Pregnancy Loss and Gender

This blog post is co-authored by Damien Riggs, Ruth Pearce, Carla Pfeffer, Sally Hines, Elisabetta Ruspini and Francis White.

Source: pixabay, no attribution required

In May 2019, the New England Journal of Medicine reported on a case where a man presented to emergency services, noting to staff that he was a transgender man and that a pregnancy test undertaken that morning had been positive. Triage staff failed to attend to this aspect of the man's presentation, with staff only later attending to the fact that he might be pregnant, by which stage the unborn child was at significant risk and ultimately died.

Certainly, the topic of pregnancy loss is often one shrouded in silence, but for transmasculine people (including transgender men, and non-binary people, queer people, and agender people who identify as masculine), pregnancy loss may be even more silenced. Given that we know that growing numbers of transmasculine people are undertaking pregnancies, it is thus important that the potential for pregnancy loss is spoken about, and that competent and inclusive medical care is provided.

In our study of transmasculine people and pregnancy, approximately a third of our participants had experienced at least one pregnancy loss. For some of our participants, the experience was met with informed and inclusive care on the part of medical providers. Some participants noted that hospital staff went out of their way to ensure that medical records accurately reflected the person's gender, that support was provided following the loss, and that hospital staff correctly gendered the person.

Other participants, however, noted that they were offered little or no support, including some who were offered no counseling following a pregnancy loss. Other participants commented that they could not find support specifically for transmasculine people, also noting that support for partners was often non-existent. A lack of support, or a lack of support that recognizes the specific needs of transmasculine people, can be a significant barrier to processing potential grief associated with a pregnancy loss.

Support is important given that, like many other people who experience a pregnancy loss, our participants described pregnancy loss in largely negative terms, such as "devastating" and "traumatizing." For transmasculine people in particular, a pregnancy loss can be distressing due to the challenges that may be associated with becoming pregnant, the challenges associated with responses from families and friends, and broader social stigma associated with transmasculine people and pregnancy.

Indeed, some of our participants noted that awareness of such potential social stigma meant that they were fearful of presenting to emergency departments when experiencing a pregnancy loss. Some were wary of how they might be treated by the staff, whether or not their gender would be acknowledged and respected, and the potential that presenting to an emergency department could result in their personal details being disclosed to other patients. These represent significant barriers to transmasculine people receiving the competent and inclusive care they need when experiencing a pregnancy loss.

Guidelines developed for service providers working with transmasculine people in the context of abortion can be usefully applied to the context of pregnancy loss. Such guidelines emphasize the importance of registration forms that do not simply include binary genders, the availability of separate waiting areas in gender-segregated services, the importance of inclusive language, and the need to ask transmasculine people about their preferred pronouns and terms used to describe their bodies.

A pregnancy loss is likely to be experienced as distressing for many people, but for transmasculine people, such distress may be shaped by service responses and broader social views on transmasculine people and pregnancy. Staff in emergency departments, as well as other medical professionals, have an important role to play in ensuring that transmasculine people receive competent and inclusive care.