Commentary Human Rights

Cisgender Women Aren’t the Only People Who Seek Abortions, and Activists’ Language Should Reflect That

Cheryl.Chastine

As an abortion provider, I now make a practice of using gender-inclusive language—not only when speaking about the issue on traditional and social media, but also when talking to my patients.

In a column for The Nation last Friday, writer Katha Pollitt questioned the push among reproductive justice activists to use gender-inclusive language when talking about abortion. Pollitt claimed that such rhetoric “render[s] invisible half of the population and 99.999 percent of those who get pregnant.”

I’m a physician who provides abortions. I’m a physician who provides medical therapy for transgender patients. Both areas of care, for me, are aspects of the same commitment: to provide necessary, lifesaving services that center my patients’ autonomy. Still, I’ll readily admit that I, too, was confused at first by calls to use language with regard to reproductive rights and justice that would be inclusive of transgender men and nonbinary individuals. It seemed like common sense to me that of course my pregnant patients were women and would be referred to as such. As a progressive, though, one of the important lessons I’ve learned is that what looks like “common sense” is often a reflection of unexamined biases. And I’ve realized that assuming every person seeking an abortion is a cisgender woman just further reproduces the prejudices that render transgender people invisible and vulnerable.

On the same day The Nation ran Pollitt’s piece, Reuters reported on a survey of trans men regarding health-care use; more than three-quarters of the individuals had transitioned medically, meaning they were using hormone replacement therapy and/or had obtained surgical treatment. Forty-two percent of the respondents reported experiencing health-care discrimination, including denial of equal treatment, verbal harassment, and/or physical assault. Furthermore, the survey respondents disproportionately reflected a privileged minority of transgender individuals: white, college-educated, employed, privately insured trans men. That figure is undoubtedly higher among less well-off demographic groups of trans men and nonbinary people.

Cisgender people, particularly white individuals, have the privilege when seeking health care of being able to present as their authentic selves without fear. Transgender people, especially people of color, do not. Dr. Kortney Ryan Ziegler, an Oakland, California-based filmmaker, writer, and scholar who is also a Black transgender man, told me that for himself and other trans men he knows, the experience of accessing medical services is fraught with bodily exposure and the risk of discrimination.

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For instance, while traveling out of town once, he went to an urgent care clinic for a cold. “The nurse noticed I had a prescription for testosterone and asked me about it. So I ‘came out’ to some random [registered nurse] because I had a cold, [even though] it had nothing to do with anything else,” he said.

He also recalled clearly how, while still presenting as a Black “woman,” “there were many times I know my race played an important role in how I was (mis)treated.”

Explicitly inclusive language is meaningfully beneficial to people like Ziegler, he says, because it can help ameliorate the harms of the fear of being harassed or mistreated: When such rhetoric is used, it can signal that trans men and nonbinary trans people are more likely to be acknowledged and accepted as themselves.

As an abortion provider working in a conservative area of the country, I’ll readily state that nearly all of my patients present as cisgender women. Does that mean that they all are cisgender women, though? We live in a cisnormative society, meaning that the experiences of cisgender people are overwhelmingly centered. In addition to the aforementioned risk of health-care discrimination, visibly trans individuals are subject to employment and other economic discrimination, family and partner rejection, housing discrimination, and a very real danger of violence. When this is the known price of coming out as trans, it’s one many people feel unable to pay.

Feminists like Pollitt who argue against inclusive language assert that because “99.999 percent of the population” seeking abortions are cis women, it is inaccurate and inappropriate to use gender-inclusive language. So how many trans people are we really talking about? It’s more than 0.001 percent. Suppose you time-traveled back to the 1950s and asked the average physician how many of his or her patients were gay. They would probably respond, “None” or, “Maybe one or two.” It’d be easy to conclude, therefore, that 99.999 percent of all people were straight, so there’d be no need to include any forms of non-heterosexual orientation in language or activism. Assuming the proportion of non-heterosexual people has stayed roughly constant, though, our 1950s physician likely did have a number of gay, lesbian, or bisexual patients. The doctor simply took them to be heterosexual. They may have even presented themselves as such, out of a legitimate fear that the physician would behave prejudicially toward them.

