LGBTQ Agenda: Impact of Dobbs decision has already affected LGBTQ health care, study finds

  • by Eric Burkett, Assistant Editor
  • Tuesday October 18, 2022
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Abortion rights demonstrators protest outside of the U.S. Supreme Court, on June 21, 2022. Photo: Jose Luis Magana/AP
Abortion rights demonstrators protest outside of the U.S. Supreme Court, on June 21, 2022. Photo: Jose Luis Magana/AP

While the fallout of the U.S. Supreme Court's decision in Dobbs v. Jackson Women's Health Organization is still being felt around the country after it overturned Roe v. Wade, which guaranteed a constitutional right to abortion, its impacts on the country's LGBTQ population are still being studied. In the case of health care, however, some of its effects are already being identified.

The Dobbs decision, issued by the court on June 24, found that the U.S. Constitution does not confer a right to abortion, thereby overturning nearly 50 years of precedent since the Roe decision in 1973. While much has been made of the ruling, and while more than half the of the 50 states have gone about either drastically restricting a person's right to choose abortion or plan to, LGBTQ leaders have warned that the decision carries huge implications for the rights of LGBTQ people.

"Policies that restrict abortion care are often accompanied by decreased access to other reproductive health services, including contraception, and worsened health outcomes for both women and children," noted the Williams Institute, an LGBTQ think tank based at UCLA School if Law, in its introduction to a recent brief titled "The Implications of Dobbs on Reproductive Health Care Access for LGBTQ People Who Can Get Pregnant." The study was done in cooperation with the Center on Reproductive Health, Law, and Policy, also at UCLA School of Law.

Brief authors Cathren Cohen, a staff attorney; Bianca D.M. Wilson, senior scholar of public policy; and research director Kerith J. Conron point out that potentially worsening restrictions on LBT access to reproductive care fall on top of already dismal health care statistics for LBT persons.

"Most conversations and media attention about the impact of Dobbs have focused on harms to the health and well-being of cisgender heterosexual women," they noted. "However, restricting abortion access will also impact members of the LGBTQ community. It is essential to consider the unique and significant impacts on LGBTQ people who can get pregnant (including LBQ cisgender women and transgender people who can become pregnant) in discussions about the harm caused by the rollback of abortion and sexual and reproductive health care access across the country."

Nearly one in six LQB cisgender women lack access to heath insurance — 14.3% — compared to cisgender heterosexual women at 10%, for example. Furthermore, more LQB cisgender women rely on Medicaid than do their straight counterparts — 13.3% versus 10.7% — and twice as many LGB cisgender women than straight cisgender women report not having a regular health care provider, or 29.3% versus 15.7%, according to the Williams Institute report. The figures are based on data from the federal Centers for Disease Control and Prevention, the brief noted.

Adding to inequities like these are the growing numbers of laws aimed directly at transgender people, particularly in health care. From laws restricting gender-affirming care for kids to additional laws threatening legal repercussions for parents or doctors of trans kids who permit or perform that care, the recent Dobbs decision seems to be emboldening those who are advocating for these laws. State governments are pressuring hospitals and clinics that provide gender-affirming care to close or cease treatments for trans people, the Washington Post recently reported.

So far, three states have passed bans on gender-affirming care: Alabama, Arizona, and Arkansas, although courts in Alabama and Arkansas have blocked those laws as they're under legal challenge. Arizona's law doesn't come into effect until 2023.

Oklahoma has taken it a step further, essentially pressuring Oklahoma University Health into not performing gender-affirming surgeries by threatening to withhold $39.4 million in funding for a new children's behavioral health facility at Oklahoma Children's Hospital.

In somewhat brighter news, the Movement Advancement Project, a Colorado-based think tank focusing on LGBTQ equality, identifies 24 states as having enacted protections for transgender patients, banning transgender exclusions in heath care coverage, including California, which has been a leader in protecting health care access for transgender people. In California, Governor Gavin Newsom last month signed a bill by gay state Senator Scott Wiener (D-San Francisco) that will make the state a refuge for trans kids and families seeking gender-affirming care banned in their states, as the Bay Area Reporter previously reported.

So far, however, one state — Arkansas — has specifically made it legal for insurance providers to target transgender people by allowing them to deny coverage for gender-affirming care.

These are only among a few of the challenges trans folks face in finding adequate health care. As the Williams Institute report states, simply finding health care providers who know how to care for transgender patients is already challenging enough.

"In general, transgender people experience discrimination, mistreatment, or denials of care when seeking health care and often have difficulty finding providers who are knowledgeable and able to provide trans-competent health care," the report states. "In particular, transgender men and nonbinary people who can get pregnant can face difficulties finding inclusive and affirming reproductive health care, including providers who use gendered language or incorrectly assume that all of their patients identify as female."

According to one study that ran in the International Journal of Transgender Health, "Despite the ability to carry pregnancies, [transgender, nonbinary, and gender-expansive] people assigned female sex at birth face barriers to accessing high-quality pregnancy-related health care, including provider knowledge barriers, structural barriers such as lack of health insurance, and social barriers such as the fear of discrimination or misgendering."

The authors of that study interviewed 1,694 eligible transgender and gender-expansive respondents and found that 210 (12%) had been pregnant at one time or another. As both this study, and the Williams Institute study found, it's very rare indeed that trans folks, much less LBQ cisgender women, are even asked by their health care providers about their family planning goals.

"The fact that nearly one in five respondents felt 'at risk' of unintended pregnancy, or were unsure of their risk, emphasizes the need for improved contraceptive counseling and care delivery for these populations," the study states.

LGBTQ Agenda is an online column that appears weekly. Got a tip on queer news? Contact Eric Burkett at [email protected]

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