People gather at a rally for LGBTQ+ rights at Washington Square Park on Oct. 21, 2018 in New York City. Based on a leaked memo, The New York Times had reported that morning that the Trump administration was considering re-defining gender as a "biological, immutable condition determined by genitalia at birth," which activists said would subject transgender and gender nonconforming people to discrimination, harassment, and violence. (Photo by Yana Paskova/Getty Images)

In 2021, the U.S. saw a wave of state legislation restricting access to abortion and other reproductive health care. Once again, every time reproductive health care is attacked, a wave of commentary emerges, all based on the same “hypothetical” situation: male pregnancy.

This isn’t new—it’s been in use since the 1970s, when Gloria Steinem and Florynce Kennedy began proclaiming, “If men could get pregnant, abortion would be a sacrament.”

Tune into any news story, read any op-ed, or listen to any political debate about reproductive health care, and you’ll find comments like Laurie Penny’s assertion that if men got pregnant, abortion would have no restrictions and “no man would be expected to justify his decision to terminate an unwanted pregnancy,” or Charles M. Blow’s op-ed in The New York Times about how back-alley abortions and criminalizing choice “would never have happened” if men got pregnant. It’s even prevalent throughout popular culture, with a 2017 episode of Veep declaring, “If men got pregnant, you could get an abortion at an ATM.”

These make for entertaining soundbites. But contrary to these assertions, many transgender men, transmasculine people, and nonbinary people can, and do, become pregnant. And sometimes, we need access to abortion. The Guttmacher Institute estimated that between 462 and 530 trans and nonbinary patients sought out the procedure in the U.S. in 2017. That’s likely an underestimate—many trans people may decide not to mention their gender identity to their doctor at all for fear of discrimination.

In Penny’s piece, they give a nod to the fact that trans men can and do become pregnant, before proclaiming somewhat paradoxically, “but their experience is not part of the popular understanding of reproductive rights—because people don’t get pregnant, women get pregnant, and when you get down to it, women aren’t really people.”

They aren’t wrong that our experiences of pregnancy aren’t part of the conversation around reproductive rights. But the reason we’re not part of the conversation is because feminists like Penny are intentionally erasing us. The truth is that being transgender often makes it even harder for us to find easy, barrier-free care than cis women. And cis people ignoring how access to reproductive care is an issue that affects us and cis women is an undeniable part of the problem.

Transmasculine People Already Struggle to Access Reproductive Care

With hundreds of legislative attacks on our identities and the right to live openly, 2021 was a difficult year to be transgender. The nationwide crackdown on abortion access has made it even more challenging to exist in the world as a trans person with a uterus. Even though transmasculine people are uniquely vulnerable in our current political environment, most policymakers, health care workers, and pro-choice activists refuse to even acknowledge our existence.

Despite what pithy quotes about men experiencing pregnancy might lead one to believe, society equating reproductive organs with gender creates major obstacles to health care for anyone who isn’t a cisgender woman. That’s true whether we are pregnant or not, whether we want to have children, and whether we’re simply trying to keep our bodies healthy.

One of the significant barriers encountered is medical misinformation. Many anti-trans activists and even well-meaning doctors have stated that transition care can cause permanent sterility in people with ovaries, but that’s simply not true. A study in 2020 found that testosterone may have little permanent impact on fertility, showing that transgender men who have stopped hormone treatment for four months retain similar ovarian function to cisgender women. It’s possible to become pregnant even on testosterone—and because it can negatively impact a developing fetus, it’s vital that transmasculine people have access to safe and effective birth control.

A recent Rutgers study found that up to 30% of transgender men have experienced an unintended pregnancy. Unfortunately, official government statistics track every pregnant patient as “female,” rendering this data almost completely invisible.

Because of widespread medical discrimination and lack of transgender competency, accessing prenatal care at all can be a struggle. The National LGBTQ Taskforce found that 19% of trans patients report being refused care outright because of their identity, 28% have been subjected to harassment in medical settings, and 50% have had to teach their medical providers how to provide transgender care.

That’s likely why a staggering 44% of pregnant trans men avoid working with obstetricians entirely, opting instead to see nurse-midwives and other non-physician providers. While only about 1% of cisgender women give birth outside of hospitals in the U.S., 17% of trans men attempt an unassisted birth, putting them at a far greater risk of complications and death.