Using the same logic, how can providers or activists dare to presume that every patient we can’t “read” as trans is cis? Numerous trans individuals “pass” as a cis member of their gender, or they present—in some or all settings—as a cis member of their assigned-at-birth gender.

So the truth is, we don’t know what proportion of the population is transgender. The blog FiveThirtyEight covered this last year: No national surveys ask the question, and “even if they did, the responses might not be reliable because some people are afraid to answer, while others disagree on what ‘transgender’ even means.” But we do know that trans and genderqueer people within the reproductive rights movement are calling, in significant numbers, to be included.

When those in the reproductive justice movement prioritize trans inclusivity, more trans individuals feel comfortable publicly identifying as such. Furthermore, that visibility can guide people who’d previously lacked the tools to articulate their feelings of difference. Anna Rubin, who was assigned female at birth, identifies as agender, and uses the pronoun “they,” says they were able to figure out they were trans while researching the best uses for inclusive language at their then-employer, a reproductive rights nonprofit.

When writing a blog post for the nonprofit, Rubin had used the term “trans*.” The use of the asterisk is controversial: Some cisgender people have advocated for the asterisk to include transvestites, who are cisgender, so many trans people feel that it represents an attempt by cis people to encroach on the trans identity. “Somebody called me out on using [the asterisk],” Rubin said. “Wanting to do the right thing pushed me toward resources that helped me figure me out.”

In turn, that self-realization equipped Rubin with a way to push back against gendered language.

“Even before I figured out that I was trans,” Rubin said, “I’d not identified strongly with the label ‘woman.’ [So] it was kind of an overload when I came onboard [the organization] and started getting hammered with it. I felt so alienated before I even figured out why.”

This, Rubin continued, reflected the implicit and explicit discrimination they saw in the wider movement. “I was also made uncomfortable by the lack of respect shown to trans people in the movement. … It was really hard to hear, ‘I think genderqueer people are just confused,’ when I was trying on the label ‘genderqueer’ for myself,” they said.

As a result, Rubin said, “I was miserable under the weight of the assumptions. … I feel like I rushed myself out of the closet in order to confront them with someone they needed to respect. Because when I tried to advocate for myself, and people like me, without being able to say, ‘Hey, this is important to me as a trans person,’ I got such disappointing pushback. [But] once it was pointed out that there was a real problem that affected a real person that they saw every day, they changed.”

Parker Molloy, a journalist who is a transgender woman, sees gendered pro-choice slogans of the past as entirely compatible with an increasing understanding of gender variation—and a corresponding update to our word choice. For example, with regard to the frequently invoked phrase “Trust Women,” Molloy said, “In its truest, most earnest form, it is a promotion of bodily autonomy. It’s trusting an individual to make their own choices, and eliminating gatekeepers. … Trans existence and identities push back against social expectations, push back on the idea that someone else should be given control of our bodies, and push back on the concept that biology is destiny.”

“Trust Women,” in other words, is a call to respect bodily autonomy, and that same respect can now compel us to update our language.

The category “women” doesn’t map neatly onto the category “people who can get pregnant,” and not just because people who aren’t women can and do get pregnant. Many women, conversely, are unable to get pregnant. Some of those women are trans, and others have reproductive tract anomalies that make pregnancy impossible.

In addition, reproductive justice advocates, including trans activists, have called for deemphasizing anatomical language as a rallying call. A trans-inclusive worldview is one that acknowledges that there are women (and nonbinary people) who have testes and penises, and men (and nonbinary people) who have vulvas and vaginas. A laser focus on genital anatomy is one of the major ways that cisgender gatekeepers exclude, ostracize, and disbelieve trans people. Cisgender solidarity around presumed shared genital anatomy, too, is a way trans people are excluded and erased. Given that, it makes sense that centering reproductive rights language around specific anatomy can strike trans people as both deliberately exclusionary and reinforcing of their dysphoria.

