Trans and non-binary familiesAll rights reserved by The Trans Pregnancy Care Project. Image by Huriana Kopeke-Te Aho

Gender-inclusive health services

Most people who give birth are women - but not all.

The stigma, discrimination and gendered norms in health care, are known to cause poorer health outcomes for transgender and non-binary people compared with the cisgender population. Transgender and non-binary birthing parents face barriers in accessing health services that have been designed for heterosexual women. Seeking to improve equity for this group, Associate Professor Suzanne Miller and Professor Sally Baddock from Midwifery collaborated with Dr Elizabeth Kerekere, Dr Jamie Veale and Scout Barbour-Evans in a research project led by Dr George Parker and supported by research assistant Alex Ker. 

In the first phase of the project, 20 trans and non-binary people were interviewed about their experiences of pregnancy health care services in New Zealand. They reported being made to feel invisible and excluded; one described being misgendered continuously as "death by a thousand cuts". They had strategies to try and manage the discrimination they faced, sending information about themselves prior to appointments for example, or on occasion "performing cisgender" to avoid spending clinical appointment time on discussion about their gender. They found it hard and tiring to have to advocate for themselves. Having a supportive Lead Maternity Carer midwife was crucial for them.

The research team have identified recommendations for health care professionals that will help reduce the discrimination faced by transgender and non-binary birthing parents:

  • Use gender-neutral or -additive language, verbally and in written materials, for example "women and pregnant people".
  • Use a person's preferred name and pronouns, rather than the name and sex recorded on their birth certificate.
  • Change the physical environment in which health care is provided, so that it is gender-inclusive.
  • Develop educational resources for health professionals about trans and non-binary parenting and about being gender-inclusive.
  • Be willing to learn, including from your own mistakes.

Phase 2 of the research will examine what is happening in practice, and what would help health practitioners to provide inclusive care for transgender and non-binary birthday parents and their whānau. Recommendations will inform the development of resources to help midwives provide gender inclusive care.