Allen Connor Luke, Muschialli Luke, Nihlén Åsa, Coates Anna, Gonsalves Lianne M
Western Health, Melbourne, Australia.
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Reprod Health. 2025 Jun 25;22(1):115. doi: 10.1186/s12978-025-02038-6.
Transgender (trans) and gender diverse people face significant obstacles when accessing sexual and reproductive health (SRH) services. This review aims to systematically identify and characterise the specific barriers to SRH barriers across a range of service domains.
A systematic literature search was carried across MEDLINE, CINAHL, Embase, PsycInfo and Global Index Medicus for studies published up until Aug 17, 2023. We included qualitative, quantitative and mixed-methods studies that illustrated which barriers to SRH services trans and gender diverse people face. Relevant data were extracted and examined using an inductive approach by which organic themes emerged across the SRH service domains. Quality assessment was carried out using the Critical Appraisal Skill Programme (CASP) checklists.
A total of 53 studies examining barriers to SRH services were deemed eligible for inclusion. This consisted of 20 studies relating to fertility care, two to abortion care, four to contraception, 15 to reproductive cancer screening, nine to antenatal, intrapartum and postnatal care and three spanning multiple domains of SRH. Eight studies were deemed to be moderate quality, the remaining 45 were high quality. 49 of the included studies were conducted exclusively in high-income countries. 40 studies were conducted from the perspectives of trans and gender diverse people, 10 from that of health providers whilst three incorporated both. Participants included for analysis ranged in age from 18 to 78 years. Domain specific and cross-cutting barriers were described throughout the included studies, including financial accessibility, lack of provider knowledge and education, limited information availability, systemic and interpersonal discrimination, cis-normative and gender biased health system practices and dysphoria associated with treatments and procedures.
Trans and gender diverse people face substantial barriers to SRH services that prohibit them from fully exercising their reproductive rights. The evidence collated by this review demonstrates that whilst some barriers are shared with cisgender women, trans and gender diverse people face unique barriers to accessing SRH services. Both systems- and individual-level reform is necessary to improve not only gender responsiveness but also gender-inclusivity.
跨性别者和性别多样化者在获得性与生殖健康（SRH）服务时面临重大障碍。本综述旨在系统地识别和描述一系列服务领域中SRH障碍的具体阻碍因素。
在MEDLINE、CINAHL、Embase、PsycInfo和全球医学索引中进行了系统的文献检索，以查找截至2023年8月17日发表的研究。我们纳入了定性、定量和混合方法的研究，这些研究阐述了跨性别者和性别多样化者在获得SRH服务时面临哪些障碍。使用归纳法提取和审查相关数据，通过这种方法在SRH服务领域中出现了自然形成的主题。使用批判性评估技能计划（CASP）清单进行质量评估。
共有53项研究SRH服务障碍的研究被认为符合纳入标准。其中包括20项与生育护理相关的研究，2项与堕胎护理相关的研究，4项与避孕相关的研究，15项与生殖癌症筛查相关的研究，9项与产前、产时和产后护理相关的研究，以及3项涵盖多个SRH领域的研究。8项研究被认为质量中等，其余45项质量较高。纳入的研究中有49项仅在高收入国家进行。40项研究是从跨性别者和性别多样化者的角度进行的，10项是从医疗服务提供者的角度进行的，3项则两者兼顾。纳入分析的参与者年龄在18岁至78岁之间。在所纳入的研究中描述了特定领域和贯穿各领域的障碍，包括经济可及性、医疗服务提供者缺乏知识和教育、信息获取有限、系统性和人际歧视、顺性别规范和性别偏见的卫生系统做法以及与治疗和程序相关的烦躁不安。
跨性别者和性别多样化者在获得SRH服务方面面临重大障碍，这使他们无法充分行使其生殖权利。本综述整理的证据表明，虽然一些障碍与顺性别女性相同，但跨性别者和性别多样化者在获得SRH服务方面面临独特的障碍。系统层面和个人层面的改革对于提高性别响应能力以及性别包容性都是必要的。
