In the year since the overturn of Roe v. Wade, 26 states have enacted abortion restrictions or bans that make obtaining care difficult, if not impossible. The protections of Roe were never enough, and leaders in the reproductive justice movement have long been advocating for a path in abortion care that is far more inclusive of people of all races, identities, and socioeconomic statuses.
It is essential that the framework for abortion equity centers LGBTQ+ people, who experience both structural and interpersonal discrimination in settings including health care, employment, and the public sphere. Abortion is an LGBTQ+ issue: lesbian, bisexual, and queer women; transgender men; and nonbinary and intersex people have the capacity for pregnancy and may seek abortion care. In fact, those who identify as LGBTQ+ are at a greater risk for unintended pregnancy, partially because they are less likely to use contraceptives. And LGBTQ+ people who have previously been pregnant are more likely to have unwanted pregnancies or pregnancies that are the result of violence than heterosexual women, and are more likely to need abortion services as well.
And it’s not just that bans on abortion care, in and of themselves, disproportionately harm LGBTQ+ people — it is also that these bans are part of a larger playbook to undermine the autonomy of women, LGBTQ+ people, people of color, disabled people, and people living at the intersection of these identities.
The similarities between attacks on abortion and attacks on gender-affirming care are evident: the same lawmakers who don’t want people to be able to make their own decisions about their pregnancies are targeting transgender people’s ability to make decisions about their medical care.
Even though every major medical association supports gender-affirming care, more than 20 states now have laws or policies banning such care for youth, affecting 30.9 percent of transgender youth in the United States. There is extensive evidence that gender-affirming care leads to better mental health outcomes, and many of these laws are already being challenged in court and enjoined as likely unconstitutional.
Conservative politicians are ignoring the will of their constituents, proposing bans on abortion care and limitations on gender-affirming care — sometimes in the very same bill. Furthermore, legislation that seeks to deny gender-affirming care for transgender individuals often explicitly allows genital surgery on intersex infants, a harmful coercive and medically unnecessary practice that the United Nations has called for ending. And a secretive group with extensive right-wing ties, including to right-wing billionaire Charles Koch, is funding both the anti-abortion and anti-LGBTQ efforts.
On the other hand, blue states are responding to restrictions on abortion access and gender-affirming care by passing legislation to protect both areas of health care simultaneously. These shield laws aim to create safe havens for those in red states who are unable to access care at home. However, state protections are inadequate in a time where the Supreme Court is actively ruling against LGBTQ+ rights, like it did in June 2023 by holding that the Constitution allows some businesses to refuse services to same-sex couples, despite a state anti-discrimination law.
The dual attacks on abortion and gender-affirming care have made it even harder for LGBTQ+ people, and transgender and nonbinary people in particular, to access necessary medical care, to devastating effect.
A 2022 nationally representative survey found nearly 1 in 3 transgender or nonbinary respondents, including 46 percent of transgender or nonbinary respondents of color, reported being refused medical care from a health care provider in the year prior. Many of these refusals of care were related to reproductive health care or gender-affirming health care. Twenty-one percent of transgender or nonbinary respondents, including 28 percent of transgender or nonbinary respondents of color, reported a health care provider refused to provide reproductive or sexual health services due to their gender identity in the year prior. Fifteen percent of transgender or nonbinary respondents, including 22 percent of transgender or nonbinary respondents of color, reported a healthcare provider refused to provide gender-affirming care in the year prior.
Discrimination and mistreatment from doctors or health care providers have an alarming deterring effect, with LGBTQ+ individuals being three times more likely to postpone or avoid getting necessary medical care. And those at the intersection of multiple identities, including queer people of color and those with disabilities, are all more likely to report delaying their needed medical care.
The impact of anti-LGBTQ+ policies and the debates around them on mental health, especially for youth, cannot be overstated. A 2023 survey found that 41 percent of LGBTQ+ youth seriously considered suicide in the past year. Having safe and affirming spaces, and access to necessary medical care for all, is essential.
Although Pride Month has ended, we must commit to upholding the health and rights of LGBTQ+ people year round. We need policymakers to protect access to abortion and gender-affirming medical care. We need states to adopt shield laws to protect access for LGBTQ+ patients. And all of us need to understand the intersectional nature of these attacks, and work together – across movements – to ensure bodily autonomy and dignity for all of us.
This post is part of our blog series examining what has happened in the year since the Dobbs decision. Read more:
