Written by: Jess Kimball
With 68.5% feeling discriminated against by their provider according to the Human Rights Watch, finding a doctor someone trusts seems to be hard, especially for the LGBTQIA+ community. Many members of the LGBTQIA+ community struggle to find a doctor, specifically one specializing in reproductive health care, who uses gender-inclusive terminology.
When providers fail to use terminology that a patient prefers it creates a lack of trust from the patient towards the provider. Trust is a key part of every provider-patient relationship. When a patient does not trust a provider they are unable to disclose important information to their provider and receive proper support.
The United Nations defines gender-inclusive terminology as “Speaking and writing in a way that does not discriminate against a particular sex, social gender or gender identity, and does not perpetuate gender stereotypes.” An example would be using “they” instead of “she” when you do not know a person’s pronouns, but are speaking about them or using the term “chestfeeding” or “body feeding” instead of “breastfeeding”.
Many qualitative and quantitative studies can be found discussing the same pattern of providers not using gender-inclusive language leading to a lack of trust between patient and provider and the results being serious mental or physical health problems in the patient and reduced rates of parents chestfeeding their infant.
In May 2017, the United States Department of Health signaled a rollback on regulations prohibiting discrimination of transgender patients. In April of 2018, a proposed rule was drafted to this effect. Those threatened the care that members of the LGBTQIA+ community experience. Human Rights Watch said, “A substantial body of social science and medical research has found that LGBT people are at heightened risk for physical and mental health problems.” (2018).
LGBTQIA+ individuals often experience higher barriers to receiving care. 43.7% of LGBTQIA+ individuals in a survey conducted by Human Rights Watch reported that this discrimination negatively affected their physical well-being.
LGBTQIA+ have more unique needs relating to reproductive healthcare and may need to be seen more regularly than a straight cisgender patient. A transgender woman may need HIV care and a transgender may need puberty blockers, hormone treatment, or gender-affirming surgeries. Despite these higher needs, they still face higher barriers to accessing care.
There are limited antidiscrimination policies in place to protect LGBTQIA+ patients and help guarantee them access to care. Many patients experience a scarcity of supportive providers, even in states where there are more policies in place to protect patients.
LGBTQIA+ parents are even turned away by providers. One parent reported to the Human Rights Watch that a pediatrician refused to evaluate their six-day-old. This discrimination leads to a lot of LGBTQIA+ feeling reluctant to seek care. Repeat bad experiences make it seem like more work than is worth it.
A qualitative study found diverse experiences and values on issues including prioritization and sequencing of transition versus reproduction, empowerment in healthcare, desire for external affirmation of their gender and/or pregnancy, access to social supports, and degree of outness as male, transgender, or pregnant. It found that anticipatory guidance from providers was central to promoting security and empowerment for these individuals as patients. The study was conducted in 2017 and published by BMC Pregnancy and Childbirth.
The training options for providers may be increasing, but even LGBTQIA+ struggle to find access to literature. There is a real lack of literature on non-binary parents. The results of this study included: feelings of loneliness and isolation in the conception period, difficulty finding maternity clothes, gender dysphoria, a desire for gender-affirming care, and gender identity influencing their parenthood experience. The loneliness and isolation were rooted in the gendered language providers used. The conclusion that came states, “The cisnormative and heteronormative scripts that surround pregnancy shaped the reproductive narratives of those who participated in this research. The findings reinforce the importance of inclusive, gender-affirming healthcare and social support services” (Fischer 2020).
The language providers use alters the experience parents have. Parents may feel less comfortable asking a provider question and the lack of literature available leads to further isolation, increased anxiety and depression, and a loss of feeling empowered and confident as parents.
A journal edition was created by Project Muse to outline different ways to achieve equitable treatment in healthcare through culturally safe perimeters. The findings were that “Participants wished providers understood their health concerns, did not expect their patients to educate them, and created a welcoming clinical environment. Medical educators, administrators, and providers share responsibility for improving patient experiences.” (John Hopkins University Press).
Even current research on lactation does not properly display the gender of lactating parents. “Of 15 U.S. surveys measuring breastfeeding rates, practices, and public opinions, 33% only sampled mothers, and another 33% made assumptions regarding the gender or sex identity of the person giving birth or breastfeeding” (Dinour 2019).
In order to achieve equitable healthcare there is a need for providers to receive further training on the use of gender-inclusive terminology and providing equal care to patients of all backgrounds. Through further training and easier access to care for LGBTQIA+ patients, it can be expected to see a decrease in rates of anxiety and depression in LGBTQIA+ patients, an increase in LGBTQIA+ patients seeking care, and an increase in LGBTQIA+ parents regularly attending appointments for themselves and their children. An increase in chest feeding can also be expected. Training for providers on gender inclusivity extends to further medical training, especially for providers supporting lactating people. Additionally, the use of gender-inclusive terminology by both researchers and providers will improve the quality of data through the representation of all individuals providing human milk to their infants.
At Global Foundation for Girls (GFG), we are active thought partners, serving global communities of birthing persons in order to advance and support the advocacy movement. To learn more about our upcoming trainings click here!
Jess Kimball, AS, CLC, Certified Birth and Postpartum Doula, PMH-C, Certified Infant Sleep Coach
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