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Trans and non-binary experiences of maternity services: cautioning against acting without evidence

02 September 2023
Volume 31 · Issue 9


Research into the experiences of trans and non-binary users of maternity services in England was recently commissioned by the Health and Wellbeing Alliance. It was conducted by the LGBT Foundation, culminating in the ‘improving trans and non-binary experiences of maternity services’ report, which made a range of recommendations for the NHS. This article argues that there are substantial problems with the framing, data collection and interpretation of data in the report, and that its findings and recommendations should therefore be viewed with substantial caution, and not be used as the basis of NHS policy. The authors further argue that caution should be taken before using the experiences of a very small minority of service users, such as those who identify as trans and non-binary, to inform policy for all service users, and instead suggest that personalised care may be the most suitable approach to meeting the specific needs of trans and non-binary maternity service users.

In 2022, research into the experiences of trans and non-binary users of maternity services in England was commissioned by the Health and Wellbeing Alliance (jointly managed by the Department of Health and Social Care, Public Health England, NHS England and NHS Improvement (LGBT Foundation, 2022). The research was conducted and published by the LGBT Foundation, and culminated in a report entitled ‘improving trans and non-binary experiences of maternity services’ (ITEMS) (LGBT Foundation, 2022). The ITEMS report argued that trans and non-binary maternity service users have ‘poor experiences’ and ‘poorer outcomes’ compared to other maternity service users, and that trans and non-binary ‘patients and their babies [are] being put at risk’ in the NHS (LGBT Foundation, 2022).

The report made a range of recommendations, which included changes to use of language, display of trans-inclusive communications in maternity settings, staff use of pronoun badges, the provision of personalised and trauma-informed care to trans and non-binary service users, staff training, and changes to IT systems and demographic monitoring that would require staff to ask all service users about their gender identity. NHS England (2022) announced plans to spend £100 000 on staff training based on the report's recommendations. These plans were subsequently withdrawn, following a petition by clinicians expressing concerns that the report's conclusions and recommendations were unsupported by its data (With Woman 2023a, b).

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