What it’s like to be a pregnant trans man in America
Three days after Roe v. Wade was overturned, Sam Guido gave birth to his first child. His doctors, unsure of what was still legal, didn’t prescribe misoprostol — a drug used in medication abortions — to help with contractions.
That was another blow, another way in which Guido felt he wasn’t in control of his labor. Guido hadn’t wanted to give birth in a hospital at all — he was afraid to be there. As a transmasculine and nonbinary person, they have faced the same ignorance and discrimination in medical institutions that many trans people in the United States experience. But a home birth just wasn’t an option; health insurance wouldn’t cover that or midwife care, and Guido’s apartment was too small.
Instead, Guido enlisted chosen family and friends to advocate for them in the hospital. Having other trans voices in the room ensured that they were respected by hospital staff as they brought his daughter, T, into the world. Guido asked that The 19th only use his daughter’s first initial for privacy.
“They made sure everybody who came into the room knew that I was going to be ‘Papa,’ that I was T’s ‘Papa,’ and that the language that they used surrounding myself and my body was all appropriate,” he said.
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In rural areas, transgender people tend to have fewer resources and face higher risks being out than trans people in urban areas, according to a 2019 report from the Movement Advancement Project (MAP). With fewer accepting employers, doctors, housing options and nearby LGBTQ+ spaces, discrimination can have a more profound effect and make hostility harder to bear.
However, regardless of where trans people live in the United States, they often face discrimination within health care. That includes being denied insurance coverage for routine sexual or reproductive screenings that are still treated as women’s health issues like Pap smears and mammograms, according to the 2015 U.S. Transgender Survey. Others must teach their medical providers about trans people in order to receive proper care. Often they are asked invasive questions.
The country’s medical system is extremely ill-equipped to care for transmasculine people, said Kellan Baker, executive director and chief learning officer of D.C.-based LGBTQ+ health care provider Whitman-Walker. It gets even more difficult for pregnant transmasculine people, especially for those who experience gender dysphoria around pregnancy, to access good care, he said.
“People assume that trans men would never want to get pregnant because of dysphoria. Or people think that testosterone is birth control, which it isn’t,” Baker said.
Health care professionals often assume that trans pregnancies don’t happen — or if they do happen, that they are so rare that it doesn’t affect their practice. This leads to doctors who don’t know how to give people proper care, Baker said.
“When people don’t have the right tools to fully understand the health care needs of trans people, it can be deadly,” Baker said.
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The Centers for Disease Control and Prevention, which only tracks how many cisgender women face the issue, says that about 1 in 8 women with a recent live birth have experienced postpartum depression. There’s minimal comparable data on the birthing experiences of trans people, and what little research has been done has largely excluded nonbinary people and trans women and has focused on White people’s experiences.
What’s known is that trans men often experience loneliness, anxiety and isolation during pregnancy, which makes trans-inclusive health care all the more important. Transgender men and women both face limited access to gender-affirming fertility preservation services, on top of erasure, stigma and discrimination within the reproductive health care system.
And considering the grave Black maternal mortality rate in the United States — Black women are at least three times more likely to die from a pregnancy-related cause compared to White women — more can be assumed: that Black transgender men, and Black nonbinary people, face even greater dangers when accessing reproductive health care.