November 13 – 19 2023 is Transgender Awareness Week; a week to increase awareness and visibility of trans people and challenges that they may face, as well as an opportunity to celebrate trans excellence. In preparation for this week, the CGSHE comms team connected with CGSHE Postdoctoral Fellow, Dr. A.J. Lowik to learn more about trans-inclusive and gender-affirming abortion care.

What does it mean for abortion to be trans-inclusive and gender-affirming?

Trans-inclusive and gender-affirming care are related and interconnected, but ultimately different.

Gender-affirming care is an approach to healthcare that affirms peoples’ genders – this means creating spaces and services where people receive recognition, support, acknowledgement and even celebration of their gender identities and expressions. Gender-affirming care is an approach to care which benefits everyone.

Trans-inclusive care, by extension, focuses on the specific and unique needs of trans people. This means carefully attending to the barriers that trans people experience when it comes to accessing care in general, and gender-affirming care in particular.

Abortion care needs to be both trans-inclusive and gender-affirming, recognizing that pregnant people are people of different genders, each of whom are deserving of care that includes and affirms them.

Why is trans inclusive care important, particularly when it comes to abortion services?

Trans-inclusive abortion care is vital, because trans people can be pregnant and may need to terminate their pregnancies for any number of reasons. However, abortion care is often delivered in ways that presume that the patient or client will be a cisgender woman – and this creates numerous undue barriers to trans inclusion.

Where the Canadian abortion care landscape is already replete with numerous access challenges, these challenges are only compounded for trans folks – we are having to navigate all of the logistical, financial and political barriers experienced by all people seeking abortion care, while also navigating spaces that weren’t designed with us in mind.

Tell us a little bit about your study, Safe, Legal… and Inclusive?

At present, virtually no Canadian data on trans people’s abortions experiences exists, despite unique delivery and access challenges in this context. Almost all abortion research focuses on cisgender women’s experiences. What little is known about trans people’s abortion experiences is the result of a handful of USA-based research studies.

Safe, Legal… and Inclusive? was designed to address this gap. It asks how trans people describe their experiences accessing – or trying to access – procedural, medication and self-managed abortion care in Canada, and what barriers and facilitators contour their experiences. It also asks what factors impact whether abortion care is experienced by trans people as inclusive, supportive, and affirming.

The aims of this project are threefold:

• to expand knowledge on trans people’s abortion care experiences;
• to investigate how trans people are rewriting canonical scripts and resisting landscapes of multi-pronged stigma related to transness, trans sexuality, and abortion; and
• to equip abortion providers with evidence-based practice recommendations to improve their services for trans people.

Safe, Legal… and Inclusive? includes a survey, an interview, and an art-based component. What do you hope to gain with this mixed-methods approach?

The goal is to provide participants with multiple ways to engage, where each approach can offer something different in terms of data.

The survey is a way to collect some of the who, what, where, when and why data – what type of abortion someone accessed, whether it was their preferred method, what factors contributed to their seeking out abortion, whether they accessed supports before, during and after, etc.

The interview is conversational, where the participants can share their stories in more depth and detail, and where the narrative arc of their stories can tell us something important about their experiences of care. They can put their experience in their own words and share what they feel is most important.

The art-based component invites participants to create poetry, photography, paintings, music, collage, or other art forms, in response to a few guiding questions. In my past projects, arts-based methods have been helpful for participants who aren’t verbal storytellers – and the art that participants produce adds something dynamic to the research outputs, where people learning about the project’s findings aren’t limited to just reading text. They can see how participants represent their stories artistically.

Abortion can be a deeply personal experience to share. What message would you like to share with anyone considering participating in the Safe, Legal… and Inclusive project?

I want prospective participants to know that their stories are safe with me. I’m a trans person who has been working in abortion care, research, and activist settings for over 15 years – my aim is to create a space where there is no judgment or shame, and where talking about your abortion experiences can ultimately feel transformative, even if it’s hard.

Since a goal of this project is to create evidence-based practice recommendations for abortion care providers, know that your story will help abortion providers learn about what it means to serve trans people. Whatever you choose to share – and ultimately, that’s up to you – will be put to work creating more meaningfully inclusive and affirming abortion care spaces.

What do you hope comes out of this research project?

For participants, I hope that they feel empowered to tell their abortion stories – in their own words, and on their own terms. Abortion storytelling can be powerful, and a way to bust stigma. For abortion providers in Canada, my aim is to provide them with guidance on how to better meet the needs of their trans patients. Abortion providers often have the desire to be trans-inclusive but are missing the practical guidance on how to do that work.

In the meantime, are there any resources available for abortion providers who want to offer trans inclusive, gender-affirming care, or for trans people seeking abortion care?

For abortion providers, I was honoured to write “Trans-Inclusive Abortion Services: A manual for operationalizing trans-inclusive policies and practices in an abortion setting.” There are over a dozen versions of the manual, adopted for use in most provinces and territories.

For trans people seeking abortion care, the National Abortion Federation of Canada hotline, and Action Canada’s Access Line are great places to start – they can help you find an abortion provider near you, and both organizations have strong commitments to trans-inclusion.