrounding pregnancy and childbirth had moved from centering women to becoming more inclusive. The inclusion of pregnant transgender people was perceived as a threat, and part of the medical community came together to prevent their inclusion.

Adoption and Alternatives to Pregnancy

With so many hurdles coming in between transgender people and conceiving biological children, many opt for adopting children instead. Unfortunately, they face barriers here as well. The state aims to reproduce its cisheteronormative family structures, which results in many prospective LGBT parents either waiting a long time before being approved, or never being approved for adoption. If an individual has officially changed their legal gender marker, the state retains a record of that change. Furthermore, the financial cost of adoption is very high, barring low income families from the practice. It is through these methods of bureaucracy and retention of support that the state controls who can and cannot reproduce and raise families.

Notes

1. Dunne, Peter Transgender Sterilisation Requirements in Europe
2. Alison W. Loren, Pamela B. Mangu, Lindsay Nohr Beck, Lawrence Brennan, Anthony J. Magdalinski, Ann H. Partridge, Gwendolyn Quinn, W. Hamish Wallace, and Kutluk Oktay Fertility Preservation for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update Journal of Clinical Oncology
3. Fertility Clinic in Vancouver, Olive Fertility

References

• Cardenas, Micha Pregnancy: Reproductive Futures in Trans of Colour Feminism Transgender studies quarterly (2016)
• Dunne, Peter Transgender Sterilization Requirements in Europe Medical Law Review, Volume 25, Issue 4, 1 November 2017, Pages 554–581,
• Alison W. Loren, Pamela B. Mangu, Lindsay Nohr Beck, Lawrence Brennan, Anthony J. Magdalinski, Ann H. Partridge, Gwendolyn Quinn, W. Hamish Wallace, and Kutluk Oktay Fertility Preservation for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update Journal of Clinical Oncology (2013)
• Dyck, Erika. Lux, Maureen. Population Control in the “Global North”?: Canada’s Response to Indigenous Reproductive Rights and Neo-Eugenics The Canadian Historical Review (2016)
• Garwood, Eliza Reproducing the Homonormative Family: Neoliberalism, Queer Theory and Same-sex Reproductive Law Journal of International Women’s Studies Vol. 17, No. 2 February 2016
• Kenyon, Gail, Chong, Kerry-Ann, Enkoff-Sage, Melanie. Public Adoption by Gay and Lesbian Parents in North Carolina: Policy and Practice. Families in Society: The Journal of Contemporary Social Services: 2003, Vol. 84, No. 4, pp. 571-575. (2003)
• Joynt, Chase. Bryson Mary. RESISTERECTOMY (2012)
• Malacrita, Claudia Eugenics and Sexuality - A special hell : institutional life in Alberta's eugenic years University of Toronto Press (2015)
• Mancini, Elena Magnus Hirschfeld and the Quest for Sexual Freedom: A History of the First International Sexual Freedom Movement. Critical Studies in Gender, Sexuality, and Culture (2010)
• Mertus, Jennifer B. Barriers, Hurdles, and Discrimination: The Current Status of LGBT Intercountry Adoption and Why Changes Must Be Made to Effectuate the Best Interests of the Child 39 Cap. U. L. Rev. 271 (2011)
• Women-Centered Midwifery, Open Letter to the Midwives of North America, 2015