Furthermore, rejecting anatomy-centered language is also about centering lived experiences. Objections from trans people and supporters to the constant association of “abortion” with “vaginas” have often been met with ridicule from many, including left-liberals: “How could abortion not be about vaginas? It involves a vagina! That’s how you get pregnant and where you have the abortion!”

To that I would simply ask: Is parenting about vaginas? Or, if you prefer: Is motherhood about vaginas? Would we use vaginas as the symbol of parenthood? Should we title, say, a maternity-leave advocacy group “Lady-Parts Leave Equality”? Should a proposed affordable child-care bill be called the “Vagina Defense Alliance”?

We wouldn’t, because we see that parenthood is about lives and families, and incidentally involves vaginas in the physical logistics along the way. Abortion, too, is about lives and families. Historically, it’s been anti-abortion activists who wanted to make abortion about naughty, dirty sex and vaginas; pro-choice activists saw abortion as being about autonomy, the full realization of all of us as humans, whether or not we have the capacity to get pregnant. So it’s perplexing to me to see mainstream left-liberals insisting on titling their abortion events after genitals. I’m all for refusing shame, but that’s an emphasis that detracts from the actual significance of abortions for the people having them.

And, again, it is not as if gender-inclusive language hurts cisgender women. As an abortion provider, I now make a practice of using it—not only when speaking about the issue on traditional and social media, but also when talking to my patients. Never once have I felt that any of my cisgender patients was harmed, confused, or distressed by my talking about “pregnant people.”

When we frame abortion access around autonomy, we should also understand this parallel: Justice for transgender people, too, is a question of bodily and personal autonomy. As physicians and as reproductive justice activists, we are called to recognize each person’s right to inhabit their true gender, rather than participate in forcing them into the category they were assigned at birth. That means that we must give primacy to people’s understanding of themselves. We can’t advocate that each pregnant person be able to effect the best decision for themselves—while simultaneously insisting that people who aren’t cisgender should go along silently with language in which they don’t exist.

As Molloy put it, “Abortion is an issue of bodily autonomy. Being trans is an issue of bodily autonomy. Abortion is a trans issue.” And, I’ll add, transness is a reproductive justice issue. The movement can’t deny trans people a seat at the table in the abortion conversation; they were already there. It’s up to everyone else to acknowledge them.

Analysis Politics

Advocates: Bill to Address Gaps in Mental Health Care Would Do More Harm Than Good

Katie Klabusich

Advocates say that U.S. Rep. Tim Murphy's "Helping Families in Mental Health Crisis Act," purported to help address gaps in care, is regressive and strips rights away from those diagnosed with mental illness. This leaves those in the LGBTQ community—who already often have an adversarial relationship with the mental health sector—at particular risk.

The need for reform of the mental health-care system is well documented; those of us who have spent time trying to access often costly, out-of-reach treatment will attest to how time-consuming and expensive care can be—if you can get the necessary time off work to pursue that care. Advocates say, however, that U.S. Rep. Tim Murphy’s (R-PA) “Helping Families in Mental Health Crisis Act” (HR 2646), purported to help address gaps in care, is not the answer. Instead, they say, it is regressive and strips rights away from those diagnosed with mental illness. This leaves those in the LGBTQ community—who already often have an adversarial relationship with the mental health sector—at particular risk.

“We believe that this legislation will result in outdated, biased, and inappropriate treatment of people with a mental health diagnosis,” wrote the political action committee Leadership Conference on Civil and Human Rights in a March letter to House Committee on Energy and Commerce Chairman Rep. Fred Upton (R-MI) and ranking member Rep. Frank Pallone (D-NJ) on behalf of more than 100 social justice organizations. “The current formulation of H.R. 2646 will function to eliminate basic civil and human rights protections for those with mental illness.”

