Supporting transgender and gender-diverse people during pregnancy

Many transgender and gender-diverse people who were assigned female sex at birth have the capacity and desire to become pregnant. While some gender-affirming treatments like removal of the uterus and ovaries eliminate fertility, only 8% of trans and gender-diverse people assigned female at birth have had a hysterectomy. Many engage in sexual activity that could result in pregnancy. For those who are interested in pregnancy, there is little clinical guidance for their health care providers through the various stages of conception and pregnancy care.

Transgender and gender-diverse people also routinely face stigma and discrimination navigating the health care system. This can include gender insensitivity, denial of services and verbal abuse in medical visits. In a national survey, 23% of people reported avoiding seeking care owing to fear of mistreatment as a trans person.

To combat this mistreatment and address the lack of clinical guidance, the team from HIVE and colleagues shared their experience caring for a trans man during his pregnancy in Obstetrics and Gynecology. With the goal of creating an inclusive, compassionate and equitable health care experience for him and his partner, as well as future patients, the team worked with multiple stakeholders throughout the healthcare system to improve patient-centered care.

The team offers ways to support transgender and gender-diverse patients in having a positive and gender-affirming experience before, during and after pregnancy: