Hood Feminism Notes from the Women That a Movement Forgot - Mikki Kendall Page 0,84

on access to contraception at the expense of communities that are still facing other obstacles. True reproductive justice involves not only access to affordable birth control, abortion, and health care but also providing access to those who are imprisoned, who are in immigration detention centers, who are seen as unworthy of controlling their own lives for a variety of reasons. And that’s before we get into the ways that trans, nonbinary, and intersex people are impacted by a framework that largely prioritizes the needs of cis white middle-class women.

Reproductive health care is about bodily autonomy, which is something trans people are often denied because of transphobia. Aside from being assigned a gender at birth that may not match their identity, they face obstacles in accessing medical care in general. Trans people can face ignorance or outright prejudice from medical professionals, who then become yet another barrier to quality care. Everything from accessing basic health care to safe hormone regimens can be difficult or even impossible depending on location and finances. Sadly, when some care providers discovered that their patients were trans people, their discriminatory attitudes increased to the point of refusing to write prescriptions or sometimes even see trans patients again. Others claimed they didn’t understand the needs of the transgender community, but also refused to seek out the education they lacked. That leaves trans patients in the awkward position of paying out of pocket for appointments they’ll spend providing free education to health-care providers.

A dear friend who transitioned outside the United States got breast cancer some years ago. Her care should have been fairly straightforward; she makes a good living, has excellent insurance, and lives in a state that has long had protections for LGBTQIA people codified in the law. But her excellent insurance routed her to a specialist who, while not outright discriminatory, had very little information about the transition process. So for a part of almost every appointment with her oncologist, my friend had to answer invasive questions that had nothing to do with her medical care. She wanted to be healed, needed this doctor’s help, and felt pressured into maintaining a cordial relationship while her doctor processed his feelings about gender in the midst of her treatment. It was incredibly unprofessional, and anytime she attempted to redirect the conversation he was quick to assert that he just wanted to be a better doctor. His prurient curiosity about how her wife had handled her transition mattered more to him than professional ethics. And yet, she was able to get the treatment she needed; she had to count that as a win.

With the recent proposal from the Trump administration to roll back protections that prevent doctors from legally discriminating based on gender identity, the American government stands ready to not only allow doctors to refuse to treat trans patients, but to actively encourage this discrimination. That can mean someone who is gender nonconforming could go to the doctor for a persistent cough, and instead of their lung function being evaluated they could be turned away with no legal recourse. It won’t matter if the cough is bronchitis, tuberculosis, or lung cancer, because unless they can find a series of good doctors, their health is going to be compromised.

While being educated about your own health can lead to better care outcomes, this goes beyond advocacy and into an exploitation of a marginalized community as a walking unpaid resource. Because of bigotry, providers who refuse to see trans patients contribute to a medical culture where people who already have difficulty obtaining providers can’t easily seek out those who are better versed in their care. That means trans patients can be forced to repeatedly engage with situations that can trigger dysphoria in order to access any level of care.

And gender dysphoria can be fatal if untreated: a staggering 41 percent of the trans community has attempted suicide. Trauma in reproductive health services can drive trans people into fearing the health-care system as a whole. Between discrimination and the fear that keeps marginalized people out of doctors’ offices, trans people are less likely to get preventive care and more likely to develop complications from delayed care. This can include care during an abortion or during pregnancy. For nonbinary and trans people, access to reproductive care is already fraught because of limited access due to the economic and social barriers. Add in any health-care trauma, and the very