Despite the pushback, Murphy continues to draw on the bill’s mental health industry support; groups like the American Psychiatric Association (APA) and the National Alliance on Mental Illness (NAMI) back the bill.

Murphy and Rep. Eddie Bernice Johnson (D-TX) reintroduced HR 2646 earlier this month, continuing to call it “groundbreaking” legislation that “breaks down federal barriers to care, clarifies privacy standards for families and caregivers; reforms outdated programs; expands parity accountability; and invests in services for the most difficult to treat cases while driving evidence-based care.”

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Some of the stated goals of HR 2646 are important: Yes, more inpatient care beds are needed; yes, smoother transitions from inpatient to outpatient care would help many; yes, prisons house too many people with mental illness. However, many of its objectives, such as “alternatives to institutionalization” potentially allow outpatient care to be mandated by judges with no medical training and pushed for by “concerned” family members. Even the “focus on suicide prevention” can lead to forced hospitalization and disempowerment of the person the system or family member is supposedly trying to help.

All in all, advocates say, HR 2646—which passed out of committee earlier this month—marks a danger to the autonomy of those with mental illness.

Victoria M. Rodríguez-Roldán, JD, director of the Trans/GNC Justice Project at the National LGBTQ Task Force, explained that the bill would usurp the Health Insurance Portability and Accountability Act (HIPAA), “making it easier for a mental health provider to give information about diagnosis and treatment … to any ‘caregiver’-family members, partners or spouses, children that may be caring for the person, and so forth.”

For the communities she serves, this is more than just a privacy violation: It could put clients at risk if family members use their diagnosis or treatment against them.

“When we consider the stigma around mental illness from an LGBT perspective, an intersectional perspective, 57 percent of trans people have experienced significant family rejection [and] 19 percent have experienced domestic violence as a result of their being trans,” said Rodríguez-Roldán, citing the National Transgender Discrimination Survey. “We can see here how the idea of ‘Let’s give access to the poor loved ones who want to help!’ is not that great an idea.”

“It’s really about taking away voice and choice and agency from people, which is a trend that’s very disturbing to me,” said Leah Harris, an organizer with the Campaign For Real Change in Mental Health Policy, also known as Real MH Change. “Mostly [H.R. 2646] is driven by families of these people, not the people themselves. It’s pitting families against people who are living this. There are a fair number of these family members that are well-meaning, but they’re pushing this very authoritarian [policy].”

Rodríguez-Roldán also pointed out that if a patient’s gender identity or sexual orientation is a contributing factor to their depression or suicide risk—because of discrimination, direct targeting, or fear of bigoted family, friends, or coworkers—then that identity or orientation would be pertinent to their diagnosis and possible need for treatment. Though Murphy’s office claims that psychotherapy notes are excluded from the increased access caregivers would be given under HR 2646, Rodríguez-Roldán isn’t buying it; she fears individuals could be inadvertently outed to their caregivers.

Rodríguez-Roldán echoed concern that while disability advocacy organizations largely oppose the bill, groups that represent either medical institutions or families of those with mental illnesses, or medical institutions—such as NAMI, Mental Health America, and the APA—seem to be driving this legislation.

“In disability rights, if the doc starts about talking about the plight and families of the people of the disabilities, it’s not going to go over well,” she said. “That’s basically what [HR 2646] does.”

Rodríguez-Roldán’s concerns extend beyond the potential harm of allowing families and caregivers easier access to individuals’ sensitive medical information; she also points out that the act itself is rooted in stigma. Rep. Murphy created the Helping Families in Mental Health Crisis Act in response to the Sandy Hook school shooting in 2012. Despite being a clinical psychologist for 30 years before joining Congress and being co-chair of the Mental Health Caucus, he continues to perpetuate the well-debunked myth that people with mental illness are violent. In fact, according to the Department of Health and Human Services, “only 3%-5% of violent acts can be attributed to individuals living with a serious mental illness” and “people with severe mental illnesses are over 10 times more likely to be victims of violent crime than the general population.”

