Traditionally, women’s health has been defined by its contrast to men’s health, but using a male/female gendered dichotomy to define entire fields of medical care has resulted in entire populations, like transgender and nonbinary (TNB) individuals, falling through the cracks. According to a new commentary co-authored by Colorado School of Public Health researchers and published in Women’s Health Issues, there isn’t enough research on TNB health needs to help restructure health services in an evidence-based way to better serve these populations.
A broad definition of women’s healthcare has previously encompassed areas like maternal health and pregnancy, sexual and reproductive healthcare, mental health, nutrition, cancer risk, disabilities, and more while transgender women expand on issues related to hormone replacement therapy, vaginoplasty, breast implants, interpersonal violence, and hate crimes. A narrower definition that limits women’s health to sexual and reproductive health issues, on the other hand, would also have to include trans men and nonbinary individuals assigned female at birth for pap smears, obstetrics, and gynecology-related care. The commentary argues for a more inclusive understanding of women’s health that spans the gender spectrum and includes culturally-responsive care for TNB individuals.
“To continue having a narrowly defined understanding of women’s (and men’s) health upholds current discriminatory practices towards trans and nonbinary individuals,” said Danielle Brittain, commentary co-author and professor of Community Health Education for ColoradoSPH at the University of Northern Colorado. Redefining women’s health care in a culturally responsive way remains difficult, though, because research on the health needs of TNB individuals is limited. The majority of published research papers on TNB individuals are single case studies, commentaries and editorials, which cannot be generalized to the population as a whole. Of the available data on TNB individuals, most of them are at least a decade old, focused on limited TNB populations, and can’t be meaningfully compared to cisgender (non-transgender) populations, or simply haven’t been used in scientific data analyses.
The commentary calls for more research on the needs of TNB individuals to inform structural changes, but in the meantime, the co-authors lay out eight recommendations to provide safe, inclusive and affirming healthcare spaces. Currently, the TNB population experiences high levels of discrimination when accessing doctors and emergency care, and two-thirds have delayed or avoided medical care due to fear of gender-related discrimination. Research shows that TNB individuals with “transgender inclusive” primary care providers are less like to have experienced suicidal thoughts or desires, highlighting the importance of culturally-responsive care. The authors’ recommendations are:
- Expand research studies beyond traditional women’s health to collect data that can be used to develop evidence-based resources.
- Provide access to these resources to a wide range of health providers, including women’s health providers.
- Share data with policymakers to help them make decisions that will have the best outcomes for TNB health.
- Modify the definition of “women’s health” to include transgender women, transgender men, other transmasculine individuals and nonbinary individuals.
- Implement evidence-based, trans-inclusive policies on the health facility level to reduce instances of TNB individuals avoiding care.
- Train all staff on TNB health issues.
- Provide safe, affirming and inclusive physical environments.
- Deliver culturally-responsive and -inclusive TNB healthcare.
“Providers and organizations must broadly define health so as to provide culturally responsive care to all individuals regardless of their gender identity,” Brittain says. “The longer we wait, the more we fail those who are the most marginalized and discriminated against. We have a responsibility to provide equity-based care to all.”
