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.

Trans inequalities in English perinatal care

About a month ago I participated in the TPATH conference. This groundbreaking online event centred trans healthcare practice, research, and activism by and for trans people.

I was very impressed with the measures taken by TPATH organisers to ensure the conference was accessible to as many people as possible from around the world. They organised live translation to and from English, French, and Spanish, provided live captioning, encouraged presenters to speak slowly and clearly to enable lipreading, and ensured that generous scholarships were available for those who would not otherwise afford to attend. Most of the event was recorded, and videos are gradually being uploaded to the TPATH Youtube channel.

At the conference I joined Tash Oakes-Monger from NHS England to present initial findings from the ITEMS project (Improving Trans Experiences of Maternity Services). The ITEMS team, led by Michael Petch from the LGBT Foundation, ran a survey in early 2021 to explore the experiences of trans people (including non-binary people) who give birth in England. I supported the design and dissemination of the survey through my former role with the Trans Learning Partnership.

Bar chart indicating that increasing numbers of trans and non-binary people are giving birth in England every year.
Bar chart indicating growth in number of trans people giving birth in England each year.


There is some really exciting information emerging from the ITEMS data. For example, it appears that more trans people are giving birth than ever before (see above). However, it was also apparent that trans people face substantial inequalities.

Many of the questions in the ITEMS survey used comparable wording to the CQC Maternity Survey – from this we can see that trans people appear more likely to have negative experiences in NHS maternity services than cis women across the board. Even more disturbing is that 30% of trans respondents gave birth without the support of an NHS or private midwife (rising to 46% among trans people of colour). This indicates a lack of trust in midwifery services among prospective trans birth parents, with potentially lethal consequences for both parent and baby.

To learn more, you can watch our presentation on the TPATH Youtube channel.

A formal report of ITEMS findings should be published in the coming months.

Of trans fathers and male mothers – the importance of centering experience

By Ruth Pearce, Sally Hines, Carla Pfeffer, Damien W Riggs, Elisabetta Ruspini and Francis Ray White. Cross-posted from the Trans Pregnancy blog. An article based on this piece has been published in The Conversation.

On Wednesday 25th September the UK’s High Court ruled that Freddy McConnell, a man who gave birth to his child, does not have the right to be registered as a “father” on his child’s birth certificate. The court also ruled out the possibility of registering him simply as the “parent”. McConnell, who is trans, has indicated his intention to appeal.

We feel that this is a disappointing outcome, with concerning consequences for the dignity of trans parents and the safety of their children. The law will continue to require that people who give birth to a child in the UK are always registered as the “mother” – even if they are legally men. For example, McConnell’s legal team noted that, “Freddy is legally a man and his legal papers display the same.”

Most importantly, the verdict wrongs the human rights of the complainant and his child, through failing to provide them with consistent legal documentation and intruding on their privacy. More widely it is wrong in terms of its failure to legally recognise diverse family forms and contemporary practices of intimacy, which question traditional gendered reproductive certainties.

Yet, paradoxically, the ruling brings into being a new legal category of “mother”, which is based on reproductive experience, rather than the traditionally sex/gendered body. From today, a ‘mother’ is not defined through binary sexed characteristics. And so, a man may be a a mother as much as a woman.

Judge Sir Andrew McFarlane is explicit on this point in his ruling. For example, in his concluding comments, he states that, “the term ‘mother’ is free-standing and separate from consideration of legal gender, thus in law there can be male mothers and female fathers” (noteably, there is no distinction between “sex” and “gender” in UK law).

This is why legal cases around gender recognition are so important. Even when they seem to fail the individuals who bring them to court, they very often also radically chip away at normative understandings of gender in unforeseen and unintended ways. Such paradoxes and contradictions are subsequently brought to light, unpacked and, very often, readdressed at appeal stages.

McFarlane’s ruling, then, may be seen as the first step in the legal undoing of binary understandings of reproduction and gender, sex and the body, wherein all families of all genders and all bodies will be recognised.

This is particularly important for the trans and non-binary birth parents we have spoken with for this research project, who seek forms of legal recognition that are consistent with how they experience gender in their everyday life.

Promotional image from the film Seahorse. Photo by Mark Bushnell.

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Seahorse screening and live Q&A in Leeds

Hyde Park Picture House are hosting a screening of the documentary film Seahorse tomorrow evening (Tuesday 27 August), in association with Leeds Queer Film Festival. I will be participating in a live Q&A session afterwards, representing the Trans Pregnancy project.

The film follows the experiences of Freddy as he becomes a father:

Freddy is 30 and yearns to start a family but this poses unique challenges. He is a gay transgender man. Deciding to carry his own baby took years of soul searching, but he was unprepared for the reality of pregnancy, both physically and challenging society’s fundamental understanding of gender and family. To him what feels pragmatic, to others feels confronting; this was not part of his plan.

Against a backdrop of increasing hostility towards trans people the world over, Freddy is forced to confront his own naivety, mine unknown depths of courage and lean on every friend and family member who will stand by him.

For the Q&A, I will be joining Freddy, director Jeanie Finlay, and Yuval Topper-Erez, a member of the Trans Pregnancy project Advisory Board who became famous in Israel following his own experience of giving birth. The discussion will be chaired by BAFTA-nominated producer Mia Bays.

You can reserve a ticket for the event here.

Family Planning workshop at Trans Health Matters (23 October)

In a couple of weeks I will be attending the Trans Health Matters conference, which is held at Resource for London on Tuesday 23 October.

You can read about and book tickets for Trans Health Matters 2018 here.

Co-hosted by holistic sexual health centres cliniQ (London) and Clinic T (Brighton), this event offers an insight into cutting edge practice and research, particularly with regards to sexual and mental health.

I will be speaking at a workshop entitled Trans Family Planning: Contraception, Fertility, Pregnancy and Childbirth, alongside Kate Nambiar, Michael Toze and Francis Ray White.

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Resource for London, Holloway Road

Trans people often find there is a lack of information available on their own fertility, or that they have been misinformed about the reproductive capacity of their own bodies. Similarly, trans people wishing to form families continue to face social, legal and medical barriers to parenthood. The workshop will comprise three short interventions, reflecting on current challenges and opportunities for trans reproductive autonomy, and an opportunity for attendees to reflect on how this might relate to their own work.

Kate Nambiar is a medical doctor and researcher who works at Clinic T. She will be discussing issues around contraception for trans people.

Michael Toze is a Research Fellow in the School of Health and Social Care at the University of Lincoln. He will talk about UK medical practice and law with regards to trans fertility, parenthood, and sterilisation procedures.

Francis Ray White is a Senior Lecturer in Sociology at the University of Westminster, and I am a Research Fellow in the School of Sociology and Social Policy at the University of Leeds. We will be discussing intial findings from the Trans Pregnancy Project.