The Reproductive Justice Movement Has A Gender Inclusion Problem

When self-proclaimed feminists decry ‘female erasure’ in pregnancy-related care, they endanger many.

Last month, The Colorado Doula Project (CDP), a grassroots organization that provides “free emotional, physical, and informational support through the spectrum of reproductive experiences,” held the first formal abortion doula training in the state of Colorado. Nearly 50 women and nonbinary people gathered to learn how to accompany clients or friends through the process of terminating a pregnancy.

Sitting in on the training to write about it for Vice, I wasn’t shocked to hear murmurs of a disturbance going-on outside. Of course, I figured, an event with the word “abortion” right there in the name would attract attention from anti-choice zealots.

One of the organizers sighed. “I was expecting to have trouble with the anti-abortion people, but I didn’t think we were going to get attacked by feminists.”

I did a double take, and she filled me in.

‘I didn’t think we were going to get attacked by feminists.’

Because the Colorado Doula Project strives for intersectionality and accessibility, they talk about their clients and potential clients in gender-neutral terms, referring to “pregnant people” and “birthing parents” so as to encompass DFAB (designated female at birth) transgender and nonbinary people who are not women, but still need pregnancy-related care.

A local self-described fourth-wave feminist attended the abortion doula training despite not agreeing with the CDP’s policy on gender-inclusive language. Early in the first day, she began posting comments on Facebook criticizing the policy, calling it “female erasure,” and saying “I can’t fucking stand third wave liberal feminism.” After being asked to leave, she exhorted a large group of her friends to post negative reviews on Colorado Doula Project’s Facebook page, many of them also accusing the group — which most of them had never had direct contact with — of “female erasure.”

As societal acceptance for trans people inches forward, it’s becoming more possible to talk about the fact that pregnancy and birth are not exclusively female experiences. Trans men and nonbinary people can get pregnant too, and have been living these same experiences for as long as humanity has existed. Including them in reproductive care is not actually new; the only thing that’s changing is the willingness of care providers to acknowledge those diverse identities and treat them with respect.

But when the Midwives Alliance of North America (MANA) updated its core competencies to replace some instances of the word “women” with “pregnant people,” the backlash was dramatic. A group of midwives, including the revered Ina May Gaskin, wrote an open letter accusing MANA of “prioritizing gender identity over biological reality.”

The underlying assumption is clear: Trans men are not real. Non-binary people are not real. Their experience of pregnancy does not matter and should not be part of the conversation.

This is part of a larger movement among a certain population of feminists to define trans people’s rights as not only irrelevant, but actually antithetical to the goals of women’s liberation. Such ideology is usually described by its adherents as “gender-critical feminism” and by its opponents as “trans-exclusionary radical feminism.” I’ve written elsewhere about how excluding trans women from feminism hurts all women, but there’s also no reason my rights should come at the expense of trans men’s health and safety. As a cis woman, I’m left wondering how offering culturally competent health care to trans and non-binary people harms me.

The “Woman-Centered Midwifery” open letter to MANA says that “If midwives lose sight of women’s biological power, women as a class lose recognition of and connection to this power.” Apparently there is some kind of cosmic energy that is intimately connected to having a vagina, and our pipeline to that spiritual force or whatever is irreparably damaged if we describe it as separate from womanhood. Having not given birth, perhaps I am simply not yet hooked into the network of femaleness, sitting here like a laptop waiting for the wireless password, unaware of what’s going on around me. This definition of female experience strikes me as profoundly objectifying — not to mention dismissive of the many women, including cis women who cannot get pregnant.

I’m left wondering how offering culturally competent health care to trans and non-binary people pregnancy harms me.

I have never given birth, but I am a parent. My transmasculine spouse is the one who carried our daughter. I have intimate personal experience with the medical realities of pregnancy, from artificial insemination to in vitro fertilization to midwifery care to herbal induction to, finally, the hospital birth we dreaded — in large part because the setting was hostile to my partner’s genderqueer identity. Every visit to a care provider other than our beloved midwife was a teeth-gritting slog through being misnamed and misgendered. There is a place for medical records to note a trans person’s real name (that is, the one they go by) if it’s different from their legal name, but as far as I can tell it’s just there to use up excess ink, because nobody at the hospital ever called my partner by the right name on the first try.

