Access to fertility preservation for trans and non-binary people in Aotearoa New Zealand

Abstract

There is a growing need for healthcare professionals to discuss fertility preservation options with trans and non-binary people before commencing medical transition as part of informed consent-based models of care. In this article, we adapt the Five-A framework of healthcare access to examine fertility preservation information and services. To do so, we present an analysis of data from Counting Ourselves, the first comprehensive national survey in Aotearoa New Zealand of trans and non-binary people’s health and the first study exploring their access to cryopreservation information and services. Among 419 participants who had received gender-affirming hormones or surgery, 33.7% received information about options for fertility preservation and 15.8% accessed fertility preservation services. Findings from the study indicate the need for greater understanding of trans and non-binary people’s desire for genetically related children, and what type of information and form of delivery would be most helpful to ensure equitable outcomes in relation to decision-making around fertility and future family-building.

Keywords:

• Fertility preservation
• healthcare access
• informed consent
• trans and non-binary

Acknowledgements

We thank the Counting Ourselves participants for sharing their experiences.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Trans and non-binary people identify with a gender that is different to that which they were assigned at birth. We use the umbrella term ‘trans and non-binary’ here to include trans people with binary genders (trans women and trans men) and those with non-binary genders. Where relevant to the analysis, we also differentiate between non-binary trans people assigned male at birth (AMAB) and those assigned female at birth (AFAB). We acknowledge that not all trans and non-binary people use nor relate to these terms.

2 The term ‘trans’ is used here because, with the exception of few studies (e.g. Kyweluk, Sajwani, and Chen 2018; Riggs and Bartholomaeus 2018; Riggs and Bartholomaeus 2020; Strang et al. 2018), the studies cited focus on binary trans people’s experiences; that is, trans boys/men and trans girls/women.

3 Rainbow Tick is a certification process that awards a ‘tick’ to businesses and organisations as inclusive of LGBTQIA + employees and consumers.

4 Each of Aotearoa’s 20 geographic regions is governed by a DHB, responsible for funding and provision of health and disability services. Consequently, the provision of and funding for gender-affirming healthcare differs across DHBs. In April 2021, major reforms to replace DHBs with one national agency were announced in the media. The proposed changes aim to ensure a consistent level of health delivery across Aotearoa and noted equity challenges faced by underserved communities, including LGBTQIA + people.

5 Costs are based on information from fertility clinic websites.

6 Gender-affirming hormones and genital reassignment surgeries are separate aspects of gender-affirming healthcare that may potentially impair fertility. Not all trans and non-binary people need or want either hormones or surgery, and not all gender-affirming healthcare results in permanent infertility.

Additional information

Funding

This research was funded by the Health Research Council of New Zealand (17/587), the Rule Foundation, University of Waikato, and Victoria University of Wellington’s Faculty of Humanities and Social Sciences, which funded the Reproductive Futures project (224801).