Framing reproductive justice in the context of institutionalized transphobia globally

20 May, 2019


Written by Naomhán O’Connor, Communications Officer, GATE (Global Action for Trans* Equality)

Historically, the movement for reproductive rights and justice hasn’t been the most trans-inclusive space. Reproductive justice is, in essence, about the right to have a child, or to not have a child. For trans and gender diverse people, this goes beyond access to abortion and/or fertility treatments, to include the right to retain our fertility. Our fight centers around the struggle for bodily autonomy: the right to choose what is best for our physical, mental and emotional wellbeing.

Globally, structural discrimination, systemic violence and institutionalized exclusion of trans and gender diverse communities is disguised as ‘social’. Attacks against trans and gender diverse people in the form of ‘discussions’ hosted by universities or fearmongering media ‘campaigns’ perpetrate false stories that re-pathologize trans people by portraying diverse gender identities and expressions as symptoms of mental disorder. Governments and policy makers implement systems that deny or limit trans people’s right to exist, such as refusing to issue identity documents that accurately reflect a trans person’s identity citing such reasons as ‘fraud prevention’, or implementing laws designed to deny trans people’s access to gendered facilities in the name of ‘protecting women and children.’ Socio-economic exclusion of, and social and institutional violence against, trans people is in breach of our basic human rights and impacts our access to reproductive justice and bodily autonomy in very significant ways.

In countries where forced sterilization is a requirement to gain access to legal gender recognition, we are made to choose between incorrect identity documents that place our safety at risk, or coerced infertility. Where psycho-pathologizing diagnoses are a requirement to access legal gender recognition and/or medical transition, we are forced to conform to binary gender ‘norms’ that deny us the right to pursue, or express our desire for, genetic parenthood. This includes trans men/trans masculine people becoming pregnant, and trans women/trans feminine people impregnating another person.

With regards to the right to not have a child, unwanted pregnancies can affect trans men and trans masculine people in a similar way to how it can affect cis[1] women. However, in addition to issues with accessing abortion and accessing consented sterilization, trans people who become pregnant can face further difficulties. For example, individuals may experience mental stress and social stigma in accessing services defined as “women’s services”; stigma, discrimination and violence from medical service providers; and refusal of provision of services from healthcare providers. Further, there may be unknown potential drug interactions between abortion pills and/or birth-control medication and hormone replacement therapy (HRT), i.e. testosterone. Individuals may also be denied  access to medical transition within psycho-pathologizing systems of transition-related healthcare (for example,  if a person becomes pregnant, they may be assumed to not be “trans-enough”). Finally, there is a general ignorance around the necessity for birth-control when on HRT.

To unpick some of these issues, it is necessary to consider the effect of institutionalized transphobia on trans and gender diverse people’s access to safe and adequate healthcare.

Firstly, the psycho-pathologization of trans and gender diverse people by medical institutions has resulted in little-to-no funding for research that focuses on the sexual and reproductive health of trans people. For trans men and trans masculine people, this is based on the assumptions that they would not engage in penetrative vaginal sex, but that, if they did, testosterone would be an adequate birth-control option to prevent pregnancy. This is despite mounting evidence that it is entirely possible for a trans person to become pregnant while on HRT (i.e. testosterone), which also proves that trans men and trans masculine people do engage in the type of sex required to become pregnant. It is also important to note that trans men and trans masculine people can also be victims of rape, whether “corrective” or otherwise.

Secondly, the lack of trans awareness and acceptance within the general medical community demonstrates how social justice issues affects trans and gender diverse people’s access to reproductive justice. Fear of violence, ridicule or any other form of discrimination often prevents trans people from accessing essential healthcare services,

Thirdly, although the psycho-pathologization of trans people is due to be removed from the International Classification of Diseases by the World Health Organization later this year, it will take much longer to change social, political and medical systems globally that continue to pathologize trans people. This means that we will have to continue to fight for such systems to be changed in order to gain our bodily autonomy, with access to little-to-no resources in order to do so.

The socio-economic exclusion of our communities from decision-making spaces perpetuates the use of psycho-medical and to uphold stigma, discrimination and violence towards trans and gender diverse people. For example, Article 16 of the Universal Declaration of Human Rights, pertaining to the right to marriage and family life, is often manipulated by states to define family as exclusive of trans and gender diverse people, utilising the term ‘natural’ to imply ‘cisgender man and woman’.[2] This is then used to deny trans and gender diverse adults access to their biological children. Article 18 pertaining to freedom of thought, conscience and religion is often misused to uphold discrimination towards trans and gender diverse people on the basis of religious belief.[3] This can include refusing access to healthcare, including sexual and reproductive healthcare, gender-affirming healthcare and general medical care. including those pertaining to physical and mental health, upholds the discriminatory distribution of resources that might otherwise be used to positively impact on trans and gender diverse person’s access to healthcare and reproductive justice. Such restrictions are manifested in the ongoing struggle over the past 10 years to ensure the depathologization of trans identities in the World Health Organization’s International Classification of Diseases, and the Western- (and USA-)centric World Professional Association for Transgender Health, which is led by cisgender medical professionals and upholds stigmatizing language and treatment of trans and gender diverse people the world over, as well as centring those narratives on Westernised understandings of gender, thus pathologizing native and culturally distinct understandings of, and language around, gender.

The link between binary sex ‘norms’ and gender expression and identity must be severed in order to ensure trans and gender diverse access to reproductive justice. However, it is just as important to enable access to power structures that can ensure socio-economic justice, as it is the distribution of resources, or lack thereof, that ultimately affects our ability to make changes to systems that affect all areas of our lives.

For more information on GATE’s work, go to


[1] Cis – cisgender, here abbreviated to cis, is a term for people whose gender identity matches the sex that they were assigned at birth. For example, someone who identifies as a woman and was assigned female at birth is a cisgender woman. The term cisgender is the opposite of the word transgender.

[2] Article 16 (3) The family is the natural and fundamental group unit of society and is entitled to protection by society and the State.

[3] Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.


Please note that blog posts are not peer-reviewed and do not necessarily reflect the views of SRHM as an organisation.