This is a research report commissioned by Health and Wellbeing Alliance. This is a VCSE partnership which is jointly managed by DHSC, PHE and NHSE&I.
The Improving Trans and Non-Binary Experiences of Maternity Services (ITEMS) research project was commissioned by the Voluntary, Community and Social Enterprise Health and Wellbeing Alliance (VCSE HWA) and delivered by LGBT Foundation in partnership with a steering group. It ran between September 2020 and April 2021, aiming to gain insight into trans and non-binary experiences of perinatal services and put forward recommendations for improvement.
The survey received 121 eligible responses, making it one of the largest studies of trans pregnancy, and the largest outside the US. It adds to the growing evidence that the number of trans and non-binary people who become pregnant appears to be increasing, and given that the NHS does not consistently record trans or non-binary status in perinatal services (or in any of its services), it is a unique and ground-breaking study of this community’s experiences.
- Trans and non-binary people’s experiences of perinatal care are consistently worse across the board compared with cis women. This is also reflected in the proportion of trans and non-binary birthing parents who didn’t access any perinatal care during pregnancy – 30%, compared with up to 2.1% of the general population.
- Transphobia and racism in perinatal care intersect to produce particularly poor outcomes for trans and non-binary birthing parents of colour.
- There are examples of good practice, where midwives and services as a whole to a proactive approach to gender inclusion, from language used to provide care options that clearly centred the needs of the individual patients. However, these were generally localised and not supported at a wider scale by the necessary resources for training/development and national-level guidance.
- The recommendations of this report aim to outline how different parts of the healthcare system can take coordinated action to improve experiences and outcomes for all trans and non-binary birthing parents.
- These recommendations include supporting the delivery of personalised and trauma-informed perinatal care; proactively adopting inclusive language and targeting outreach to trans and non-binary birthing parents; and implementing IT and demographic monitoring systems to enable the sensitive collection of data about gender identity and trans status in perinatal services.
- We call on commissioners, health care professionals, and policymakers to use this report to ensure perinatal services are designed and delivered inclusively to meet the needs of all service users, including trans and non-binary people.