Reproductive Justice for Trans and Non-binary People is About More Than Language
It is pivotal to acknowledge and understand that the conversation about reproductive justice for trans and non-binary people with wombs extends far beyond the language we choose to use when speaking about bodies. It is not simply a matter of inclusivity and framing and so to argue such is to over-simplify and misrepresent the issue at hand. We must also remember that it extends far beyond the current conversation of abortion rights, and the reprehensible decisions being made over our bodies right across the world. Reproductive justice for trans and non-binary people with wombs is a topic we must discuss in and of itself because the structural barriers to us accessing healthcare, in cases, is materially different to that of cis-gendered women, which I will explore through this short essay. The conversation needs to be about both the language that is used and our specific barriers and the specific injustices we face so as to not erase us in our fullness.
Reproductive justice for people like me who exist at the intersection of being black, having a womb, and being trans cannot be reduced to the component parts of our identities. To have a womb, does not mean to be a woman. To be a woman, does not mean to have a womb. To suggest either is to violently erase trans people right across the gender spectrum. When we speak of reproductive justice we are speaking of a history of institutionalised medical sexism* and racism. From the inception of medical practices in the West, there has been a clear bias against the fair treatment of people who differ from the white norm, of people who are not cisgender, and of people who are assigned female at birth.
Here I am focusing on the injustices against people who are (for the most part) assigned female at birth but do not align with that gender — and especially those — like myself — who go down the path of some level of hormone replacement therapy. There is a war being fought in the quiet and the dark, where trans men, trans-masculine, and non-binary people are fighting for our reproductive rights in the face of a system that has been for years routinely sterilising us on the basis of a now provenly entirely flawed science. This fight has been relevant since the first person accessed the vile that they pushed deep beyond their skin with love, a hormone that would allow them to feel at peace and at home in their own body. It is ironic how gaining a right — the right to be yourself and embrace your gender — can come to erase another — that to reproductive justice and quality healthcare.
These are the reasons I don’t fight for a world of rights; a civil right can only offer us so much if we exist in a system that is still beholden to the subjugation of a group. The light of a civil right often comes with a darker-side of more sinister and cruel ways to continue oppressing a people. With one hand we are given a right to determine our own gender that should make us feel freer, though, with the other hand, the conditions upon which we are allowed to be free (an oxymoron in and of itself) are set — and proper reproductive healthcare and justice are one of those harsh conditions in this instance. Still, whilst we fight for the vision of a different world we must try to recover as many of these rights as we can so that we can all live the fullest lives that we choose.
As all trans people know — most healthcare professionals are not educated in either the process nor the medicine of gender transition. This leads to a great deal of misinformation being passed on to trans patients — misinformation that could literally change the path of their entire lives. Some misinformation that I was given could have resulted in me feeling forced to sterilise myself based on medical advice and the fear within the trans community that that medical advice has invoked. Had I not been able to do my own research and had I not been able to collect the funds to access private care to ask some of these questions this could have very easily been my destiny. Since I have been a child, I have wanted to have children and I have always thought of some of those children as biologically related to me, this advice made me feel that I would have to choose between embracing myself in my fullness and having the children I had always dreamed of. At some point we need to speak about the ways in which queer people are considered greedy or wrong for desiring biologically related children — but I’ll leave that for another piece.
The misinformation that I was given that led me to this crossroads was the advice that trans people who take testosterone need to have a full hysterectomy — eliminating all recourse to reproduction — after being on hormone replacement therapy (HRT) for 2–5 years. This misinformation came as a result of the fact that that for years this was actually the National Health Service’s (NHS) line, that people with wombs should have a full hysterectomy when they go on testosterone for a sustained period of time. It is unclear whether this is still the official NHS line, however regardless the damage of enforcing this belief for so long has been done, and the risk has been unproven as I will demonstrate. Generations gone by of trans-men, trans-masculine, and non-binary people, sterilised on the basis of misinformation and still, generations of trans people to come may choose sterilisation on the basis of a fear driven by this precedent.
Interestingly, there is no other aspect of the transition process for any gender that is required, encouraged, or even suggested, in the way the hysterectomy has been for trans masculine people. This is akin to forced sterilisation and it sits too uncomfortably with me especially given the history of forced sterilisation of black women as a longstanding product of the eugenics movement. Having lived 22 years of my life conscious as can be of the experience I was having being perceived as a black woman I was aware of such biopolitical problems within my global community. This sterilisation took place during slavery and colonisation but also in to the modern day, the most documented examples of this history of sterilisation are in the US but with a fair amount of certainty this has happened/ happens to “undesirable” races across the globe. Some recent citing’s of forced sterilisation have been documented in apartheid Israel, where it has been found Ethiopian Jews have been forcibly given birth-control injections without their consent.
Michael Toze from the University of Lincoln released, what I consider, a truly flagship paper in a recent journal of Feminism & Psychology entitled The Risky Womb and the Unthinkability of a Pregnant Man: Addressing Trans Masculine Hysterectomy. In this paper Toze examines the perceived ‘risk’ of ovarian related illness for trans masculine people as a result of HRT that the NHS uses or has used as the basis for the recommendation of a hysterectomy. Toze concludes it to be no more than a fallacy, materialised through “unproven risk”. Thus, raising important questions about whether this push towards all trans masculine people that are on HRT having a hysterectomy is driven by a deeply transphobic ideology that questions the right, ability, and morality of trans parenthood or by sound medical reasoning.