I don’t know what it’s like to be misgendered, not from the inside, but I have sat very close to the person I love most in the world and watched it happen, and even from that distance it hurts. It has never made me feel connected to my womanly power.

I really want to understand where this argument is coming from, so I reached out to the woman behind the campaign of harassment against CDP.

“Female oppression is rooted in our biology,” she says, “in how we are born, not how we identify.” I fight the urge to say something counterproductively sarcastic, because this radical feminist shibboleth makes me see red. My body is not the source of my oppression. Men are the source of my oppression.

She continued, “Pregnancy and abortion are heavily contaminated by patriarchal expectations, and it is not feminism or liberation to deny the ability to birth a child is female.” This is the closest she and I will ever come to agreeing. Certainly, the way pregnancy, birth, abortion, infertility — basically anything that happens in or around a uterus — are constantly subject to restriction, judgment, and violence is rooted in virulent misogyny. Pregnancy is considered something that happens to women, so it’s taken less seriously than issues that primarily affect men, however emotional, traumatic, and even life-threatening it can be.

My body is not the source of my oppression. Men are the source of my oppression.

But this is also true of sexual assault, intimate partner violence, single parenthood, and even poverty. The misogyny inherent in the way we talk about them and the resources we allocate to deal with them is unmistakable, but we can acknowledge that — and push back against it — while also making space for the men who are affected. Referring to rape as a women’s issue, for instance, has the effect of making male survivors fear they won’t be taken seriously or treated with sensitivity and understanding if they come forward. As a result, men who are raped have a rate of underreporting even more dramatic than that of female sexual assault survivors. Treating women’s needs as private property doesn’t effectively counter sexism, but it does leave men and nonbinary people bereft of resources they might need badly.

A 2015 survey found that nearly a quarter of all trans people had, at some point in the previous year, not sought medical care they knew they needed because of fear of being mistreated. While little comprehensive research exists on trans and nonbinary birth parents, it’s not hard to imagine that such fears — and their deleterious health impact — would be present during pregnancy, which for many is an intensely dysphoric experience. Failing to make it clear that care providers welcome all genders of patient may be deterring trans and nonbinary people from receiving the best care for themselves, and potentially their future children.

Gabe, a trans man and birth father, recalls a deeply awkward experience going to the doctor for a transvaginal ultrasound and being told by the admitting nurse that there must be a mistake — men don’t get that procedure. Zoe, a femme genderqueer parent, had an intense bout of dysphoria shortly after giving birth that their providers didn’t even know how to diagnose, much less treat. “I generally just don’t get medical care,” said Zoe, “because I never get gendered correctly or treated well.” Using gender-inclusive language tells trans and nonbinary people that a care provider is welcoming and ready to serve them. Refusing to do so accomplishes the opposite.

The woman protesting CDP’s language policy says that isn’t what she wants: “All people deserve the right to quality health care.” She says that “trans men should have services to specialize in their health care if that is what they want” rather than expecting all providers to be culturally competent with trans issues.

‘I generally just don’t get medical care, because I never get gendered correctly or treated well.’

But even if such specialized clinics existed, how many trans and nonbinary people would be able to access them? How common would they be in rural areas that are already lacking health care options? How likely is it that insurance would cover them, or that trans people (who are disproportionately likely to live in poverty, even more so if they are trans people of color) would be able to pay for them out of pocket? In an era when abortion clinics are being targeted by unnecessarily restrictive laws intended to put them out of business, how likely is it that even one clinic just for trans and nonbinary people could be established — much less one in every community where they might be needed?

The fact is that trans and nonbinary people can’t afford to wait for a utopia of trans-centered health resources; they have medical needs that are going unmet right now. And some of their needs include compassionate, sensitive abortion support. While the medical establishment lags behind on both trans competence and abortion care, community organizations and doula projects give women and trans people the opportunity to step up and support each other in the fight for reproductive justice. It isn’t really liberation if there’s not enough for everyone.