Phase One methods

Phase One of the Trans Pregnancy Care Project received Ethics approval from Te Herenga Waka – Victoria University of Wellington’s Human Ethics Committee in October 2021 (#0000029879).

Study design: A whānau-centred approach

As a research team, we developed the following statement to guide our project and the values underpinning our commitment to Te Tiriti o Waitangi and whānau-centred research:

This project honours rangatiratanga of whakapapa by centering the mana and voices of trans, non-binary, takatāpui and Intersex whānau. We hold space for whānau to self-determine their identities and bodies and to decide who to include in sharing their experiences of perinatal care with us.

At an operational level this meant we provided opportunities for participants to tell us who was part of their perinatal care journey. We welcomed non-gestational parents, as well as support people and other whānau members, to take part in the interviews if they chose to. This meant that some interviews involved non-gestational parents, including transfeminine, non-binary and cisgender partners or lovers. Some participants chose to have individual interviews. Others contacted us wanting to share their experiences about fertility treatment. In response we expanded our scope to include fertility/conception experiences, in recognition that conception can be more complex for some trans people and that trans people conceive in diverse ways. In our analysis, we paid attention to the unique experiences and dynamics that exist for both pregnant people and non-gestational parents. We further centered the experiences of trans whānau in the perinatal healthcare workforce survey by using their experiences to inform the questions we asked in the survey.

Data collection

Phase One of the project received ethics approval from the Victoria University of Wellington Human Ethics Committee in October 2021 (#0000029879). We used purposive convenience sampling methods to invite trans, non-binary, takatāpui and Intersex people to take part in semi-structured interviews on their experiences of perinatal care in Aotearoa. Prospective participants were recruited through social media posts on the project’s public Facebook page and Instagram account, trans and Intersex Facebook groups and pages, through the Professional Association of Transgender Health Association’s (PATHA) email listserv for professionals working in transgender healthcare in Aotearoa, and via word of mouth. Participant recruitment documents and the interview guide were developed in consultation with the project’s parent advisor and through stakeholder consultation with Gender Minorities Aotearoa (GMA).

People were invited to participate if they were aged 18 years or older; self-identified as transgender, non-binary, Intersex or takatāpui and gender diverse; and had accessed fertility, pregnancy or birth care within the past five years in Aotearoa. Our definition of ‘accessing services’ was intentionally kept broad, acknowledging that trans people create families and whānau in diverse ways that can involve several people accessing services alongside the pregnant person. This meant that trans non-gestational parents, who accessed services in this role, were welcome to participate, and people were invited to bring whānau or support people along.

In total, 27 whānau initiated contact or expressed interest in participating. Of the 27, seven did not respond after a follow-up email. Twenty whānau agreed to take part in an interview. As nine of the interviews were held with two people, this resulted in 29 participants in total. Of these 20 interviews, 19 were conducted by George Parker, a nonbinary Pākehā health researcher, registered midwife, and parent, and one interview was conducted by Alex Ker, a transmasculine Pākehā research assistant. Of all interviews, 15 were held over Zoom and five were held face-to-face, four in the participant’s home, and one in a public space. Each whānau was sent a $30 gift voucher as acknowledgement of their participation.

See Table 1 in Appendix 1 for detailed participant demographics.

Data analysis

Interviews were audio recorded and transcribed verbatim by an external transcriber who signed a confidentiality agreement prior to transcribing. AK, the research assistant, removed identifying details from the transcripts to ensure participants’ confidentiality however we had ethics approval for participants who wished to retain their own name rather than use a pseudonym. Guided by trans epistemology (Streed et al., 2023) and indigenous research practices (Svalastog & Erikksen, 2010), our project parent advisor elected to participate in the research as a participant and retained use of their own name for transparency. However, their transcript was anonymised to the research team members who coded it. The interviewer was excluded from this process. Prior to beginning analysis, each participant was sent their de-identified interview transcript, which they were invited to provide feedback on. In total, seven responded with feedback on their transcript (such as adding thoughts or requesting to remove some details from the transcript). Transcripts were analysed using reflexive thematic analysis led by GP and AK (Braun & Clarke, 2019). First GP and AK performed complete coding on each transcript independently and met frequently to discuss the codes. Codes were then discussed in wider team hui to understand how our subjectivities as researchers influenced our interpretations of the data. GP, AK, SM and SB all coded the same part of a chosen transcript independently and then met to discuss their coding and rationale. AK manually grouped the data excerpts into a coding scheme, which was discussed in a wider team hui and used these groups to develop candidate themes and subthemes. Candidate themes were again discussed at wider team hui until consensus was reached on the central themes. EK confirmed the analysis of data from takatāpui participants and central themes were presented back to the project’s parent advisor and Gender Minorities Aotearoa for discussion.