The act “is trying to prevent gun violence by ignoring gun control and going after the the rights of mentally ill people,” Rodríguez-Roldán noted.

In addition, advocates note, HR 2646 would make it easier to access assisted outpatient treatment, but would also give courts around the country the authority to mandate specific medications and treatments. In states where the courts already have that authority, Rodríguez-Roldán says, people of color are disproportionately mandated into treatment. When she has tried to point out these statistics to Murphy and his staff, she says, she has been shut down, being told that the disparity is due to a disproportionate number of people of color living in poverty.

Harris also expressed frustration at the hostility she and others have received attempting to take the lived experiences of those who would be affected by the bill to Murphy and his staff.

“I’ve talked to thousands of families … he’s actively opposed to talking to us,” she said. “Everyone has tried to engage with [Murphy and his staff]. I had one of the staffers in the room say, ‘You must have been misdiagnosed.’ I couldn’t have been that way,” meaning mentally ill. “It’s an ongoing struggle to maintain our mental and physical health, but they think we can’t get well.”

Multiple attempts to reach Murphy’s office by Rewire were unsuccessful.

LGBTQ people—transgender, nonbinary, and genderqueer people especially—are particularly susceptible to mistreatment in an institutional setting, where even the thoughts and experiences of patients with significant privilege are typically viewed with skepticism and disbelief. They’re also more likely to experience circumstances that already come with required hospitalization. This, as Rodríguez-Roldán explained, makes it even more vital that individuals not be made more susceptible to unnecessary treatment programs at the hands of judges or relatives with limited or no medical backgrounds.
Forty-one percent of all trans people have attempted suicide at some point in their lives,” said Rodríguez-Roldán. “Once you have attempted suicide—assuming you’re caught—standard procedure is you’ll end up in the hospital for five days [or] a week [on] average.”

In turn, that leaves people open to potential abuse. Rodríguez-Roldán said there isn’t much data yet on exactly how mistreated transgender people are specific to psychiatry, but considering the discrimination and mistreatment in health care in general, it’s safe to assume mental health care would be additionally hostile. A full 50 percent of transgender people report having to teach their physicians about transgender care and 19 percent were refused care—a statistic that spikes even higher for transgender people of color.

“What happens to the people who are already being mistreated, who are already being misgendered, harassed, retraumatized? After you’ve had a suicide attempt, let’s treat you like garbage even more than we treat most people,” said Rodríguez-Roldán, pointing out that with HR 2646, “there would be even less legal recourse” for those who wanted to shape their own treatment. “Those who face abusive families, who don’t have support and so on—more likely when you’re queer—are going to face a heightened risk of losing their privacy.”

Or, for example, individuals may face the conflation of transgender or gender-nonconforming status with mental illness. Rodríguez-Roldán has experienced the conflation herself.

“I had one psychiatrist in Arlington insist, ‘You’re not bipolar; it’s just that you have unresolved issues from your transition,'” she said.

While her abusive household and other life factors certainly added to her depression—the first symptom people with Bipolar II typically suffer from—Rodríguez-Roldán knew she was transgender at age 15 and began the process of transitioning at age 17. Bipolar disorder, meanwhile, is most often diagnosed in a person’s early 20s, making the conflation rather obvious. She acknowledges the privilege of having good insurance and not being low-income, which meant she could choose a different doctor.

“It was also in an outpatient setting, so I was able to nod along, pay the copay, get out of there and never come back,” she said. “It was not inside a hospital where they can use that as an excuse to keep me.”

The fear of having freedom and other rights stripped away came up repeatedly in a Twitter chat last month led by the Task Force to spread the word about HR 2646. More than 350 people participated, sharing their experiences and asking people to oppose Murphy’s bill.

