Commentary Calls for Culturally Responsive Care and Stronger Research to Improve Health of Trans and Nonbinary Individuals

WASHINGTON, DC (Nov. 14, 2019) — When transgender and nonbinary (TNB) people seek health care, they often face gender-based discrimination and harassment—and sometimes even physical violence. A new commentary in Women’s Health Issues calls for health care providers and organizations to improve their practices, and for those involved with research to strengthen the data collection and analysis that can inform improvements.

Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health and is based in the Department of Health Policy and Management at the George Washington University Milken Institute School of Public Health (Milken Institute SPH).

At minimum, the commentary authors advise that health care organizations train staff and providers on evidence-based standards of care for TNB patients and create safe, affirming and inclusive care settings. They highlight online resources for providing culturally appropriate and affirming care (e.g., materials from the University of California San Francisco’s Center of Excellence for Transgender Health and the Fenway Institute’s National LGBT Health Education Center) and emphasize the importance of using gender-neutral language and inclusive questions, including on intake forms. Care settings should include health pamphlets or other waiting-room materials that demonstrate commitment to TNB health issues and “easy to locate and accessible” gender-inclusive restrooms, the authors recommend.

To ensure that providers can offer high-quality care to TNB patients, researchers must expand the evidence that informs such care—but that can be challenging when many large-scale surveys don’t capture sufficient information about participants’ gender identity, or involve too few participants who identify as trans or nonbinary. The commentary authors identify existing large data sets that include detailed questions about gender identity and note opportunities for improved data collection in the future—including the possibility of adding a gender identity question to the 2030 census. “Next steps must include an intentional collection and analysis of representative data from TNB individuals of all ages and stages of transition,” the authors write. 

“The Supreme Court will soon be deciding whether it will consider ‘sex discrimination’ prohibited under the Civil Rights Act of 1964 to include discrimination against people whose gender identity differs from the sex they were assigned at birth,” notes Anne Rossier Markus, interim chair and associate professor of health policy and management at Milken Institute SPH, associate editor of Women’s Health Issues, and an author of the commentary.  “This is an important time to be examining discrimination trans and nonbinary individuals face, and how those of us who work in public health and health care can alleviate it.”

To help researchers, policymakers, providers, and health care organizations address TNB health, the authors propose modifying the commonly understood definition of “women’s health” to include TNB individuals. 

“The field of women’s health has long included the study of how cisgender women’s experiences and outcomes differ from those of cisgender men,” explains commentary first author Shanna K. Kattari, assistant professor at the University of Michigan School of Social Work. “Trans and nonbinary individuals also experience challenges in accessing care and achieving optimum health because of their gender, so it makes sense to include them in the population that women’s health experts and practitioners address.”

Kattari, Markus, Danielle R. Brittain of the Colorado School of Public Health at the University of Northern Colorado, and Kelly C. Hall of the College of Kinseiology at the University of Saskatchewan authored the commentary. “Expanding Women’s Health Practitioners and Researchers’ Understanding of Transgender/Nonbinary Health Issues” was published on Nov. 14 and will appear in the Jan/Feb 2020 issue of Women’s Health Issues.