An open letter from LGBTQ+ birth professionals
There has been recent discussion about ‘trans issues’ within perinatal services. A collective of LGBTQ+ perinatal workers in the UK, would like to explain some of the issues. Most of the coverage surrounding inclusion for LGBTQ+ people in the birth world is written by and for cisgender heterosexual (cishet) people. They wrote an open letter (which we are reposting to show our support), not in response to one single event but as a means to have a voice.
TRIGGER WARNING: Please read this story with care. If you’re finding the content challenging, please give yourself permission to step away. If you need support click here, if you need urgent help click here.
Discrimination and inequality
We also know from studies from organisations such as Stonewall (Trans in Britain 2018) that LGBTQ+ folk experience a disparity in accessing medical care [1]. LGBTQ+ folk are more likely to be isolated, in a lower social economic group, are less likely to advocate for their health care needs, are more likely to avoid seeking health care through fear of discrimination and to struggle with unprepared and uneducated health care professionals [2]. LGBTQ+ couples were only allowed in British law to adopt in 2002 [3], discriminatory fostering practices were legal until this time. However, we have been growing our families alongside the cishet [4] community since time immemorial. [5]
Changing times
It may appear as though there is an increasing number of LGBTQ+ folk now, but this is not the case. We are now seeing more people come out into their true selves based on a variety of factors including protection in law, access to services, social media, peer to peer support as well as popular culture moving away from only portraying LGBTQ+ folk as light entertainment or for pornography only. The concept of the gender binary is very modern. In comparison some indigenous and first nation persons communities have existed without a strict gender binary for hundreds of thousands of years. [6] As being openly LGBTQ+ becomes safer, family composition is also changing, for example, we know that there has been a 15-20% year on year increase of lesbian couples having babies in the UK [7], and more trans people are choosing to have children.
Challenging times
The difficulty with this change is that health care policies, procedures, and training haven’t been updated to ensure that all who move through these services will be able to access them in the same way as cishet people.
Health care professionals do not have sufficient training and support to know how to care for LGBTQ+ families. Caring for LGBTQ+ people during the perinatal period does not form a core part of the curriculum in any medical qualification we are aware of, and practice examples will rarely include families like ours. In addition to our health care professionals being unprepared for our arrival at their clinic doors, we also have a historic system, from Government ministers and the Department of Health downwards, who have assumed that all perinatal care will be delivered to cishet people.
The difficulties for LGBTQ+ people start well before giving birth. Access to funding for fertility treatment is restricted for same sex couples [8]. Trans men may not be able to be recorded in perinatal booking systems, access appropriate antenatal testing, or physically access the obstetric ward whilst in labour. Lactating non gestational mothers or parents fall outside of the scope of practice for midwives and therefore are not eligible for support in their breast-feeding journey. Existing in a system that wasn’t designed for your family can increase risks to parents’ and babies’ physical and mental health.
Once we are expecting, we are confronted with a system that is not expecting us to be there. Computer systems may not allow LGBTQ+ families to complete the forms necessary for getting onto the correct NHS pathway or system. Language and terminology may be exclusionary, and perinatal research rarely includes families like ours [9]. We also can’t forget that there are people out there that either want to hurt us or want us not to exist as LGBTQ+ parents.
Once we have our babies, we are still at odds with the heteronormativity of the birth and baby world. Many LGBTQ+ people cannot be recorded accurately on their baby’s birth certificates, from unmarried same sex families to trans parents.
Where services are designed by us, for service users like us, those who create the service may be met with distain and violence.
When Brighton and Sussex University hospital released their document on Gender inclusion, we saw many of our LGBTQ+ midwifery colleagues attacked on social media, decried in radio phone-ins, in newspapers and television for weeks after the launch. The document that caused these attacks simply gave suggestions to midwifes and HCP working within the trust to language and terminology when caring for trans and non-binary folk and was prepared in their own time by LGBTQ+ midwives, to help their NHS Trust. [10]
Many LGBTQ+ perinatal workers have received expletives filled damaging and harmful threats of violence, and even death. So have our Cishet colleagues that openly work with LGBTQ+ clients.
This plays out repeatedly on social media. We see our allies mentioning that we exist once, and we know that there will be cries of erasure and exclusion. These cries of exclusion often come from those with high visibility, who are in positions of great influence and power. Inclusion of us and our families doesn’t mean erasure for the vast majority. We aren’t calling for the eradication of cisgender heterosexual parents. We are simply asking for a seat at the table.
This isn’t something we need to prepare for in the future. We already are in your hospitals giving birth. We are already sat outside your clinic or group wondering if we are welcome inside.
We are simply asking to be included in your language, policies, and procedures. Adding to your language to include us and families that look like ours will ensure that we know your product or service is open to us. That we will be safe with you, and that we can trust you during our most vulnerable time.
Solutions
To other perinatal workers we say – it is okay not to know. It is okay to seek further education and understanding of a community that you are not a part of. But how you do that matters. Paying LGBTQ+ people for their education, lived experience and time is a part of allyship. Demanding our labour, lived experience and past trauma’s surrounding our LGBTQ+ identities for free is problematic. It not only invalidates us, it retraumatises us. It takes our time and energy away from supporting other LGBTQ+ people and redirects it to your education.
There is a plethora of free education available to everyone with internet access. We will be listing some excellent resources at the end of the document. We are also listing our paid resources and cash apps if you want to financially support our work. Working through the Action Plan attached is a good place to begin to find solutions.
Simply put, LGBTQ+ parents are just as worthy as any other parents; they love their children just as much. We are not arguing for more rights or special treatment.
LGBTQ+ people want, need, and deserve the right to give birth safely supported by people who will protect our mental and physical health.
Signatories
Ash Bainbridge
Beth Godbolt
Mari Greenfield
Kai Lambert-Russell
Rowan March
Jen Muir
Kim Roberts
AJ Silver
[1] https://www.stonewall.org.uk/system/files/lgbt_in_britain_health.pdf|[2] https://www.stonewall.org.uk/system/files/lgbt_in_britain_health.pdf
[3] https://www.legislation.gov.uk/ukpga/2002/38/contents
[4] Cisgender and heterosexual
[5] https://elischolar.library.yale.edu/cgi/viewcontent.cgi?article=1065&context=jcas
[6] https://www.tandfonline.com/doi/abs/10.1080/00043125.2009.11519017?journalCode=uare20&
[7] https://www.tandfonline.com/doi/full/10.1080/02646838.2019.1649919
[8] https://www.stonewall.org.uk/help-advice/parenting-rights/donor-insemination-and-fertility-treatment-0
[9] Karaian, L. (2013). Pregnant Men: Repronormativity, Critical Trans Theory and the Re(conceive)ing of Sex and Pregnancy in Law. Social & Legal Studies, 22(2), pp. 211-230
[10] https://www.bsuh.nhs.uk/maternity/our-services/specialist-support/gender-inclusion/