In the meantime, Sen. Lamar Alexander (R-TN) has introduced the “Mental Health Reform Act of 2016” (SB 2680) which some supporters of HR 2646 are calling a companion bill. It has yet to be voted on.

Alexander’s bill has more real reform embedded in its language, shifting the focus from empowering families and medical personnel to funding prevention and community-based support services and programs. The U.S. Secretary of Health and Human Services would be tasked with evaluating existing programs for their effectiveness in handling co-current disorders (e.g., substance abuse and mental illness); reducing homelessness and incarceration of people with substance abuse and/or mental disorders; and providing recommendations on improving current community-based care.

Harris, with Real MH Change, considers Alexander’s bill an imperfect improvement over the Murphy legislation.

“Both of [the bills] have far too much emphasis on rolling back the clock, promoting institutionalization, and not enough of a preventive approach or a trauma-informed approach,” Harris said. “What they share in common is this trope of ‘comprehensive mental health reform.’ Of course the system is completely messed up. Comprehensive reform is needed, but for those of us who have lived through it, it’s not just ‘any change is good.'”

Harris and Rodríguez-Roldán both acknowledged that many of the HR 2646 co-sponsors and supporters in Congress have good intentions; those legislators are trusting Murphy’s professional background and are eager to make some kind of change. In doing so, the voices of those who are affected by the laws—those asking for more funding toward community-based and patient-centric care—are being sidelined.

“What is driving the change is going to influence what the change looks like. Right now, change is driven by fear and paternalism,” said Harris. “It’s not change at any cost.”

Culture & Conversation Family

Breastfeeding, Bias, and Men Who Give Birth: Q&A With Trans Activist Trevor MacDonald

Britni de la Cretaz

In his new parenting memoir, Trevor MacDonald talks about pregnancy and breastfeeding as a trans man—and why we must dislodge the idea that bearing children is only women's labor.

Pregnancy, birth, and breastfeeding are acts often associated with womanhood. We talk about pregnant women and nursing mothers, but this language—which depends on the male-female gender binary—seems inadequate as trans and nonbinary folks are increasingly visible in the parenting sphere.

With his first book, Where’s the Mother?: Stories From A Transgender Dad, Trevor MacDonald hopes to blow the conversation wide open. MacDonald is a Canadian author who has been blogging about his journey as a nursing man on his blog, Milk Junkies, since 2011. He also facilitates a Facebook group for trans folks who nurse, and he initiated and helped design a University of Ottawa study focusing on the experiences of transmasculine individuals with pregnancy, birth, and infant feeding.

MacDonald’s book explores his transition from living as female to living openly as a man, and how that transition ultimately led to his decision to carry and birth a child with his partner.

By sharing his experiences and documenting the many challenges he faced as a man who planned to give birth and nurse his baby, MacDonald asks readers to reconsider everything they think they know about what it means to be a gestational parent. By the end of the book, readers come away understanding that despite a person’s gender, pregnancy and nursing are universal experiences and valid regardless of how they happen. MacDonald’s voice is an important and necessary one in the birthing community, and there are surely many more people out there like him.

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Rewire: You talk a lot about struggling to find literature that you related to because pregnancy, birth, and breastfeeding are typically only associated with women—and motherhood. Can you tell me about the kind of language you’d like to see used to talk about these experiences and why it’s important?

Trevor MacDonald: I think I was a bit naive at first when I was reading those materials. I felt like, “If only the authors knew, I’m sure they would have used different language. They just didn’t know about people like me.” And that’s definitely been the case for some of those authors. Many are starting to change language and using words like “parents” or “pregnant people.” It’s a simple shift, really.

Where I was naive, though, is that there are some people who really don’t want to use inclusive language. Ina May Gaskin is one. I had read her book [Ina May’s Guide to Childbirth] during my first pregnancy and had been so inspired by her writing, and the birth stories are so valuable and needed. I was so hungry for information about what others had experienced. I love that book so dearly, and to realize she really was opposed to including gender-diverse people in her writing was really upsetting. [Gaskin signed this open letter by Woman-Centered Midwifery, a group of “gender-critical” midwives who believe that biological sex determines gender and were concerned about the Midwives Alliance of North America’s use of gender-neutral language to talk about pregnancy and birth.]

