4th November 2022
Ahead of Trans Parent Day on 6 November, we are delighted to share this Voices blog from Emily Rounds, Professional Development Officer, Perinatal & Infant Mental Health at the iHV.
Since starting my new role at the iHV in June 2022, I have had the privilege of developing our new programme: ‘People who identify as LGBTQI+ and Perinatal Mental Health Champion Training’ in partnership with Lucy Warwick-Guasp. As a proud sister to my non-binary[i] sibling who identifies as queer, I feel very lucky to have the opportunity to work in this area professionally; to shine a light on LGBTQI+ experiences and to endeavour to improve outcomes for parents and their families in this community.
As registrants under the Nursing and Midwifery Code, health visitors must prioritise people: ensuring we “Treat people as individuals and uphold their dignity”; “Avoid making assumptions and recognise diversity and individual choice”; and “Listen to people and respond to their preferences and concerns.” These standards are particularly relevant to caring for trans[ii] and non-binary people.
Our ambition at the iHV is that all mothers, birthing people, fathers, co-parents and intended parents receive high quality care and support, fostering equity in health and wellbeing for all.
In 2019, “transgender” was removed from the World Health Organisation’s classification of mental and behavioural disorders. Trans and non-binary people continue to experience discrimination, violence, and poorer health outcomes, and their experiences continue to be sensationalised by the media. Alarmingly, the UK has announced not one, but two ‘first’ pregnant men, once in 2012 and again in 2017, invalidating the experiences of all the trans and non-binary parents who have given birth both before, and after this. There has been a lack of attention to the specific perinatal health and care needs of this community and the reality of the way in which families are comprised today, calling for an urgent investment into this area.
We know that people who identify as transgender or non-binary are at a far higher risk of experiencing common mental health problems compared to the general population. Those who have experienced a hate crime based on their sexual orientation and/or gender identity are at even greater risk of poor mental health, as are those from Black, Asian and minority ethnic groups; aged 18-24; disabled; or from lower income households. Compared to cisgender[iii] people, trans and non-binary people are more likely to experience, or have a history of discrimination, trauma, anxiety and depression, self-harm, and suicide attempts. Furthermore, trans or non-binary parents may have increased vulnerability to perinatal mental health difficulties and traumatic births, due to increased dysphoria[iv], isolation, exclusion, and feared/experienced prejudicial treatment associated with transphobia and misgendering.
This year, the LGBT Foundation published a landmark survey: Improving Trans and Non-binary People’s Experiences of Maternity Services (ITEMS) Survey. Throughout the report, the fear of prejudicial treatment and poor-quality care was unmistakable. Many reported avoiding maternity services altogether and ‘Free Birthing[v]’, while others chose to conceal their gender or trans status to navigate services safely and avoid transphobia. Those who accessed care, reported significant inequalities and poorer experiences compared to cisgendered people. Respondents also reported receiving a lack of information around their birthing process, feeding their baby, perinatal mental health, and where to seek support for their mental health if required.
Health visitors play a vital role in promoting the perinatal mental health of parents, so how can we improve the care we offer to trans and non-binary parents?
- Use additive and inclusive language: using gender neutral language alongside the language of womanhood, in order to ensure that everyone is represented and included. The right language can promote trans and non-binary people’s mental health and wellbeing and influence how likely they are to access healthcare when necessary, for example, “pregnant women and birthing people.”
- Offer personalised, trauma informed care and share tailored information around birthing choices, infant feeding choices, and perinatal mental health.
- Access training: The LGBT Foundation recommends every clinician, as well as service managers, commissioners, and policymakers, participate in training to improve experiences and outcomes for trans and non-binary parents. The Institute of Health Visiting will be launching People who identify as LGBTQI+ and Perinatal Mental Health Champion Training in February 2023 to celebrate PRIDE History Month. To find out more or book your place, please contact [email protected]
Emily Rounds, Professional Development Officer, Perinatal & Infant Mental Health at the iHV
- Nursing and Midwifery Council (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates
- Stonewall (2018) LGBT In Britain – Health. https://www.stonewall.org.uk/lgbt-britain-health
- LGBT Foundation 2022 Trans and Non-Binary Experiences of Maternity Services ITEMS report. https://dxfy8lrzbpywr.cloudfront.net/Files/97ecdaea-833d-4ea5-a891-c59f0ea429fb/ITEMS%2520report%2520final.pdf
- Greenfield & Darwin (2020) Trans and non-binary pregnancy, traumatic birth, and perinatal mental health: a scoping review. International Journal of Transgender Health Volume 22, 2021 – Issue 1-2: Fertility, reproduction and body autonomy. https://doi.org/10.1080/26895269.2020.1841057
- Gender Inclusive Perinatal Services Brighton & Sussex University Hospitals NHS Trust: Green, H and Riddington, A (2020) Perinatal Care for Trans and Non-Binary People https://www.bsuh.nhs.uk/maternity/wp-content/uploads/sites/7/2021/01/MP005-Perinatal-Care-for-Trans-and-Non-Binary-People.pdf
- Green, H and Riddington, A (2020) Gender Inclusive Language in Perinatal Services, Brighton & Sussex University Hospitals NHS Trust https://www.bsuh.nhs.uk/maternity/wp-content/uploads/sites/7/2021/01/Gender-inclusive-language-in-perinatal-services.pdf
[i] Non-binary: An umbrella term for people whose gender is something other than man or woman.
[ii] Trans or transgender: An umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, the sex they were assigned at birth. Trans people may describe themselves using one or more of a wide variety of terms, including (but not limited to) transgender, transsexual, genderqueer (GQ), gender-fluid, non-binary, gender-variant, agender, nongender, third gender, bi-gender, trans man, trans woman, trans masculine, trans feminine and neutrois.
[iii] Cis or cisgender: Someone whose gender is the same as that which they were assigned at birth
[iv] Dysphoria: Gender dysphoria describes the distress experienced by those whose gender identity feels at odds with aspects of their body and/or the social gender role assigned to them at birth. This can be experienced as physical discomfort, and psychological and emotional distress.
[v] Free-Birthing: deciding to give birth at home or somewhere else without the help of a healthcare professional such as a midwife. Not to be confused with giving birth at home before the midwife had time to arrive (this is called ‘born before arrival’.)