It must be noted that for some trans masculine people these organs form a part of their dysphoria and so removal of them is integral to their transition, this is of course valid though this is not the narrative of everyone in our varied community. For me, transition itself opened up the door for me to feel that one day possibly carrying a baby in my own body may be something I genuinely want to do. After watching an incredible film at the BFI a few months ago called A Deal With The Universe by Jason Barker which documents one British trans man’s journey to giving birth only crystallised this desire and moved me in ways I didn’t know I could be moved. Pregnant men, pregnant trans-masculine people, and pregnant non-binary people are a truly beautiful thing to behold.
Further, there have been a number of recorded cases of trans masculine people giving birth to healthy babies, especially in the US, beyond the NHS recommended timeframe of hysterectomy. Toze also made the insightful point that the first baby to be conceived through IVF was born just 40 years ago and research shows that the majority of trans masculine people receiving medical assistance are in their 20s and 30s so such sterilisation could indeed block us from benefitting from advancements in reproductive technology to come in the future.
So, aside from the speculative claims that we as trans masculine people are at a higher risk of ovary/ womb related illness, the only plausible way the NHS has seen us as viably having biological children is through egg storage prior to HRT or, the less advised, taking a break in the first few years of HRT to harvest eggs. Storing eggs to be frozen over a period of years has been found to be far less successful than embryo storage or immediate fertilisation and placement in to the surrogate womb. Thus, being encouraged to have such surgery as a part of the transition process leaves trans masculine people less likely to have successful IVF. If I am able to safely maintain my reproductive organs in the meantime, regardless of whether testosterone would have affected my fertility, I would have another option, making a successful pregnancy a far more likely occurrence.
Still, the procedure to store eggs is a postcode lottery or an extremely costly process. Given the current structure of the NHS, each Clinical Commissioning Group (CCG) decides whether they fund fertility treatment or not. I am from a relatively poor area in south London, Croydon, it is the only CCG in London to not offer fertility treatment on the NHS at all. This area also happens to have one of the largest ‘Black and Minority Ethnic’ communities in the country at 45% of the population and with that the black population is almost twice that of the London average and almost six times the national average. This clearly is also a broader intersecting problem of race, class and gender — this lack of access in the borough effects all people, both cis and trans.
Still, in boroughs that do fund such treatment the provision for trans patients are widely variable or simply unknown, NHS guidelines state fertility treatment (of different kinds) is available to cisgender women that are; over a certain age, heterosexual couples that have been trying to conceive for over two years, ciswomen that are to undergo cancer treatment and same sex couples. The basis on which all of these cisgender women are able to access fertility treatment is because they are at a heightened risk of becoming infertile or cannot conceive through intercourse. Herein lies a core injustice — transmasculine people will become infertile as a result of a full hysterectomy as encouraged by the NHS, and that is the same NHS that will not consistently fund treatment to store our eggs. We are literally being told to sterilise ourselves for free but that if we want the chance to have children later in life we need to find thousands of pounds to make this even a slim possibility.
In order to receive treatment privately in the UK the costs are simply not a possibility for so many trans people. I have been quoted £8,000 to harvest my eggs and an additional £300 each year to ensure they remain frozen by a fertility clinic in the North of England. Similarly, trans women and trans feminine people that undergo HRT and/ or gender affirming surgeries are encouraged to freeze their sperm at a cost of £400 and an additional £300 each year, despite the cost being lower this still is simply not an option for so many of my trans sisters. For those that may not feel comfortable producing sperm in the societally common way will incur further costs to undergo a form of surgical sperm extraction which would require significant funds. Beyond these initial costs when the time comes to fertilise the eggs/ sperm there is a further substantial cost for IVF. Last year, the British Fertility Society issued guidance that stated trans masculine people must be offered egg storage on the NHS to ensure equity, this is already the case in Scotland and Wales.
In essence, the need and fight for reproductive justice is not the property of any essentialised form of womanhood. Transmen, trans masculine people, and non-binary people firmly deserve reproductive justice and, as we struggle towards that justice, we need to recover our reproductive rights. The right to not be lied to, to not be misled, to be financially covered by the NHS, to be able to wear a baby on board badge and not be ridiculed or ignored even if we appear as ‘men’, to be cared for, to be understood, to be respected. To me, the unfounded sterilisation that my trans brothers and siblings are experiencing is an inherently ideological problem, and as such requires an ideological fight. It feels that it is less about saving our lives and more about ‘saving’ the lives of children who would otherwise bare the misfortune of being born to a trans parent(s), worse yet a poor trans parent. Our bodies and way of life are seen as not worthy of reproductive choice, we are perceived as vile, as lesser, as perverse, as inadequate. Reproductive justice for people like us is too often ignored, misunderstood, or simply pales into insignificance. We are here, and our voices should be heard, and our rights preserved. Reproductive justice for all.
If you’re able to please consider reading more about and donating to my top surgery fund here: https://www.gofundme.com/melz039s-top-surgery-fund