Demonstrators display signs in favor of protecting abortion access during a demonstration at Freedom Plaza in Washington last year. (Brittany N. Gaddy/Capital News Service)

By Gabrielle Lewis, Capital News Service

When Lee Blinder heard that Roe v. Wade had been overturned, they weren’t surprised. Having followed news coverage leading up to the decision, Blinder felt like it had become inevitable. They believed in the importance of feeling “the devastation of that moment.”

But moving forward from that decision, Blinder, as a nonbinary person and a transgender rights advocate, feels even more empowered to keep fighting for what they believe in.

“Those who came before me in this work [advocacy] … literally made it so I could walk down the street and not be arrested while wearing pants,” they said. “Folks really paid those debts with their wellbeing, their sanity and sometimes their lives for me to have that ability, so I feel it’s incumbent upon me … to serve our community where I can and continue on the legacy.”

The overturn of Roe v. Wade received backlash from pro-life advocacy organizations to local activists voicing frustration and anger. Some states, like Kentucky, Louisiana and South Dakota, have trigger ban laws that went into motion, banning abortion across the state. Other states like Maryland, California and Washington bolstered legislation protecting abortion rights.

The conversations around who’s affected by this ruling have been geared toward women. However, the Supreme Court’s decision doesn’t just affect them — there are transgender, nonbinary and gender-nonconforming people who can become pregnant.

LGBTQ individuals historically have more barriers to accessing healthcare due to discrimination and stereotypes, and abortion access and reproductive care are no exception. With the right to an abortion no longer a constitutional right, transgender, nonbinary and gender-nonconforming people’s chances of receiving adequate care may shrink even more.

A 2021 study, published in BMJ Sexual & Reproductive Health, gathered reports via an online survey from people of different gender identities about their experiences with abortion. Out of 1,694 respondents, 67 reported an abortion, 76 reported considering a non-clinical abortion and 40 attempted a non-clinical abortion.

Heidi Moseson, a senior research scientist at Ibis Reproductive Health in Oakland, California, co-authored the study. It’s part of a larger project of “qualitative and quantitative work” started by Moseson and her colleagues, focused on addressing transgender and nonbinary people’s needs and barriers in reproductive care.

Moseson said this project arose when people at Ibis noticed the lack of scientific research on transgender people’s experiences in regard to abortion, despite the fact that transgender and nonbinary people have abortions.

“If we can address the barriers for people who are facing the greatest barriers, we’re going to make care more accessible for everyone,” she said. “As a scientist, it’s simply inaccurate to say abortion is only a women’s issue because trans men, nonbinary people, gender-expansive people have abortions.”

Moseson acknowledged that anybody trying to obtain an abortion faces multiple obstacles — such as high cost of care, a limited number of providers in the U.S. and travel expenses — and the overturn of Roe v. Wade exacerbates them, especially for transgender and nonbinary people. These communities face additional unique challenges like misgendering during treatment, transphobia from providers and lower levels of insurance coverage.

Lee Blinder is the executive director and co-founder of Trans Maryland, an advocacy group for transgender rights in Maryland. The organization focuses on policy advocacy, holds virtual support group meetings and spaces to share resources and also hosts the largest name change program in the state, Blinder said.

Reproductive care is heavily gendered, often referred to as women’s health or women’s care. For Blinder, personal advocacy is a large part of their patient experience, and they often find themselves in an “educational role” with providers. Some community members have also told Trans Maryland they were denied reproductive care services because they appeared to be masculine.

“There are cisgender women … intersex women … who are impacted by this assumption that everybody who has an F on their birth certificate or an F on their state I.D. has a uterus,” they said. “What we’re advocating for is just making space for transgender people, and by proxy, we’re often advocating for extra space for cisgender people as well.”

In states that ban abortions, Moseson said there may be laws criminalizing abortion — meaning transgender and nonbinary people may also be disproportionately affected by legal risks.

Moseson’s study also asked respondents about what methods of non-clinical, or self-managed, abortions respondents attempted.

One striking finding from the project, Moseson said, was the disparity between cisgender women and transgender and nonbinary people’s attempts at non-clinical abortions. When surveying primarily cisgender women in the U.S., an estimated 7% had attempted a self-managed abortion at some point in their lives. But when asking the same question to transgender and nonbinary people, it was almost 20%.

“When we asked people about how they tried to end their pregnancies, not a single person among our trans and nonbinary sample mentioned using medication,” Moseson said. “It was really concerning that people were attempting methods such as physical trauma, self-harm … out of a sense that clinical care was not accessible to them or unsafe for them to access.”

Moseson says multiple steps should be taken to improve transgender and nonbinary people’s access to abortion and reproductive health services and mitigate abortion barriers. Among these include training providers on gender-affirming care, raising awareness about and giving money to abortion funds to help people travel to providers and sharing gender-affirming information on self-managed abortion options and their legal and health risks.

As the U.S. moves into an era without the constitutional right to abortion — and an era more similar to the past where certain forms of healthcare may go underground — Blinder noted it’s easy to illustrate transgender and nonbinary people as helpless, especially in anti-abortion states. But doing that, they said, does a disservice to the people protesting these decisions.

“I’m cautious to paint this picture of trans people as completely disempowered because there’s a lot of agency,” Blinder said. “I think for our sanity and the ability for our community to move forward, we really do need to have an understanding of the fierce resistance that is occurring.”

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