It’s been reported that NHS England has paused plans to deliver a training programme to improve inclusion of gender diversity in pregnancy services. This is following a reported “revolt” by midwives. However, our recent research suggests training is needed and that professionals may actually welcome it.
The Maternity Gender Inclusion Programme was due to be rolled out in the first three months of 2023 across 40 NHS providers offering educational resources for staff. It was informed by research from national charity, the LGBT Foundation. This research found many trans and non-binary people were not confident in accessing “maternity” services or in professionals’ ability to care for them.
The programme was paused following an open letter signed by around 650 clinicians, researchers and members of the public. This letter was critical of the LGBT Foundation’s research.
While there are always limitations in research, the LGBT Foundation’s was one of the largest studies of its kind globally. Its findings are also generally consistent with international peer-reviewed research. Other research undertaken by Equality Network also demonstrates how reproductive services can be challenging and complex to navigate for trans and non-binary people.
If healthcare data systems were designed to routinely collect data on service users’ gender identity, outcome data relating to trans and non-binary people could be more reliably compared to the general population. Equally, medical results based on sex would no longer be improperly flagged and relevant screening and serious diagnoses would no longer be missed.
The proposed NHS programme was also criticised for being excessive, as
some midwives may never care for a trans or non-binary person. However, this is not a strong argument for not preparing staff to do so. Perinatal professionals will care for more trans or non-binary people in future as societies become more inclusive of these communities who are no longer discouraged from giving birth.
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Most research conducted so far has focused on the childbearing experiences of trans men. We spoke to more than 100 UK health professionals (predominantly midwives) for our recent research and it is the first to focus on their educational needs and experiences in this area. Along with the majority of people in the UK, our participants were generally trans inclusive. Nevertheless, they remained frustrated by a lack of knowledge about relevant terminology and how to use gender inclusive language.
Only a small minority of our participants expressed concerns that terms like “pregnant people/parents” may erase (cisgender) women. While our data may not be representative of all midwives, the open letter against inclusive education equally cannot tell us how widely these views are held within the profession at large. The loudest voices may in fact be in the minority.
The majority of our participants were keen to understand how to practise in an inclusive manner. Barriers to this included systems built exclusively for cisgender women, where it is assumed that all pregnancies take place in heterosexual relationships.
Some professionals reported witnessing transphobia among midwifery colleagues (for example, mocking and refusing to use personal pronouns). Education and training may go some way towards tackling such discrimination within these services.
Providing appropriate care for both cisgender women and trans and non-binary people need not be mutually exclusive. Overall improvements in practice and services can benefit everyone. So let’s provide the training and resources that professionals need without making maternity services the latest battleground in a culture war.
Sally Pezaro works for Coventry University and the Nursing and Midwifery Council. She is a Fellow of the Royal College of Midwives.
Adam Jowett works for Coventry University. He is a Chartered member and Associate Fellow of the British Psychological Society, is Chair of their Equality, Diversity and Inclusion Board and Chair of their Sexualities Section which exists to promote psychological research on LGBTQ+ issues.
