This article is part of a larger series titled The End Of Roe. Head here to read more.
Three years ago, Jack Meraxes had an abortion after being sexually assaulted. Despite the circumstances, Meraxes, who is a trans man, initially wanted to keep the baby.
“I wanted to keep the pregnancy, which is something I want to be really clear on,” Meraxes told HuffPost. “The ultimate decision to have an abortion because of a lack of financial resources and communal support was one I hated making and one I still feel grief over.”
Because the idea of trans men being pregnant and needing reproductive health care is so foreign to many people, Meraxes believes there’s an assumption that trans men seek abortions because they “hate the thought of pregnancy.”
But Meraxes, who lives in New England, said he had the “the same impulse to create life that many other people do” and stressed that “trans men have abortions for the same myriad reasons many other people do.”
There are some unique reasons trans men seek out the procedure as well. A 2019 study from Rutgers University showed that an unwanted pregnancy can lead to adverse mental health outcomes for trans men, including gender dysphoria, a distress you feel when the sex you were assigned at birth doesn’t match what you believe is your true gender.
Each case is different, obviously.
When he sought out his abortion, Meraxes said his family and friends didn’t understand his need for emotional support because he had already begun transitioning.
“I wasn’t seen as a man mourning a loss in their eyes. I was seen, in one person’s words, as a man ‘removing a tumour,’” the 35-year-old said. “The idea that as a trans man I could have been comfortable being pregnant was obviously absurd to the people in my life.”
“It’s hard to articulate how frustrating [it is] that I see dozens, if not hundreds of posts going, ‘If men could get pregnant, abortions would be legal and convenient.'”
- Jay Holloway, a trans man and staff pharmacist at Heart City Drug in Valentine, Nebraska
When he did have the abortion, Meraxes was relatively lucky; he had access to abortion through the same family planning group that was handling his trans-related health care, so he was never misgendered, deadnamed or faced any type of anti-trans violence.
But now, as the US Supreme Court appears to be poised to overturn Roe v. Wade, which established abortion rights in 1973, Meraxes fears a future in which reproductive health care would be difficult to access or trans men would be forced to give birth.
What makes it doubly hard right now is how much of the conversation about reproductive health care and reproductive rights seems to be centred on cis women, leaving out the unique experiences of trans and nonbinary people like him.
“We should be allowed a voice,” he said. “Reproductive bodily autonomy is not just a women’s issue – it’s a human issue, because every person capable of getting pregnant deserves the right to determine what happens to their body.”
Though the overwhelming majority of people who need abortions and reproductive care are cis women, transgender men, intersex and other gender-nonconforming people who have transitioned hormonally and are taking testosterone but retain their female reproductive organs can and do get pregnant. They will also be affected if Roe is overturned.
How many trans men get abortions? It’s hard to say because there is no one central database where information on abortion rates is collected. (The Guttmacher Institute conducts a semiannual Abortion Provider Census surveying facilities that conduct abortions – but not all facilities provide data.) In one 2021 survey, of over 1,700 transgender, nonbinary and gender-expansive adults (ages 18 and older) assigned female or intersex at birth, only 4% had ever had an abortion, including a third (32%) of those who had ever been pregnant. More than half of the pregnancies were unintended.
Even without overturning Roe, trans men and nonbinary people already face systemic barriers to reproductive health care, including low levels of health insurance and discrimination from providers, according to Heidi Moseson, a doctor and senior research scientist at Ibis Reproductive Health who’s studied pregnancy intentions and outcomes among transgender people. (Moseson conducted the aforementioned 2021 survey.)
According to her most recent research, nearly 1 in 5 transgender, nonbinary and gender-expansive participants who had ever been pregnant had attempted to end a pregnancy on their own, without clinical support. That’s considerably higher than the proportion of cisgender women, estimated at about 7%.
“All to say, even with Roe in place, access to clinic-based abortion care has been all but impossible for many in this country, particularly for transgender and nonbinary people, who face some of the greatest marginalization and barriers to care,” she said.
Despite the increased visibility of transgender people–— the Human Rights Campaign estimates that there are more than 2 million people who have transitioned across the US – medical providers are largely unprepared to care for them and most have had limited educational opportunities.
