January 25, 2017
On a conference call working out the details of a brochure about fertility and family building for gay men affected by HIV, something was nagging at me. Eventually I asked the question, "But what do we actually mean by 'men'?" The call was silent for a minute as we all thought about it. "When we're talking about gay men or 'men' in the context of family planning, fertility and reproductive technology, do we mean people who identify as men, or do we mean bodies that produce sperm? Because if we mean 'men' as a signifier, we also have to talk about fertility options for trans men, and if we mean 'bodies that produce sperm,' we also have to talk about trans women. Either way, the language is more complicated."
I've been a psychotherapist long enough that I can remember times when my comments would have been met with resistance, and colleagues would have said I was unnecessarily complicating whatever the issue had been narrowed to. My collaborators at HIVE were excited by the turn in the conversation, and as we continued talking, it became clear that we needed to produce additional brochures. Instead of trying to fit trans men and trans women into brochures for gay men or cis women, we needed to collaborate with multiple communities to write content and language that attempted to tend to the nuances and multitude of possible relationships among gender identities and bodies.
HIVE's Yamini Oseguera-Bhatnagar says, "Our brochures on fertility and safer conception for trans men and women were informed by trans-competent clinicians for clinical accuracy, advocates and activists for inclusivity of language, and consumers for readability and accessibility. The resources section was put together with input by all."
When we consciously ask questions about what bodies are capable of, and what we mean by identities, the language we chose allows us to share fantasies and make them enactable possibilities.
The brochure for transwomen contains this asterisked note: "In this brochure we use the term trans women to include gender non-conforming (GNC), gender non-binary (GNB), gender-fluid, genderqueer, trans-feminine-identified people. We use this label as imperfect shorthand to refer to bodies that may have the capacity to produce sperm but without ovaries and/or a uterus."
And the brochure for transmen contains the asterisked note: "In this brochure we use the term trans men to include gender non-conforming (GNC), gender non-binary (GNB), gender-fluid, genderqueer, transmasculine and masculine of center-identified people. We use this label as imperfect shorthand to refer to bodies that do not produce sperm and may or may not have ovaries and a uterus."
During more than 15 years of working with LGBTQI clients in the Bay Area, I have fumbled and made many mistakes as language signifiers changed, and communities developed ranges of labels and pronouns to express the endless ways of claiming a self and a body. The possibilities bloom exponentially when we include partners, spouses, lovers and chosen family in the conversation.
When I spoke about reproductive technology with one of my psychotherapy colleagues, a seemingly cisgender heterosexual woman, she told me that a family member of her husband had provided sperm for the conception of their child.
The truth is, when we expand the language to include everyone, even people who fit the normative center are given more ways to express their lives. As providers we walk a fine line, reading, listening, educating ourselves so that clients don't have to educate us on the cultural contexts of their dailiness, even as they explain and explore the nuances of their particular embodied lives.
Queer families have always made it up as we've gone along. When I was first in practice, mostly lesbians wanted to talk about fertility and babies. Sometimes they had questions about finding sperm donors and grieved that many of the men who they'd made queer families with had died or were HIV positive and unable to be donors.
It took longer for gay men in my practice to start talking about family building. Some of the men who'd been seropositive since before highly active antiretroviral therapy hadn't allowed themselves to want to become parents out of fear that they or their partners wouldn't live long enough to raise their children. Younger gay men believed in the possibility of their survival, but were often discriminated against by a reproductive medical establishment that still enforces a ban on gay sperm donors and is often financially prohibitive, as well as adoption agencies that favor heterosexual couples over single or partnered LGBTQ prospective parents.
More and more trans men and trans women are also exploring parenthood. While trans people have always been parents, now they are beginning to be treated with respect for their fertility and bodily self-determination by providers who had previously denied their fertility. It was only in 2014 that the World Health Organization released a report urging governments to end the practice of forcing or coercing sterilization as a prerequisite for allowing gender confirmation procedures.
The genders of "mother" and "father" may not be the same as the expected biological functions involved in conception. This means that a body that produces sperm might be the intended mother, and a body with ovaries and a uterus might be the intended father. Yes, we still talk about the health benefits of breastfeeding -- and we include language about chestfeeding.
There is still a long way to go. Speaking recently with a trans woman about the HIVE brochures, she said that even though she was glad providers were addressing what was medically possible, until the possibility existed of successful uterine transplants and carrying a baby to term in her body, other paths toward parenthood would only be disappointing.
There is so often grief when our bodies can't do what we had dreamed they would do. For many people who are seropositive and parents, or hope to become parents, part of their grief has been the idea that seropositivity had taken away the possibilities of parenthood. But we're in a medical moment -- and a cultural one -- when that is no longer true. Treatment as prevention, pre-exposure prophylaxis (PrEP) and viral load undetectability have opened up possibilities of biological and genetic participation in the conception of children. And better health access and treatment options have made living long enough to raise children equally possible.
HIVE's director Shannon Weber says, "HIVE's mission is advancing reproductive and sexual wellness for people and communities affected by HIV. Creating the trans feminine and trans masculine safer conception materials adds to the growing suite of HIVE's safer conception resources for people, regardless of gender identity, HIV serostatus or sexual orientation, to have the option to choose whether or not to be a parent. HIVE is thrilled to be at the forefront of advocating for reproductive rights for all."
HIVE's conception and reproductive health brochures are available online. This is in part so that they can be easily accessed by patients and providers who aren't in the Bay Area, and in part to make the information accessible to patients in service of their self-determination and self-advocacy.
Familial and bodily self-determination is a basic human right, especially in the face of a historically transphobic, homophobic, misogynist and heterocentric reproductive technology field.
I imagine these brochures as living documents. As the fields of reproductive technology, transgender health and HIV change, so will these documents. As a practitioner, the conversations and collaborations that created these brochures have been an affirmation of a little bit of joy, and even -- I'll allow myself to say it -- a little bit of hope for the future.
[Author's note 1/25: This piece was written before the reinstatement of the global gag rule on Jan. 23, which bans U.S. federal funding for any international health organizations that counsel people about family planning options that include access to safe abortion. The gag rule will radically reduce access to education and resources for reproductive health information, birth control, sex education and HIV testing. True reproductive health care and empowerment means access to medically and culturally attuned information and providers. This article and the links it contains are part of a campaign to ensure that people of all genders and relationship status have access to appropriate knowledge about all of their fertility and family planning options.]
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