Introduction

As a population, trans, non-binary and takatāpui (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. In the past decade, notable efforts have been made to improve trans people’s access to and experiences within healthcare settings as part of the move towards depathologising gender diversity (Coleman et al., 2022). In Aotearoa, this includes the development of guidelines for gender-affirming healthcare based on Tā Mason Durie’s Te Whare Tapa Whā (Ministry of Health, 2017; Oliphant et al., 2018) and recent Government investment into gender-affirming healthcare in primary care (New Zealand Government, 2022).

One area of health care that remains overlooked in relation to trans inclusivity in Aotearoa is perinatal care services. Many trans and nonbinary people seek to create families and whānau in diverse ways, including through the birth of their own children (Stolk et al., 2023). Counting Ourselves, a national study conducted in 2018 of trans and non-binary people’s health found that almost one in five participants (19%) ‘definitely wanted’ a child or more children, and this rate was higher for Māori (32%). Out of participants who were assigned female at birth, 4% had been pregnant since identifying as trans or non-binary and 1% were unsure if they had been (Veale et al., 2019). The narratives of reproduction and family-building told by trans people continue to inform health and public understandings of trans pregnancy (e.g., Finlay, 2019). It is likely that more trans people and their whānau will access fertility, pregnancy and birth care as they realise their reproductive rights. It is imperative that the perinatal care workforce and systems in Aotearoa are equipped with the knowledge and resources to ensure safety for, and proactively meet, the needs of trans people and their whānau throughout their pregnancies.

Providing policy direction and educating health professionals to provide clinically and culturally safe care to trans and non-binary people is a key strategy in transforming the experience of health services for them and their whānau. There is currently no research on trans people’s experience of perinatal services in Aotearoa nor on the knowledge and beliefs of the Aotearoa perinatal workforce in providing care to trans people and whanau. As a result of this we undertook Understanding the need for trans, non-binary and takatāpui inclusive perinatal care (HRC 20/1498) (Trans Pregnancy Care Project)to generate evidence. The aim was to inform perinatal healthcare provision for trans people and whānau in Aotearoa’s unique model of midwifery-led perinatal care.

Upholding Mana Motuhake for Māori and trans communities in perinatal healthcare

The articles of Te Tiriti o Waitangi were the stars which guided every stage of this project. The research team is in firm agreement that our perinatal sector still has some way to go to uphold the principles of Te Tiriti o Waitangi. We acknowledge the disparities of care forced upon Māori communities that are underpinned by colonisation and racism. Our team is comprised of a diverse mix of voices – Māori, takatāpui, transgender and non-binary, Pākehā, queer, cisgender and heterosexual identities alike. The mātauranga Māori included in this report are taonga gifted to this project by Dr Elizabeth Kerekere who is the kaitiaki of this mātauranga. No voice held supremacy in team hui, but appropriate weight was given to the lived trans, Māori and takatāpui experiences. After all, we abide by the principle of “nothing about us without us”.

We intend for this research to enhance and solidify the mahi being done within the perinatal and other health sectors to uphold Te Tiriti o Waitangi and improve equity and outcomes for Māori and all people. The road is long, and the obstacles are many – but progress is made through collective action and solidarity.