It’s also really important to me to point out that no one needs to throw out the words “mother” or “woman”; you just need to include more words. So you could say “women and men and gender-nonconforming people” or “parents.” It’s nice to have more than one word to mix things up a little bit.

Rewire: What was the decision to carry a baby like for you?

TM: It was something I’d never thought I would do until after I transitioned and after getting together with my partner. For me, transitioning in the medical way that I did [through hormone therapy and top surgery involving breast removal] made me comfortable enough with myself to contemplate carrying a baby. Before that, there was so much stress and constant background noise in my thoughts and in my life to do with gender, with bathrooms, and with all the ways I really wasn’t comfortable. When I transitioned and so much of that fell away, I started to consider things I never had before. It helped that I was able to present as male throughout my pregnancies because I had taken testosterone [before pregnancy]. Those things enabled me to express my gender and present myself during pregnancy in ways that were comfortable for me.

Rewire: Did you experience any gender dysphoriathe distress or discomfort that occurs when the gender someone is assigned does not align with their actual gender—during your pregnancy?

TM: For sure, but for me it was more around medical stuff than around everyday living. In my everyday life, I was still presenting as male. But with health-care providers, especially providers who specialize in prenatal care, they’re so used to everything being woman-centered, and it’s really important to some providers to use woman-centered language.

I didn’t have any providers who had worked with an openly trans client before, so people certainly had trouble with the language. One midwife offered a blanket apology that she was going to have trouble remembering to use the right words and that she didn’t mean to be offensive. For me, I think I would have preferred if she had made more of a commitment to trying to change her language—going beyond apologizing, but trying to do something to remember to use my pronouns. I think it must be hard when it’s your first client who has asked you to use new language. It’s a new skill that has to be practiced and learned, like any other.

Another place where I sometimes experienced challenges was when people at work who had previously been using the correct pronouns for me switched to using the word “mom” and female pronouns when they found out I was pregnant.

But for me personally, in my body, I didn’t feel like the experience of being pregnant triggered dysphoria. It was more the way society responded to me that did.

Rewire: Birthing at home was something important to you. Can you talk a bit about why that option felt safest?

TM: I think the difference for me was that care is different. In Canada, we have midwifery care that is part of the health-care system, and it is covered by insurance. We still have a shortage of midwives, so not everyone who wants one can get one. I was fortunate to get midwives for both my births. For me, the continuity of care that they provide and that you get with a home birth is important.

At a hospital birth, there is no way to meet all your providers before you go there and labor, and I felt like there might be a lot of explaining that I might have to do. I did go to a hospital during pregnancy and another time when I had a miscarriage. I had to come out to every provider there, starting with the first nurse and every subsequent person that I saw. Each person needed to hear the same story about how I, a man, was pregnant. One doctor even had a lot of questions about how I could no longer be taking testosterone and still have facial hair. I couldn’t imagine having to explain those things and educate during labor.

Even with midwives, though, it’s not a magical recipe for getting exactly the kind of care that you need. I still had midwives at my first birth that I hadn’t met before.

Rewire: How do you think care providers—whether they’re doctors or midwives, or lactation consultants—can best support families like yours, or people who are not women but may be giving birth or nursing their babies?

TM: I think considering the topic, doing reading and practicing using the language ahead of time, before they ever meet their first trans or gender-nonconforming client is really important. There are more and more resources available now and places to go to read about people’s experiences, and there are a number of different medical associations who have called on their members to do exactly that. This is so they are not asking their individual patients to educate them, particularly when that person needs care and is in a vulnerable position. That’s not the time to be asking questions that they could learn about in other places.