“Every health care appointment can be an uncertainty of how trans folks will be treated. Especially in the context of pregnancy care, where there is an assumption that the service user will be a married, heterosexual, cisgender woman,” said Kate Luxion, a nonbinary/genderqueer postgraduate researcher studying at University College London with a focus on LGBTQ+ reproductive health.
“Every point of communication, all of the educational documents and even the marketing material are still heavily skewed towards these women,” they said.
According to a recent report by the Center for American Progress, half of transgender people and 68% of transgender people of colour say they were mistreated by a medical provider in the year before the survey, discouraging them from getting medical care.
And 48% of trans men have avoided or delayed preventive health care, such as pelvic exams or screenings for sexually transmitted infections, because they anticipate mistreatment and judgment.
Clinics that provide abortion services are often the same clinics that provide gender-affirming care – and for many people, these clinics might be the only affordable, feasible option to access these medically necessary services, said Jess Venable-Novak, a queer, nonbinary educator and an organiser at Family Equality, a national organisation for LGBTQ+ families.
“So restricting access to reproductive health care might necessarily restrict access to gender-affirming health care for the trans community,” they said.
Looking at the issue more broadly, some LGBTQ people fear the reversal of abortion rights protections could affect their health and other rights, such as marriage equality.
Laws restricting abortion rights and trans rights are inextricably linked, advocates say
Over the last year, more than 166 bills in different parts of the US would directly affect trans youth by attempting to criminalise parents or doctors for providing gender-affirming medical care, as well as by banning trans children from competing in sports.
Though not outwardly related, many LGBTQ+ rights advocates and abortion rights advocates see parallels in these legislative efforts.
“The cruel rationale behind both anti-abortion and anti-gender-affirming care legislation is alarmingly similar — both movements restrict and criminalise bodily autonomy in the name of protecting ‘children’ while, in actuality, the legislation itself causes the harm, not abortion or gender-affirming care,” Moseson said.
“Just like abortion care, we know that access to gender-affirming care is essential for physical and mental health,” she said. (As a demographic, trans youth have suicide attempt rates as high as 40% – though a recent Harvard Medical School study showed that laws that work to limit transgender discrimination result in a drastic decrease in suicidal thoughts and plans.)
“The political movements that aim to curtail access to abortion and gender-affirming care fly flagrantly in the face of the best public health evidence and seek to force government involvement and criminalisation in what should be personal and private decisions about what is best for an individual’s body and life,” she added.
Inclusive language matters, but it’s more than that, trans men said
Given the gravity of the situation, urgent efforts are needed to raise awareness about abortion funds – nonprofits that provide financial assistance to cover expenses for the procedure and sometimes transportation to other states ― and other practical support options to help transgender and nonbinary people find and access clinic-based abortion care if that is desired, Moseson said.
Other advocates have urged people to donate to the National Network of Abortion Funds, a clearinghouse for these organisations, or some of the individual organisations listed on the association’s webpage.
“Efforts are also needed to raise awareness about how to safely self-manage abortions with pills for those who need or prefer a private, at-home abortion,” Moseson said.
As the debate over Roe intensifies – the leaked opinion is still subject to change and argument up until its official release, which is expected this summer – it’s important to use gender-inclusive language, like “pregnant people.”
But it’s deeper than just tweaking language. Even people who consider themselves trans allies can dismiss the experiences of trans men without reflecting, said Jay Holloway, a trans man and staff pharmacist at Heart City Drug in Valentine, Nebraska.
“It’s hard to articulate how frustrating [it is] that I see dozens, if not hundreds of posts going, ‘If men could get pregnant, abortions would be legal and convenient,’ or ‘Hey, men, listen to women about this,’ when it’s already difficult for trans men to seek OB-GYN care for fear of violence, misinformation or stigma,” he said.
What’s more, Holloway said, “anti-trans violence against trans men and other folks who can get pregnant is often couched in the idea that we can’t self-determine, that we’re too immature to decide or want to ‘escape womanhood.’ It erases our existence overall. We’re erased in our own struggles.”
Both Holloway and Meraxes wish people would recognise how interrelated the current rollback of LGBTQ and women’s rights are – and how little sense it makes to exclude trans men from the national abortion discourse.
“I can say from personal experience that this erasure is damaging,” Meraxes said. “Erasing us from the conversation and from access to abortion serves absolutely no one.”