These difficulties engaging with the medical system have other consequences. Discrimination and anxiety around obtaining gynecological care also puts transmasculine people at a much higher risk of death from ovarian, uterine, and cervical cancer. Even when cancer is caught at the early stages, doctors may simply refuse to treat trans patients—in 1999, a trans man named Robert Eads died of ovarian cancer after being refused care by more than a dozen doctors. Unfortunately, this remains an issue: in 2017, trans health care advocate Kaden Merrill spoke about his struggle to get insurance to cover treatment for pre-cancerous cervical cells, which was denied because his provider didn’t have a code that would pay for a trans man to have a hysterectomy.

Despite what pithy quotes about men experiencing pregnancy might lead one to believe, society equating reproductive organs with gender creates major obstacles to health care for anyone who isn’t a cisgender woman. That’s true whether we are pregnant or not, whether we want to have children, and whether we’re simply trying to keep our bodies healthy.

Access to reproductive care, and particularly abortion, becomes even more urgent when looking at sexual assault and domestic violence statistics. Though there are few studies, it’s estimated that trans men experience significantly higher rates of both than cisgender women. Simply put: transmasculine people are more likely to get pregnant as a result of rape. We’re also at greater risk of being physically attacked or killed by romantic partners if they find out we’re pregnant—studies find that people with unintended pregnancies are two-to-four times more likely to experience violence than those with planned pregnancies, and homicide is the leading cause of death for pregnant people in the U.S.

Even when transgender people don’t need access to abortion care itself, the crackdown on providers can have devastating consequences. In many parts of the country, Planned Parenthood may be the only provider offering hormone replacement therapy for trans patients, and when those clinics are shut down, patients are cut off from the medical care they need. For all of these reasons, inclusive reproductive care is literally a matter of life or death.

Transmasculine people—and allies—are pushing for change

While this may paint a grim picture, there are reasons for hope. At the 2021 Women’s March, transgender athlete Schuyler Bailar pushed for activists to include trans men and nonbinary people with uteruses in discussions around abortion access, saying, “I am here to remind you to make it absolutely clear that people of all genders can have abortions, and people of all genders should have safe and legal access to abortions.”

Other figures like Cazembe Murphy Jackson are urging LGBTQ+ people who’ve had abortions to speak out about their experiences so that members of the pro-choice movement realize reproductive rights are not solely a “women’s” issue. He notes that there is a culture of silence about abortion in the trans community, saying, “Some trans men are passing or in the closet, and don’t want to talk publicly about abortions because it outs them. Even to this day, I have friends who tell me that I shouldn’t be sharing my story because people won’t respect me as a man if I am talking about abortion.”

And in 2018, filmmakers Yee Won Chong and Brooks Nelson released the documentary Trans Dudes With Lady Cancer, exploring their experiences navigating the medical system and being treated for breast and ovarian cancer.

Allies from outside the transmasculine community are also pushing for inclusion in discussions and public policy. Actress and activist Laverne Cox has been a vocal advocate for inclusive language. Democratic lawmakers like Reps. Cori Bush and Alexandria Ocasio-Cortez have gone out of their way to use gender-neutral terms like “menstruating people” and “birthing people” instead of assuming these issues only affect cisgender women.

When she was mocked for her choice of words, Ocasio-Cortez simply tweeted, “Trans, two-spirit, and non-binary people have always existed and will always exist. People can stay mad about that if they want, or they can grow up.”

Even the Biden administration has attempted to update language in their budget proposal for 2022, allocating additional funding to end race-based disparities in pregnancy care for birthing people of all genders.

Of course, simply changing the language we use is not enough on its own. Lawmakers must continue to defend anti-discrimination protections for trans patients in health care. Health care providers also need to train their staff to competently treat trans patients. And trans people need to be invited to participate in the reproductive rights movement and listened to with respect for our own experiences, rather than being shut out or dismissed as an afterthought. 

At the very least, media and pop culture commentators need to expand their ability to criticize patriarchal obsession with abortion beyond lazy metaphors and what-if scenarios based on a false gender binary. Our lives literally depend on it.

Orion Rodriguez (he/they) is a nonbinary writer, artist, and activist. His writing has been published in Salon, Lightspeed Magazine, Inhabitat, and elsewhere. He is currently working on "The Life and Times...