Reproductive rights includes fertility treatment for trans people

In the world of conversations about reproductive justice, the right to parent doesn’t come up as often as it should. Much of the focus is on preventing pregnancy and accessing abortion — two very important issues surrounding bodily autonomy — but pregnancy is not the focus of many movements. That’s especially true of pregnancies involving fertility treatment, which is still a highly controversial subject in some circles, where people are shamed for investing in fertility treatment or fighting their insurance companies to get it covered. Wanting to have children is a reality that many people experience, and it’s one that not everyone defends.

It’s a reality that many trans people experience alongside their cis counterparts. There are lots of ways to parent while trans — some people adopt, some have pre-transition children, some have children during or after transition, some have a relationship to gender that doesn’t necessary require medical care that causes fertility problems, like going on hormones or receiving surgical procedures. Trans people have lots of different ways to approach parenting. Some raise children born to cis partners, or to family members.

Yet, there’s no real room in the medical or social system for them. People who want access to egg freezing and sperm banking are often turned down by their insurance companies because it’s not deemed ‘medically necessary.’ A cancer patient concerned about how treatment will affect fertility, especially if that treatment involves surgical removal of parts of the reproductive tract, can typically receive insurance coverage. Some companies cover cis couples who need help conceiving. But trans people are left in the dark.

Fertility care is incredibly expensive. Trans people who think they might want kids would have to pay tens of thousands for collection and storage of gametes, and it’s simply not covered. Poverty and lower income are perennial problems in the trans community, which means that many are effectively completely cut off from the opportunity to become genetic parents unless they want to do something that triggers intense dysphoria, like opting to hold off on medical transition until they have children.

Many physicians don’t even provide fertility counseling at the outset of medical transition, or when they do, it’s incomplete. Trans people may ask about it, quite reasonably, as clearly many transition-related treatments are going to affect future fertility, but they don’t always receive the best advice. The level of care available depends on where patients receive treatment, and how much their insurance will cover — some physicians might not bring it up as an option because they know insurance won’t pay for it, or because they assume trans people don’t want kids for some reason.

For some people, the prospect of having children is a really important part of their lives. Transition can be a traumatic period not just because of all the changes happening, but because of a door that slowly swings closed — a door you might be able to prop open by banking eggs or sperm. Other trans people desperately want to have children but can’t — some trans women, for example, really want the experience of being pregnant and bearing their own children, and experience distress because they cannot.

Transness is complicated, and so are the politics surrounding reproductive justice and childbearing. But no one should be deprived of the right to have children, and everyone should be provided with the tools to make that happen. That includes comprehensive fertility care tailored to the needs of the individual patient, just as it includes aggressive pushback on attempts to take children from disabled parents on the grounds that disability makes people ‘unfit to parent.’

It includes accurate, thorough, and honest discussions about fertility issues when people start transition. Because trans people should know about their options ahead of time so they can make choices, even if some of those choices are hard. The denial of fertility care to trans people reflects extremely poorly on the health care system and many providers, for few transgender health care centers even bother to include a provider with fertility experience. Instead of considering counseling as an integral part of transition, it’s tacked on as an afterthought at best.

Some trans people don’t want children — indeed, for some, pregnancy triggers intense dysphoria, and restrictions on abortion access carry a really sharp and sometimes fatal sting. Trans people who don’t want to have children should have access to the tools they need to prevent pregnancy, just like everyone else. But those who do, or think they might want to at some point in the future, shouldn’t be deprived simply because society has no framework to conceptualise their experiences. Parenting is a right, and many parents are deprived of the sociocultural supports they need to protect this most fundamental of rights.

In talking about reproductive rights, it’s critical to have open, clear conversations about all aspects of reproductive health care, including those that some people might have limited experience with. There are lots of trans parents out there, and lots more trans would-be parents who need supports they are not getting not just from the medical establishment and society in general, but specifically from the reproductive rights movement. They’re left out of important conversations about access to basic rights within the medical system, including equal access to fertility counseling and treatment before they make medical decisions that will definitively end their opportunity to have genetic children.

Image: We are Trans Parents, Tim Evanson, Flickr