In 2019, nine states have passed legislation restricting access to abortion services. Utah and Arkansas, the most generous of these, ban abortions after 18 weeks, Missouri after eight, Georgia, Kentucky, Louisiana,
Mississippi and Ohio after six, and Alabama passed a comprehensive ban on abortion after conception. Reproductive rights advocates have filed multiple lawsuits challenging these laws.
Unfortunately, as is common in discussions about reproductive issues, transgender men, who are assigned “female” at birth, are left out of the discussion.
Charlie King-Miller, a 33-year-old father of two, was his children’s gestational parent. King-Miller had his first child in 2015, and for him, the experience helped form his attitudes on abortion. “I had awful pregnancies,” says King-Miller, “During my first pregnancy I was diagnosed with hyperemesis and had a really hard time getting care for that. If I hadn’t desperately, desperately wanted the child I was carrying I don’t know if I could have continued that pregnancy.”
The lack of gender-affirming health-care providers exacerbated the kinds of issues that cisgender women traditionally have to deal with. “Just dealing with the medical establishment and people who couldn’t be bothered to remember my name or check my chart made me not want to push for more care,” says King-Miller. “It made me so sure that if you don’t want to be pregnant you should not be pregnant.”
Louie Hines, a 26-year-old black trans man and father of one, had similar issues during his pre-transition pregnancy. “Even before I transitioned I wasn’t taken seriously when I was pregnant, delivering or in labor,” says Hines. “The nurses made all the decisions and it was a traumatic experience.” Black gestational parents are three times as likely to die in childbirth as white gestational parents, and adding an additional factor like queerness and trans identity worries Hines. “I think everyone would look at me in disgust as a pregnant trans man,” says Hines, “I’m worried that abuse and neglect from the health-care system would be worse now...”
Hines, who identifies as “queer,” is one of the trans men for whom reproductive health-care issues are particularly pressing. “Transmasculinity is assumed to be a reification of the masculine norms that go along with heterosexuality,” says King-Miller, “people don’t think of gay trans men. Gay trans men are at a fairly significant risk of having unintended pregnancy. They are at an increased need of abortion care.”
Unexpected pregnancies place an incredible burden on most transgender men. “If I get pregnant right now I would be out of options,” says Hines, “I’m at my wits’ end finding child care for the child I do have.” The National LGBTQ Task Force notes that black transgender people face an unemployment rate of 26 percent.
The wave of legislation is also concerning for transgender men in straight relationships. The language in the recent bills could potentially have implications for people like King-Miller, who used in-vitro fertilization (IVF) to get pregnant. “We did four cycles of home insemination and four cycles of intrauterine insemination and none of those were successful. We did a cycle of IVF and came out of that with three embryos. Two of those are now children.” Does the third embryo, which is currently frozen, count as a person? It does in some countries. “People who live in Italy are required to have every single embryo that comes out of their IVF cycle transferred back to their uterus immediately,” explains King-Miller, “so you get these crazy multiple pregnancies or situations where pregnancy is unsafe because they believe it is unethical to create embryos that don’t have a chance of life.” However, King-Miller is doubtful that such legislation would be applied in the U.S., “They’re never going to ban IVF. IVF is available for rich people. They want to punish poor people, not rich ones.”
Many of the abortion bans do not have exemptions for rape or incest, which is concerning. The National Center for Transgender Equality’s 2015 U.S. Transgender Survey found that 51 percent of transgender men have experienced sexual assault, and because of negative experiences with the health-care establishment, many trans men are hesitant to seek care. Hines considers himself lucky. “I got an IUD right after I gave birth to Oliver, and it’s good for 10 years,” he says. But transgender men in the affected states face a bleak future.
“There are so many ways reproductive choices are constrained,” says King-Miller, “it’s true for women, non-binary people, queer people, trans people. There are so many ways we’re not allowed to control our bodies because it is inconvenient for the medical establishment.”