Executive Summary

Understanding the need for trans, non-binary and takatāpui inclusive perinatal care (HRC 20/1498) (Trans Pregnancy Care Project) was undertaken in response to the 2020 Maternity Services Research Request for Proposals through a joint initiative between Health Research Council NZ and Mānatu Hauora|Ministry of Health. The joint initiative sought to fund projects to directly inform the development of policy and practice for Aotearoa New Zealand’s maternity service to achieve equitable outcomes and support a quality improvement culture. As a population, trans, non-binary and takatāpui people who are gender diverse (trans) people experience significant health disparities compared to the general population, which can either be compounded or alleviated by the quality, safety, and cultural responsiveness of health services. Prior to this study little was known about how trans people experience perinatal care in the context of Aotearoa New Zealand’s unique perinatal service model. International research suggested a lack of perinatal system readiness to provide inclusive care and deliver equitable outcomes for trans people and whānau.

This study has addressed this knowledge gap in two phases seeking to understand what constitutes quality, safe and culturally responsive perinatal care services for trans people and to assess the readiness of the perinatal workforce to provide equitable care to trans people and whānau. Phase one of the study involved qualitative semistructured interviews with 20 trans whānau (29 participants in total including gestational and non-gestational parents) who were on their whanau building journey from trying to conceive through to the early years of parenting. Participants described their engagement with perinatal services and their reflections on what constitutes trans affirming and inclusive perinatal care. These narratives from our phase one participants were integral –along with extensive consultation with Tangata Whenua, health professional organisations and community trans advocacy groups - to informing the design of phase two of the project: an anonymous online nationwide survey of perinatal healthcare providers. The survey findings provide an encouraging glimpse of an appetite for change within the practice of perinatal care providers but acknowledge the current limitations of poor resourcing and lack of education opportunities to support progress towards to a more equitable and inclusive perinatal care service.

The key themes from analysis of our participants’ narratives (phase one) are followed by insights from the health practitioner survey about readiness for providing trans inclusive care (phase two). We conclude with recommendations for practice, relevant at both individual practitioner and system-wide levels.