Trans & Non-Binary Folks on Why Birth Control Isn’t Just for Cis Women

As we say #ThxBirthControl, we sat down with some trans and non-binary folks about their thoughts on reproductive health care, the birth control benefit, and what they want to make sure that advocates for birth control access should know in order to be a movement that centers the needs of trans people.
J (left) is a white, queer, non-binary activist and massage school student. They office-manage and co-facilitate trainings at the Washington Peace Center and are studying bodywork to create a trans- and queer-affirming practice.
Garfio (center) is an undocuqueer college student. They are a non-binary survivor of sexual violence who organizes around issues of immigration justice and reproductive health care.
Romeo (right) is a Black, queer, non-binary feminist who is dedicated to intersectional justice and cross-movement building. They are currently attending the University of Utah and pursuing their graduate education in Student Affairs and Gender Studies.
1. Has the birth control benefit in the Affordable Care Act helped you?
Garfio: Because I am undocumented, I didn’t have access to health insurance until I received it through my college. Growing up, I had ovarian health issues that I wasn’t able to address because I couldn’t afford to access health care. If I had had access to health care with the birth control benefit, I could have used the pill to manage excessive pain and other symptoms that I had.
I now have Deferred Action for Childhood Arrivals or DACA status but cannot access health insurance through the Obamacare exchanges. Thankfully, in college, I now have health insurance through my school, so the birth control benefit has benefited me. The health insurance I receive from my college lets me access reproductive health care that’s affordable to me. I am queer, and I don’t use birth control to prevent pregnancy on a regular basis. When I was sexually assaulted in school, I needed to access emergency contraception and post-exposure HIV-prevention medication. Afterward, I decided I wanted to also have access to the pill because it made me feel safer to not have to worry about unplanned pregnancies due to violence. Because of the birth control benefit, this was an affordable option to me.
J: Yes, always knowing that my birth control is going to be available and free of cost helps with peace of mind, access, and affirmation. Even when doctors aren’t trans and queer competent (which is the norm), having preventive service coverage means one less hoop to jump through. Having free access to birth control translates to knowing that I’ll be able to function, due to having PCOS* (polycystic ovary syndrome, which is a hormonal disorder that is oftentimes managed using birth control.) Without birth control, I would be in a lot of unnecessary debilitating pain.
2. Have you faced challenges accessing birth control? Has that changed or not changed because of the health care law?
Romeo: Moving to Utah, birth control and sexual protection materials have been harder to get because of stigma, although my care has been pretty much the same. When I went to the doctor here and asked to be on PrEP (Pre-Exposure Prophylaxis, which prevents people who are HIV-negative from getting infected with HIV), the doctor didn’t know what I was talking about.
J: My privileges have kept me from facing challenges — being white, having English as my first language, living in D.C., having access to trans-competent care, etc., but that is not a reality for most trans/non-binary folks.
3. Do you see yourself reflected in the typical narratives of the birth control benefit?
Garfio: I don’t really see myself represented – historically queer voices and undocumented voices aren’t included in the birth control discussion. If the narrative made clear that people who aren’t women need birth control, that would help. I don’t identify as a woman, but accessing birth control has been crucial to my health both physically and mentally.
J: Absolutely not. I don’t see visibility of the importance of birth control for non-contraceptive reasons. I don’t see trans people, including non-binary trans people, represented. I don’t hear enough discussions by large organizations that work on issues of reproductive health about why birth control access (for contraceptive reasons) is even needed. I don’t see myself reflected in the language used about men and women and bodies and pronouns. My fluid identities across gender and sexuality are erased thanks to transphobia and biphobia. Up until a few months ago when I found a queer and trans-competent doctor, going to the doctor was something to avoid if possible because of the education and emotional energy it required to advocate for my health care needs. This education void is something reproductive health organizations should be taking on. Doctors shouldn’t assume my gender or my sexuality when I walk in, and I shouldn’t have to hold their hands to explain why I need birth control.
4. Do you feel that trans justice and reproductive justice are connected?
Romeo: I don’t think trans justice and reproductive justice are as connected as they should be. Reproductive justice advocates and transgender justice advocates should talk more about how the root causes of restricting access to reproductive healthcare and restricting the rights of trans folks are interconnected. Both movements are grounded in ideas of bodily autonomy. So they seem deeply connected in that way, but I think in practice we suck at that. In practice, cisgender women are transphobic—women’s movements don’t integrate the needs and voices of trans women enough into the work.
Trans folks aren’t receiving adequate sexual education, and I consider that a reproductive health issue, because without that education we don’t know what we need for our bodies. Trans woman and femmes might not know, “I’m a woman, but I still need a prostate exam.” This aspect of reproductive health and justice is missing from the conversation.
We need to center all people who are disproportionately affected by reproductive coercion—not just cisgender women. For example, when I’ve gone to receive reproductive healthcare, sometimes the forms you have to fill out assume you have certain needs if you say you’re a man or a woman. Instead, I think forms should ask what body parts you have, so people can get the health care they actually need. When healthcare is binary – and assumes you’re either a cisgender man or a cisgender woman, it’s unclear where to go as a non-binary person.
J: They need to be. These connections which I have spoken to above must be understood in the reproductive justice world, and trans folks, particularly Black trans woman, must be centered so that they are not excluded. By centering folks who are the most marginalized, we can work towards providing care for everyone. Access to birth control and abortion affects people across gender, and we must start honoring that.
Garfio: I don’t think it’s connected right now as much as it should be. People who are trans and non-binary should have access to birth control and should be represented in conversations about who needs and uses birth control.
5. What is something that you want advocates for birth control access to know?
Romeo: I want advocates to consider how the decisions they make affect trans women of color who don’t have access to health care. Organizations that provide and advocate for reproductive health care should be asking themselves: How are your services different for trans women? Are you meeting the needs of trans women in clear ways?
If reproductive justice is putting trans women and people of color at the center, we’d be paying attention to the fact that trans women of color have high rates of being HIV positive. What does that mean for reproductive justice? Do we consider HIV/AIDS to be something that we consider when discussing reproductive justice?
J: If you are speaking to women, you are not speaking to me, and I do not know if you are a safe space where I will not have to exhaust myself educating you and risk being completely unaffirmed. If you are including trans men in your birth control work, spell that out—the same goes for including services for non-binary folks and trans women. That opens a door for access and conversation. This is not a moment to further isolate each other in our specific communities that are all fighting to live in a society dominated by racism and patriarchy. We must reach across movements to share resources and knowledge and affirm each other.
* Note, this resource implies that only cisgender woman experience PCOS. All people with ovaries can experience PCOS.