Who Decides?

On abortion and trans healthcare, a little humility is in order.

Photo by Patrick Perkins on Unsplash

A bit of good news this week, as a federal judge struck down Arkansas’s ban on gender-affirming care for minors. The ban, the judge wrote, violated the constitutional rights of both transgender people and doctors, and the state of Arkansas simply failed to make the case that doctors were providing hormones or surgeries willy-nilly.

This is being seen as a test case for the constitutionality of a growing number of bans and limitations on medical care for trans young people, and in some cases, trans adults. These bans are often coming in tandem with laws criminalizing abortion — across conservative states, abortion bans and trans healthcare bans are a kind of one-two punch of government interference into the most intimate aspects of our lives. And a small group of right-wing reactionary doctors, who are far out of step with most in their fields, have had outsized influence in shaping laws on both abortion and gender-affirming care.

There is a reason you see so much overlap between the anti-abortion movement and the anti-trans movement: Both hinge on a basic ideology of a society organized around distinct roles and obligations for each sex, a hierarchy with God at the top with all submitting to Him, and men as the mini-gods of the family, with women submitting to men. Feminists call this system “patriarchy.” Abortion, which puts reproductive choice in women’s hands and gives women the power to determine their own futures, undermines this model. So does the very existence of trans people, who are living embodiments of the fact that this gender hierarchy is neither preordained nor natural (for something allegedly natural, it takes a lot of social and legal coercion to maintain). Same-sex marriage undermines this as well, creating a legally-recognized family unit based on love and individual ability, not sex-differentiated roles and obligations.

Here is a map of states that ban abortion, via the New York Times:

And here is a map of states that ban or limit gender-affirming care for minors, or are considering those bans, also via the New York Times:

To explain this via meme:

There are good reasons to be concerned about the quality of healthcare on offer for trans people, and especially for gender-dysphoric kids. While gender-affirming care for adults is not exactly brand new, the surge in young people identifying as trans or nonbinary has created a never-before-seen level of demand for care that remains fairly novel for bodies that are still developing, and there are not enough specialists — including mental health specialists — to provide high-quality care to everyone who currently seeks it. It’s important for researchers, health workers, journalists, and other watchdogs to study, assess, and report on what’s working, what’s not, where there are questions, and how care could improve. And this is happening: Medical professionals who specialize in care for trans adults and minors alike are doing their best to study these questions, and come up with best practices.

But the results are far from perfect, in part because the circumstances in the US are really far from perfect, and in part because there have been really significant changes in the past decade that have experts adjusting and re-adjusting their recommendations.