# A qualitative study on healthcare providers’ biases towards transgender and gender diverse people accessing contraceptive care

## TL;DR

This study explores biases among healthcare providers toward transgender and gender diverse patients seeking contraceptive care, finding gaps in understanding and inclusivity.

## Contribution

The study identifies specific implicit and explicit biases among providers and proposes institutional solutions to improve care for transgender and gender diverse patients.

## Key findings

- Providers struggled with understanding gender diversity and applying gender-inclusive care frameworks.
- Explicit biases were evident in gender binarism and lack of experience with transgender patients' needs.
- Solutions suggested include institutional changes to create more trans-inclusive healthcare environments.

## Abstract

Bias in sexual and reproductive health care (SRH) undermines the quality and delivery of essential services. For transgender and gender diverse (TGD) patients, barriers to care may be acute when seeking gendered services, such as contraception. Few studies have assessed providers’ perceptions of TGD patients in SRH. Our objective was to examine bias in contraceptive providers’ attitudes towards and experiences with TGD patients. We conducted in-depth interviews, from August 2022 to August 2024, with 41 healthcare providers located throughout the US and attending CME-accredited trainings on contraceptive counselling. We utilised deductive thematic analysis to identify the domains of implicit and explicit bias specific to TGD patients. Many providers struggled to understand gender diversity and had difficulty using gender-inclusive frameworks in care delivery. Explicit biases were exemplified in the pervasiveness of gender binarism within the healthcare system and providers’ lack of experience with TGD patients. Providers demonstrated implicit biases through their deficits in knowledge regarding TGD patients’ medical needs and culturally insensitive approaches. They offered suggestions to mitigate bias, including institutional changes to make clinics more trans-inclusive and affirming. Biases and disparities specific to TGD patients are perpetuated through a lack of awareness and stigmatisation in healthcare settings. Our findings highlight areas to improve awareness of bias, dispel confusion with evidence on gender-inclusive care, and integrate structural changes within clinics to reduce the burdensome impacts of bias on TGD patients. Advocacy at both the provider and institutional levels is needed to offer quality contraceptive care for TGD patients.

Bias and discrimination in sexual and reproductive health care reduce the quality and accessibility of essential services. Transgender and gender diverse (TGD) patients face many barriers and biases when seeking contraceptive care. We conducted interviews with healthcare providers working in contraceptive care to assess different types of bias in their experiences with TGD patients. We found that many providers struggled to understand gender identity and to use gender-inclusive frameworks in care delivery. Biases were present within the healthcare system itself and further perpetuated through providers’ lack of experience with TGD patients’ medical needs, pronouns and gender identities. They also brought up solutions to mitigate bias, including institutional changes to make clinics more trans-inclusive and affirming. Our findings highlight areas to improve awareness of bias, reduce confusion with evidence on gender-inclusive care and incorporate structural changes within clinics to reduce the burdensome impacts of bias on transgender and gender diverse patients.