Resources for trans pregnancy a cause for optimism

Cover of the Trans and Non-Binary Experiences of Maternity Services report. Cover art depicts two Black transmasculine people - one standing and smiling with a visibly pregnant belly, and the other is kneeling next to them and has their face pressed against the belly, with their eyes closed and a peaceful expression on their face. The title text and clothing for the people on the cover uses the colours of the non-binary flag - yellow, black, white, and purple.

There have been some really exciting developments in England over the last couple of months for trans birth parents (that is: men and non-binary people who conceive, carry, and give birth to their own children).

In April, a groundbreaking report on Trans and Non-Binary Experiences of Maternity Services was published by the LGBT Foundation. I am really proud to have co-authored parts of this report with colleagues in NHS England and the LGBT Foundation, and to have supported the research which informs it.

The report, which was funded by NHS England, offers a sobering account of healthcare inequalities for trans birth parents. However, it also includes important examples of good practice and recommendations for professionals.

  • Trans people’s experiences of perinatal care are consistently worse across the board compared with cis women.
  • 30% of trans birth parents didn’t access perinatal healthcare at all during pregnancy – this compares to less than 2.1% of the general population.
  • Transphobia and racism in perinatal care intersect to produce particularly poor outcomes for trans parents of colour.
  • Recommendations include: supporting the delivery of personalised and trauma-informed perinatal care; proactively adopting inclusive language and targeting outreach to trans birth parents; and implementing IT and demographic monitoring systems to enable the sensitive collection of data about gender identity and trans status in perinatal services.

Excitingly, it appears that work is already underway on many of these points. For example, last year a fabulous series of resources for practitioners were published by Brighton and Sussex Gender Inclusion Midwives, and I have heard good things about progress on trans-inclusive data collection.

Best of all, NHS England now provide a range of tailored, accessible advice to trans parents as part of their new guide to having a baby if you’re LGBT+. This includes ways to become a parent, advice on testosterone and pregnancy, and chestfeeding/breastfeeding for men and transmasculine non-binary people.

These resources should really be seen as a starting point (for example, there is no advice for trans women who breastfeed). But equally, it is brilliant to see progress being made on the provision of practical advice that will help prospective and new parents. I am especially grateful to an NHS whistleblower who ensured their dissemination through revealing to The i that their publication had been blocked by some senior figures at NHS England for nearly a year.

This all serves as an important reminder that NHS England is not a monolith, and that concerted pressure from community groups and allies can have real long-term benefits.

It’s very easy to be cynical about our NHS given the poor overall state of trans healthcare, as well as opposition to equitable provision by some within the health service. However, all the positive moves I have reported in this post are also the result of hard work by numerous NHS midwives and members of the NHS digital team. Alongside community members who generously offered their time and knowledge, they have collectively fought to ensure that trans birth parents and the practitioners who work with them have access to resources and information.

All of this makes me feel hugely optimistic. These are difficult times, in which prejudice and disinformation are rife. Yet ordinary people are still fighting – successfully! – for positive change. This new research and guidance should be of great help to new parents and their children, and for that we can be grateful.

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