“The entire healthcare system is just set up to fail for these patients.” – Abortion professionals’ perceptions of the needs of marginalized patients, especially gender expansive patients, seeking telemedicine abortion care in the South Restricted; Files Only

Barnett, Aliza (Spring 2023)

Permanent URL: https://etd.library.emory.edu/concern/etds/8910jv989?locale=en


Background: Telehealth medication abortion (TMAB) is a method of receiving abortions via virtual telehealth platforms that may increase accessibility for some marginalized populations that face barriers to in-person care. People of all genders will have the need for abortions in their lifetime, and yet, the field of abortion care is still an extremely gendered landscape, focusing on the needs, experiences, and challenges of women seeking abortion care. Experiences and health outcomes of transgender, nonbinary, and gender expansive (TGE) individuals seeking abortions may vary greatly from their cisgender counterparts.

Purpose: The purpose of this thesis is to use two data sources to answer the question: What are abortion professionals’ perceptions of the needs of marginalized populations, especially trans, nonbinary and gender expansive patients who access telemedicine medication abortion care in the US South? This thesis aimed to identify practical guidance for abortion providers on ways to create more gender inclusive health care spaces.

Methods: Two data sources were used for this thesis. The first are qualitative interviews (n= 21) with abortion professionals in the South about their readiness to implement TMAB services. The second data source is a qualitative study with a focused sample of key informants (n=4) who are experts in gender affirming care and have experience with providing abortions.

Results: Study findings point to a clear gap in abortion professional knowledge about the barriers and needs of TGE patients seeking abortions via telehealth. Among 21 abortion professionals interviewed, none specifically identified the needs of TGE patients. Key informants expressed that the understanding of abortion as a “woman’s” issue creates spaces that are inherently exclusive to gender diverse patients. However, providers with training and education about how to adequately care for TGE patients can utilize gender affirming care to create more inclusive abortion care spaces.

Discussion: Reproductive healthcare and gender diversity are being politically attacked in the United States, particularly in the South. TGE patients deserve access to abortion care that is safe, compassionate, and centers their needs. Abortion professionals should increase their knowledge and skills to create sexual and reproductive health (SRH) spaces that center their marginalized patients.

Table of Contents

Chapter 1: Introduction 1

Chapter 2: Literature Review 3

Abortion Overview 3

Abortion among Transgender, Nonbinary, and Gender Expansive (TGE) Individuals 4

Abortion Methods 7

Abortion as Healthcare 10

Abortion in the U.S. 12

Abortion in the U.S. South: 19

Literature Gap and What is Needed 20

Chapter 3: Methodology and Results 22

Methodology 22

Results 31

Patient Needs for TMAB from the Perspective of Southern Abortion Professionals 31

TGE Needs from TMAB Interviews: 37

Chapter 4: Discussion, Recommendations, and Conclusion 51

Discussion 51

Limitations & Strengths 57

Recommendations for Practice 59

One Pager Recommendations from Providers to Providers: Creating Gender Inclusive Abortion Spaces 60

Conclusion 61

References 63

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