Table 1 Exemplar quotes for each theme from key informants (n=4) engaged in the provision of gender-affirming and abortion care, 2023
Theme 1: | All reproductive healthcare providers see TGE patients (whether they know it or not). |
“I've had other providers say to me… ‘I haven't seen TGE patients in my practice.’ And I'm like, you have. You just didn't know, and you didn't ask.” – OB/GYN in abortion-restrictive state | |
“I think un-gendering the spaces and understanding that TGE patients also need abortion care, and probably are at even more risk of not being able to access that care because of not feeling safe in this space. And I think we need to really look at ourselves and understand that well, maybe the majority of our patients we take care of are cis female patients, [but] even ACOG has made the statement about ‘pregnant people,’ right? All of us recognize that like you don't have to be a woman to be pregnant. And we need to create safer space for them.” – Advanced OB/GYN in abortion-restrictive state | |
Theme 2: | All reproductive healthcare providers see TGE patients (whether they know it or not). |
“A lot of the problem is the name of the clinics… ‘A Woman's Choice,’ ‘A Pregnant Woman…’ when in reality, we know that we're not just caring for women. So even before they walk through the door, a lot of the time, TGE patients are already feeling affronted.” – Advanced OB/GYN in abortion-restrictive state | |
“Patients encounter front-of-house staff before they ever see a provider when they're seeking out an abortion or other reproductive health care. And if those are bad experiences, like, obviously, what happens with the provider still matters, but it's not going to be a good experience if their experiences before they see the provider were not good experiences.” – Family Nurse Practitioner in abortion-protective state | |
“I mean, my high-risk clinic that I work at, I think if a transgender patient came in, people would literally not know what to do. Our forms are very gendered. We talk about moms and dads and babies and pregnant women, and it kills me a little bit. Our clinic manager does not understand the concept of pronouns. We're also in the Deep South, not that that's an excuse, but it is what it is, right? Like there's only so much change you're going to be able to make.” – Advanced OB/GYN in abortion-restrictive state | |
Theme 3: | Context, resources, and lack of knowledge or training on gender-affirming care present additional barriers for patients. |
“There are great many people out there who, I think, just really lack the basic vocabulary, [and] don't know where to look for resources. There's just a huge dearth of provider information… patients present to care, the front desk staff misgendered somebody [or] dead names them in the waiting room, and they're in a clinic that says ‘Women's Health Center, and [are] the only non-woman in the waiting room—by the time they even see a provider the whole experience has just been super dysphoric. And so, the entire healthcare system is just set up to fail for these patients.” – Family Medicine Provider in abortion-protective state | |
“Those of us who were there to do the abortion work-- you have to be really familiar with the laws and policies. I'm wondering if that's the same thing in spaces where it's really regulated, if [gender-affirming] care is so siloed, because trying to get someone up to snuff on how they don't break the law by providing abortion care is so much, that I don't know that you could even dedicate any time to then helping them learn how to do gender-affirming care.” – Advanced OB/GYN in abortion-restrictive state | |
“None of this [TGE specific care], is taught in medical schools. Folks who are more than three or four years out of medical training, have received literally no education on any of this at all, and you know in many ways that's not their fault, like we don't choose what is taught to us in medical school, right? We're sort of at the whims of our education committee.” – Family Medicine Provider in abortion-protective state |