Reproductive rights and reproductive health services historically center around cisgender women — but these services are also needed by transgender, non-binary and gender non-conforming individuals as well. Access to quality health care has long been out of reach for many LGBTQ people due to medical bias and discrimination. Many health care facilities, doctors and insurance companies do not provide gender-inclusive care that would help bridge this accessibility gap. And the Trump administration has sought – and continues to seek — to reduce such access for LGBTQ individuals.
Recently, the Trump administration gutted the Health Care Rights Law (Section 1557 of the Affordable Care Act), which protects people from suffering discrimination in health care. Under section 1557, people are protected from discrimination because of their race, color, national origin, sex, age or disability in certain health programs or activities. Section 1557 also protects those who have previously sought an abortion from being denied care. The new finalized rule seeks to eliminate these explicit protections from discrimination based on sex stereotyping and gender identity that have existed under the law. It also seeks to allow discrimination based on someone’s reproductive health history or decision to have an abortion.
Gender-inclusive care allows for anyone who needs sexual or reproductive health services to feel comfortable and supported. Gender-inclusive care includes the right to have access to safe, stigma-free reproductive health care, such as abortion care, contraception and STI testing. It’s the right to have a child if you wish to, and to be able to raise that child with adequate economic security, housing, transportation and health care. It’s also the right to access gender-affirming health services that recognize and acknowledge the individuals gender identity and expression.
Transgender individuals face higher rates of discrimination in health care facilities than cisgender women, even when seeking the same care. A study done by the Guttmacher Institute estimated that “462 to 530 TGNB [Transgender and Gender Non-Binary] individuals obtained abortions in 2017 and that 23 percent of clinics provide transgender-specific care.” Seventy-three percent of nonhospital facilities that provided abortions to TGNB patients did not provide transgender-specific health care.
Transgender and gender non-conforming individuals need access to comprehensive reproductive health care. The findings from this study emphasize the need to support efforts to implement and expand gender-inclusive care in sexual and reproductive health care facilities. Trans folks also need and deserve access to health care providers who provide gender-affirming care and use gender-inclusive language.
The finalized 1557 rule will not only make it harder for transgender people to access sexual and reproductive health services but may prevent them from accessing such care all together. Health care providers could simply choose to not provide care based on their own personal beliefs. If they do happen to find a doctor that will provide gender-inclusive care, they may face an added barrier to services if they have previously had an abortion. Transgender people already face discrimination from health care providers who simply do not — or choose not to — know how to provide adequate care for gender non-conforming bodies.
The new finalized rule is part of an ongoing attempt by the Trump Administration to narrow the legal definition of sex discrimination to exclude transgender people. Recently, however, the Supreme Court of the United States ruled in Bostock v. Clayton County, Georgia, that Title VII of the Civil Rights Act protects all LGBTQ employees from being fired. In doing so, the court recognized that discrimination against LGBTQ employees constituted sex discrimination. This landmark decision could have a significant effect on the Section 1557 rule. Although the court’s ruling does not have an immediate impact on the health care rule, it could make legal challenges more likely to succeed.
LGBTQ patients already face great barriers to access adequate and inclusive sexual and reproductive health care services. The Trump administration’s continued attacks on this already difficult access to care are unacceptable. Sexual and reproductive health care services are not only needed, but vital. Transgender people need gender-affirming care without the worry that their doctor will misgender them, or deny them access to needed care. A transgender person who has previously had an abortion faces double the risk of being denied care under this new finalized rule by the Trump administration. The Supreme Court has emphasized that LGBTQ people’s existence is protected; likewise LGBTQ people’s access to sexual and reproductive health care services also must be continue to be protected.
