Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.
Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.
Glob Public Health. 2023 Jan;18(1):2246059. doi: 10.1080/17441692.2023.2246059.
Transgender and non-binary (TNB) people are at increased risk of adverse sexual and reproductive health (SRH) outcomes compared to cisgender people. With this qualitative study, we investigated the experiences of TNB people with access to primary SRH care in the Netherlands. We conducted semi-structured, explorative interviews with fourteen TNB individuals. Data were analysed using thematic analysis. We identified three themes: 'navigating cisgender assumptions', 'depending on your healthcare provider' and 'access requires labour'. In primary SRH care, respondents felt that healthcare providers made incorrect assumptions about their care needs which required respondents to actively disclose their gender identity or medical history. However, some respondents felt disclosure also exposed them to clinical bias, or reduced them to a medical category 'transgender' that their healthcare providers perceived to require specialised knowledge. In this context, respondents felt the onus was on them to ensure their SRH care needs were met. Using the concept of trans erasure, we highlight how TNB people are put at risk of adverse SRH outcomes. Creating equitable care access requires not only that providers are educated on TNB health needs and their own cisnormativity, but also an ongoing, critical reflection on the use of gender- and sex-based categories in medicine.
跨性别者和非二元性别者（TNB）与顺性别者相比，其性健康和生殖健康（SRH）结局较差的风险更高。本研究采用定性研究方法，调查了荷兰 TNB 人群获得初级 SRH 保健服务的经历。我们对 14 名 TNB 个体进行了半结构式、探索性访谈。采用主题分析对数据进行分析。我们确定了三个主题：“应对顺性别假设”、“依赖医疗保健提供者”和“获得服务需要付出努力”。在初级 SRH 保健中，受访者感到医疗保健提供者对他们的护理需求做出了错误的假设，这要求他们主动披露自己的性别认同或病史。然而，一些受访者认为披露也使他们面临临床偏见，或者将他们简化为医疗类别“跨性别”，而他们的医疗保健提供者认为这需要专业知识。在这种情况下，受访者感到有责任确保他们的 SRH 护理需求得到满足。我们使用跨性别遗忘的概念，强调 TNB 人群如何面临不良 SRH 结局的风险。创造公平的护理机会不仅要求提供者接受关于 TNB 健康需求和自身顺性别偏见的教育，还需要对医学中使用性别和基于性别的类别进行持续的、批判性反思。
