Cisnormativity, Erasure, and Discrimination: How Do Trans, Non-Binary, and Intersex Persons Experience Obstetric Care Compared to Endosex Cisgender Individuals in Germany?

Abstract

Trans and intersex individuals are often not considered in obstetric care—neither in practice nor in research. This quantitative study used an online survey to compare the experiences of pregnant trans men, non-binary individuals, and intersex people with those of endosex cisgender individuals who received care in obstetrics. Trans men and non-binary individuals reported discrimination during pregnancy and childbirth on the interactional, institutional, and structural level: for example, they reported more unsatisfactory encounters with health care personnel and more barriers in the structure of health care services and facilities. Trans and intersex individuals had less access to information relevant to them concerning pregnancy and birth compared to cisgender endosex individuals. Although it happened less frequently, cisgender endosex individuals also reported negative experiences, such as discrimination or violence during birth in a hospital. Our findings indicate a need for change concerning several aspects of the obstetric care spectrum—especially, but not exclusively, for trans, non-binary, and intersex people. Some suggestions for improvement include the following: On the hospital level, measures should be implemented to reduce structural discrimination and to ascertain one-on-one care during active labor. Inclusive information material should be developed and disseminated and health care institutions should raise awareness among their staff regarding care for their LGBTIQ patients. More studies on obstetric issues concerning queer, trans, and especially intersex people should be conducted and diversity and inclusion should be implemented as core topics in the training curricula for midwives, physicians, and nurses.

Keywords:

• LGBTIQ
• queer
• pregnancy
• health
• reproductive rights

Acknowledgments

Thanks are due to Meike Watzlawik, Elisabeth Ponocny-Seeliger, and Joey Powers for their friendly intellectual support.

Disclosure Statement

The authors report there are no competing interests to declare.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, Ska Salden, upon reasonable request.

Notes

1 In Germany, all costs for a hospital birth are usually covered by national health insurance, while the birthing person has to carry some of the costs for a birth in a birth center or at home with a midwife.

Additional information

Funding

This work was supported by the Gunda Werner Institute/Heinrich Böll Stiftung.