November 13 – 19, 2023 is Transgender Awareness Week. a week to raise awareness and visibility of transgender people and the challenges they may face, as well as an opportunity to celebrate excellence. In preparation for this week, the CGSHE communications team connected with CGSHE postdoctoral fellow Dr. AJ Lowik to learn more about gender-inclusive abortion care.
What does it mean for abortion to be trans-inclusive and gender-affirming?
Trans-inclusive care and gender-affirming care are related and interrelated, but ultimately different.
Gender-affirming care is an approach to health care that affirms people’s genders – this means creating spaces and services where people receive recognition, support, recognition and even celebration of their gender identity and expression. Gender-affirming care is an approach to care that benefits everyone.
Trans-inclusive care, by extension, focuses on the specific and unique needs of trans people. This means paying careful attention to the barriers transgender people face in accessing care in general and gender-affirming care in particular.
Abortion care must be both gender-inclusive and gender-affirming, recognizing that pregnant women are people of different genders, each deserving of inclusive and affirming care.
Why is trans inclusive care important, especially when it comes to abortion services?
Inclusive abortion care is vital because transgender people may be pregnant and may need to terminate their pregnancy for a variety of reasons. However, abortion care is often delivered in ways that assume the patient or client will be a cisgender woman – and this creates numerous unjustified barriers to transgender inclusion.
Where the landscape of abortion care in Canada is already fraught with many access challenges, these challenges are only exacerbated for trans people – we must overcome all the logistical, financial and political barriers that all people seeking abortion care face, while at the same time we browse through spaces that were not designed with us in mind.
Tell us a little about your study, Safe, legal… and inclusive?
Currently, there is virtually no Canadian data on transgender abortion experiences, despite the unique delivery and access challenges in this context. Almost all research on abortion focuses on the experiences of cisgender women. What little is known about transgender people’s abortion experiences is the result of a handful of US-based research studies.
Safe, legal… and inclusive? was designed to address this gap. It asks how trans people describe their experiences of accessing – or trying to access – procedural care, medication and self-administered abortion in Canada, and what barriers and facilitators make up their experiences. It also asks what factors influence whether abortion care is perceived by transgender people as inclusive, supportive, and affirming.
The objectives of this project are threefold:
- expand knowledge about transgender people’s experiences of abortion care;
- explore how trans people rewrite normative scripts and resist landscapes of multifaceted stigma related to transsexuality and abortion; and
- to equip abortion providers with evidence-based practice recommendations to improve their services for transgender people;
Safe, legal… and inclusive? includes a survey, an interview and an art-based component. What do you hope to gain with this mixed methods approach?
The goal is to provide participants with multiple ways to participate, where each approach can deliver something different in terms of data.
The survey is a way to collect some of the data about the who, what, where, when and why – what type of abortion someone had access to, whether it was the preferred method, what factors contributed to seeking an abortion, whether they had access to support in past, during and after etc.
The interview is conversational, where participants can share their stories in greater depth and detail, and where the narrative arc of their stories can tell us something important about their caregiving experiences. They can express their experience in their own words and share what they think is most important.
The art-based component invites participants to create poetry, photography, paintings, music, collage or other art forms in response to some guiding questions. In my previous projects, arts-based methods have been useful for participants who are not verbal storytellers – and the art that participants produce adds something dynamic to the research results, where people learning about the project’s findings are not limited to reading text only. They can see how participants represent their stories artistically.
Abortion can be a deeply personal experience to share. What message would you like to share with anyone considering joining the Safe, legal… and inclusive work?
I want prospective participants to know that their stories are safe with me. I am a trans person who has worked in abortion care, research and activist spaces for over 15 years – my goal is to create a space where there is no judgment or shame and where the conversation about abortion experiences can ultimately be transformative, even if it’s hard.
Since one goal of this project is to create evidence-based practice recommendations for abortion care providers, know that your story will help abortion providers learn what it means to serve transgender people. Whatever you choose to share – and ultimately, it’s up to you – will work to create more meaningfully inclusive and affirming spaces of abortion care.
What do you hope will come out of this research project?
For the participants, I hope they feel empowered to tell their abortion stories – in their own words and on their own terms. Abortion storytelling can be powerful and a way to combat stigma. For abortion providers in Canada, my goal is to provide guidance on how to best meet the needs of their transgender patients. Abortion providers often have the desire to be trans-inclusive, but lack the practical guidance on how to make this work.
In the meantime, are there resources available for abortion providers who want to offer transgender inclusive gender-affirming care or for transgender people seeking abortion care?
For Abortion Providers, I was honored to write “Trans-Inclusive Abortion Services: A Handbook for Making Trans-Inclusive Policies and Practices Work in an Abortion Setting.” There are over a dozen editions of the manual, adopted for use in most provinces and territories.
For transgender people seeking abortion care, the National Abortion Federation of Canada Hotlineand Action Canada’s Access Line are great places to start – they can help you find an abortion provider near you, and both organizations have strong commitments to relocation.
