Texas abortion ban will likely ‘disproportionately impact trans and marginalized people’

• Link to: Northwestern Now Story

A trans man living in Texas may choose to conceal his transgender status to coworkers, friends and even in-laws to protect himself from violence and gender dysphoria. As his abdomen grows due to a pregnancy for which he can no longer legally get an abortion, however, keeping identity private in public spaces may become next to impossible.

The abortion ban in Texas imposes the burden of pregnancy — and with it, the burden of potential dysphoria, being outed or violence — on trans and gender nonconforming individuals without viable alternative choices.

Though the attack on reproductive rights has been taken up as a women’s issue by advocates and the media, Northwestern University experts say the legislation imposes a heavy burden on trans people and could set the groundwork for additional restrictions on decisions people can make about their bodies.

Northwestern scientists warn excluding this already-marginalized group from the conversation increases barriers transgender people encounter when trying to access abortions and explain why the bill will take a special toll on trans and gender nonconforming individuals.

Experts include:

• Dr. Angela Chaudhari, associate professor of obstetrics and gynecology, chief of gynecology and gynecologic surgery, Northwestern University Feinberg School of Medicine
• Dr. Cassing Hammond, associate professor of obstetrics and gynecology, director of Northwestern Center for Complex Family Planning, Feinberg School of Medicine
• Ricky Hill, research assistant professor at the Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine
• Chris Barcelos, fellow, Northwestern University Center for Applied Trans Studies, assistant professor of women’s, gender and sexuality studies

To interview an expert contact lila.reynolds@northwestern.edu.

‘The goal is the same: to control people’s bodies’

Chris Barcelos: “Legislative attempts to restrict abortion access are made by the same set of people who want to make it illegal for trans people to receive gender-affirming care. The goal is the same: to control people’s bodies.”

Ricky Hill: “When we put restrictions on this piece of health care, we’re going to start putting restrictions on other pieces of health care. I wish we looked at abortion as being health care and not as a moral issue and gender affirming care as being health care and not a moral issue – things that are only between the physician and their patient.”

What delays trans populations from accessing medical care?

Dr. Angela Chadhauri: “There are already significant disparities in receiving gynecological and contraceptive care in the transgender population. We know pregnancies happen and are happening despite appropriate precautions. Many transgender patients seek out mental health care to battle dysphoria about their bodies. Even the idea of becoming pregnant often creates dysphoria, so forcing a patient to carry a pregnancy against their will may lead to significant mental health needs in this population.”

Barcelos: “Trans people tend to delay care of any kind and that is also true of abortions. One study found trans people prefer to have a medication abortion three-to-one — which is more private, done at home — over having a vacuum aspiration, but most in the study were at a late enough time in pregnancy that they needed the latter. We know there are a lot of barriers to terminating a pregnancy for trans people, and the Texas law is the latest, making it exponentially more difficult.

“Research has also found trans people have higher rates of attempts at abortion without clinical supervision than cisgender women (19% and 7% according to survey data), which we know doesn’t always work well and you could die.”

Dr. Cassing Hammond: “There’s sometimes a myth that the LGBT community is affluent when the reality is that many members are more likely to confront poverty and have more limited access to health care. Anyone who is poorer in Texas is now going to find it harder to have an abortion, harder to get out of state to have an abortion and they’re going to be more likely to have to deal with the ramifications of that. It means more self-sourced abortions, more later abortions for those who can make it to safety (procedures which put individuals at greater risk) and in the long-run in Texas, exacerbate maternal mortality.”

Why does inclusive language matter when we discuss abortion?

Barcelos: “Framing abortion as a cisgender woman’s issue is part of the larger work of cissexism that contributes to the fact trans people don’t get good health care. There isn’t proper training or inclusive language, providers refuse care, and framing it as a women’s issue helps create a system that’s hostile to trans people.

Hammond: “Our language reflects who we are and what we value, and if we don’t use the right language, we risk marginalizing communities that are already marginalized and are going to be disproportionately affected by this legislation.”

What are the long-term implications of this bill?

Hammond: “The clinics that are going to close in Texas don’t just provide abortions — they provide a host of other reproductive health services and often provide to poor or marginalized communities including members of the LGBT community. Many of the clinics also provide hormone therapy and other services to the trans and gender nonconforming community, and I think you’re going to see those services also at risk.”

Hill: “I’ve been doing this work on the ground for over a decade including in Oklahoma, and especially in the South it’s easy for people to say, ‘well, what do you expect, it’s Texas?' I think the nation has to pay attention to what’s happening in Texas, because now every state is looking at how they can do this. It’s really about the ways the right has built a broad coalition, and now is the opportunity for us to do the same and realize this is not just about abortion, this is about any medical decision.”