Rewire: Finding donor milk for your son Jacob seemed to be quite a challenge. You mention that you produce about a quarter of the milk your baby needed, and the rest had to come from donors. Can you talk about what some of the challenges to finding donor milk are? Do you think protocols that see milk sharing as “risky” keep babies from being breastfed who might otherwise benefit from receiving breast milk?

TM: I think some of the taboo against milk sharing is really starting to shift in our culture right now. Currently, a lot of regulatory bodies—for example, the Food and Drug Administration and Health Canada—have a position against peer-to-peer milk sharing—like through Facebook groups like Human Milk 4 Human Babies, where we found many of our milk donors.

But La Leche League (LLL) has actually changed their position on it. LLL’s leaders, who facilitate their local support groups, used to not be allowed to discuss peer-to-peer milk sharing in any way, but last year the organization released a statement with a new policy. Leaders are allowed now to share information and can say that these milk sharing websites exist. It would be a great shift if other groups start to take a position more like LLL, where they can provide information. It would be awesome if medical professionals started to tell patients that these networks exist. Karleen Gribble has written papers about the ethics of peer-to-peer milk sharing and the ethical implications of letting patients know about it and how care providers could discuss risks and benefits, not just of peer-to-peer milk sharing, but of using formula.

In pop culture, when people talk about being worried about milk sharing, the fear most often brought up has to do with diseases like HIV. But something we had to consider as well was the medications that people were taking and whether it could be passed through breast milk. Many people who donate milk through peer-to-peer sharing do so because formal milk banks have such strict requirements around who can donate to them. Formal milk banks are not necessarily in competition with peer-to-peer milk sharing, which is important to understand.

Rewire: You talk a lot in the book about milk donation and the community that sprung up around you to help your family achieve your breastfeeding goals. Can you speak about the support you received and how it affected your breastfeeding journey?

TM: We met people that we otherwise never would have met and never would have become friends with. Many of our milk donors are still our friends, and they were such a diverse bunch of people. From a Mormon donor to a military family to a Mennonite family, all these different kinds of families from different backgrounds came together to help us feed our baby. It was amazing to meet these different people and to realize that despite us being a different kind of family in this one particular way, what was most important to all these people was that a baby needed breast milk.

Rewire: It sounds like prior to having your son, you didn’t know any other trans people who had nursed their babies. Has that changed? Are their experiences similar to yours?

TM: Before Jacob, I only knew about the guy, Thomas Beatie, who went on Oprah. I didn’t know anyone in person. I knew a few trans people who had children prior to transition. Through writing my blog, that’s how I first started to connect to a lot of other trans parents and people who were carrying babies while being out as trans. People asked me questions through my blog about how I navigated the medical system and a lot of questions about breastfeeding.

I also got a lot of questions from cisgender women as well, who were grappling with all kinds of different breastfeeding challenges. Many people deal with low milk supply and try to use a supplementer, like I use to nurse my baby (since I only make about a quarter of the milk my baby needs, I use a supplementer to deliver the milk at my chest, which allows me to feed my baby at my chest). So many people can relate to these challenges. A lot of the time, it’s a private struggle that people have, and it’s intense but you don’t necessarily talk about it that much. All kinds of people reached out to me because they could relate to these issues.

Rewire: What do you wish you had known before giving birth to Jacob?

TM: I wish I had trusted my own instincts a little bit more, and given myself more space to just see what my body would want to do in labor. I felt like I was looking to my care providers and my doula for suggestions, and I’m sure a lot of people have that experience when they’re going through something they’ve never been through before.

Rewire: What do you hope people take away from your book?

TM: I really hope that it will open up conversations. I hope it will provide opportunities for people to talk more about gender diversity, not just generally, but in parenthood and related to pregnancy and breastfeeding. If this book contributed to a conversation that way and opened up discussion, that would be amazing. I would be really thrilled.

This interview was conducted by email and by phone. It has been lightly edited for length and clarity.