AILSA CHANG, HOST:
Abortion rights are on the ballot this year in Kentucky, Montana and a handful of other states. And since the Supreme Court's decision overturning Roe v. Wade, at least a dozen states have banned abortion altogether at any stage of pregnancy. These restrictions affect not only women seeking abortion care but also transgender men and some nonbinary people who can become pregnant even if they're taking testosterone. And as NPR's Brianna Scott reports, trans people already face a unique set of obstacles when trying to end a pregnancy.
BRIANNA SCOTT, BYLINE: In 2012, Orion Rodriguez was studying special education and art at a college in Denver. He was 24 and had been dating someone for a few months when he got pregnant despite being on birth control.
ORION RODRIGUEZ: We were both poor students trying to finish up our undergrads. I didn't know what to do. I was really panicked because neither of us were in a position to raise a kid.
SCOTT: Rodriguez decided to get an abortion and went to a private clinic in Denver. But when it came time to talk to the doctor, he says he left out important details about his gender identity.
RODRIGUEZ: I didn't ask for the pronouns that I wanted people to use. I went by the legal name that I had when I was born, which is a very feminine name. And so I didn't feel comfortable talking about my gender issues with my medical providers. So I wasn't out to the OB-GYN that we saw.
SCOTT: That hesitation to share his gender identity, it's common, according to a 2015 survey of more than 27,000 transgender adults in the U.S. And there are many reasons why, says Sybastian Smith. He's with the National Center for Transgender Equality, which conducted the survey.
SYBASTIAN SMITH: When someone shows up at an abortion clinic and they're not your typical type of patient, then here we go being denied or here we go insensitive questions being asked. Why are you here? What do you need?
SCOTT: In fact, 13% of respondents said they were denied insurance coverage for gender-specific reproductive health services, things like pap smears or prostate exams. Others said doctors asked them invasive questions about their gender unrelated to their care or, worse, verbally harassed them. Smith says experiences like that can push trans people outside the medical system.
SMITH: They will delay care. They will not receive care. They will go through black market methods or methods that just - that are not being followed by a physician.
SCOTT: Including for abortions. A study out last year in the journal BMJ Sexual & Reproductive Health surveyed trans, nonbinary and gender-expansive people in the United States. Of the 210 respondents who had ever been pregnant, about 1 in 5 said they had attempted to end their pregnancies without clinical supervision. That's about three times higher than the estimated rate of self-managed abortions among women in the U.S.
JUNO OBEDIN-MALIVER: We've got a situation where our current medical system is really failing trans and nonbinary people across the board.
SCOTT: Dr. Juno Obedin-Maliver of the Stanford University School of Medicine was the paper's senior author. Some survey respondents told her they used physical trauma or herbs to attempt to end their pregnancies, and this was despite the fact nearly all had insurance. In a separate study, the same respondents suggested a few fixes to improve their abortion care. They said more gender-neutral language from providers and on patient intake forms would be a start.
OBEDIN-MALIVER: This is actually relatively easy to do in that it doesn't take a lot of money. It doesn't take policy. It really just is about a change of awareness and then having our built environment and our systems reflect that.
SCOTT: But even when tools like that are in place, they don't always work.
D: I had been living as an out trans person for a few years at that point.
SCOTT: That's D. We're only using an initial because D is concerned about abortion rights opponents harassing them. Now, D had an abortion in 2019 at a clinic with gender-neutral intake forms, including boxes for legal name and chosen name.
D: I put my name that I go by on my form. I put my pronouns. I put my gender identity. And I was called the wrong name and I was misgendered. And there was a trans flag hanging on the wall behind me. And I just, like, could not believe what was happening.
SCOTT: Here's Dr. Obedin-Maliver again.
OBEDIN-MALIVER: There needs to be systems of accountability because that's actually getting critical pieces of information in a medical setting wrong.
SCOTT: She said better training would be a step in the right direction. In a 2011 study, she found that the median time spent on LGBT health topics at medical schools was just five hours. But better training doesn't really address the politics around health care for trans and nonbinary people.
OBEDIN-MALIVER: We're seeing a multiplicity of legislations that are really limiting care for trans and nonbinary folks and for people who are pregnant.
SCOTT: Dr. Obedin-Maliver says these overlapping policies will make it harder for trans people to access not only abortion services but basic health care as well. Brianna Scott, NPR News. Transcript provided by NPR, Copyright NPR.
