Many long-term efforts to educate young people about contraception and teenage pregnancy in reason years were made to good effect: The rates of teen pregnancy in the US declined rapidly in the 1990's, and continue to steadily fall, according to the CDC. Yet despite prevention education from pop culture and public health organizations, there has still been a striking absence of research into this issue for transgender youth—until now. Researchers have just conducted the first-ever study to look at pregnancy and young trans people.
The study, "Prevalence of pregnancy involvement among Canadian transgender youth and its relation to mental health, sexual health, and gender identity," was conducted by researchers at the University of British Columbia. In 2014, researchers from UBC and other Canadian universities conducted the Canadian Trans Youth Health Survey (CTYHS), in which nearly one thousand (923) transgender people between the ages of 14 and 25 were surveyed. For this new study on trans youth and pregnancy, principal investigator Elizabeth Saewyc culled data from the CTYHS, finding that pregnancy rates among sexually active trans youth (5 percent) are comparable to the general population.
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"What I found most striking was that youth of all gender identities—trans masculine, trans feminine, non-binary—had been involved in pregnancy," Saewyc says. In an interview with Broadly, Saewyc explained that trans youth and pregnancy may not have been studied before because physicians assume that trans people are sexually inactive. She believes that this false assumption could be based on the fact that many trans people experience gender dysphoria. "Gender dysphoria is distress because their internal gender identity does not match society's gendered expectations, and their sex assigned at birth might not align with their gender identity either," Saewyc says. But not all transgender people mind their genitalia, and trans people obviously have sex.
Misinformed assumptions about the nature of gender dysphoria may be holding back research into transgender reproductive health, as could assumptions regarding the sexuality of trans people, Saewyc explains. For instance, it may be expected that trans girls are only sexually attracted to cisgender boys, and trans boys to cis girls, making impregnation by intercourse impossible. Yet trans people can be, and are, attracted to different genders; like cisgender people, trans men and women have varied sexual orientations.
"Trans youth have the same needs as cisgender youth for accurate, comprehensive sexual health education, but school-based sex ed might not cover some of their specific needs," Saewyc says. She gives the example of hormone replacement therapy (HRT). The medications that transgender people take in order to hormonally transition genders impact their reproductive capacity, but the effects of HRT varies from person to person. School health educators may not be aware that while one trans person might become infertile on hormones, another might not.
The danger of this is that young people might not know they could still be fertile, and so might get pregnant when they did not intend to do so.
"Hormones may affect fertility, but might not completely suppress it," Saewyc explains. Trans youth deserve to be provided sexual health education that is relevant to their specific needs. But that information isn't necessarily being given to them and, on top of that, "healthcare providers may not have time or comfort levels in talking about sexual health with trans youth," Saewyc says.
"The danger of this is that young people might not know they could still be fertile, and so might get pregnant when they did not intend to do so."
The study cites an old belief that infertility is the "price to pay" for gender transition. While Saewyc's study didn't measure whether or not the trans youth had been on HRT at the time of impregnation, one study out of the University of California at San Francisco found that adult transgender men have become pregnant both before and after taking hormones. The assumption that transgender people must sacrifice their fertility is also related to a cultural bias against the choice to change one's gender, and a questioning of whether or not it is ethical for physicians to assist transgender people in becoming parents. Though it seems grotesque today, sixteen years ago such questions were seriously being considered by researchers. In 2000, a study was published titled, "Gender reassignment and assisted reproduction: An ethical analysis." This history helps to place today's transgender healthcare into context and may explain, in part, why researchers lack understanding about basic health needs for trans people.
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There are numerous obstacles to adequate education for transgender youth. Both direct and subtle prejudice can diminish the likelihood of adequate care. For instance, Saewyc says that gendered language can be alienating. "Healthcare providers and educators can be more trans-sensitive in their terminology, so that trans youth aren't tuning them out, thinking the information is only relevant to cisgender youth," she says. This is the 21st century; men can give birth and women can inseminate. Failing to understand and educate young trans people not only leaves young people vulnerable to unplanned pregnancies, but also sexually transmitted infections. The trans youth who had a history of pregnancy in Saewyc's study reported STI levels at six times the normal rate.
Young trans people today have inherited a long history of discrimination, but they also benefit from recent advancements in the field of transgender medicine. Saewyc believes that the findings in her study are socially significant. "Some sexually active transgender or non-binary young people are getting pregnant—they have a similar chance of getting pregnant as their cisgender peers, and this is something health care providers and sexual health educators should be aware of," she says. "Trans youth also need sex education and sexual health care, so they can make informed choices about their health and their fertility.