Promoting the Health, Inclusion, and Belonging of Sexual and Gender Minorities in the Clinical Space

A magazine issue on the state of women’s health would be remiss in not acknowledging the spectrum of identities of patients who receive care under the banner of obstetrics and gynecology.

Adults who identify as a sexual or gender minority (SGM) make up roughly 7% of the United States population, according to data from the NIH’s All of Us Research Program. If this is extrapolated to the city of Worcester, which has an adult population of 166,800 people, then as many as 11,675 Worcester adults identify as a sexual or gender minority (US Census Bureau). This number represents a significant portion of potential patients in the Worcester area.

Now that we have established the need for queer-inclusive care in Worcester, it is important to recognize the problem. We know that individuals who identify as members of the LGBTQIA+ community have worse reported health outcomes in many realms compared to the general population. We also know that a large part of these worse outcomes is driven by a lack of access to safe, affirming healthcare and a deep-seeded mistrust of the medical community.

Like all medical specialties, the field of obstetrics and gynecology provides care to patients who identify as SGM, or those excluded by heteronormative and/or cis gender labels. Unlike other specialties, however, obstetrics and gynecology (OB/Gyn) is a specialty uniquely positioned in its historical mandate of providing care to a patient population marginalized on the basis of sex. For many readers and health institutions, ‘women’s health’ undoubtedly is nearly synonymous to ‘OB/ Gyn’. Following this logic, both the general public and institutional policy often assume that a patient who receives care in an OB/Gyn clinical setting identifies as a woman. I encourage you to challenge this assumption.

As a future care provider with a clinical interest in LGBTQIA+ health and gender affirming care, I began my undergraduate medical training with a desire to further my knowledge and understanding of how best to serve SGM patients. I identified obstetrics and gynecology as a potential area of vulnerability for this patient population, given its heavily gendered nature. Much to my chagrin, I discovered that the curriculum in LGBTQIA+ health was sparse. Apart from a few phenomenal lectures by Dr. Yasmin Carter, Assistant Professor of Translational Anatomy and the Director of DRIVE (Diversity, Representation and Inclusion for Value in Education), SGM populations were largely absent. The vast majority of educational opportunities involving the care of SGM patients were opt-in experiences which thus only reached the handful of self-selected students who typically possessed a pre-existing interest in the area.

In an effort to learn more, I worked with Dr. Carter and Dr. Tara Kumaraswami, Assistant Professor of Obstetrics and Gynecology, to develop a project analyzing the inclusivity of UMass Memorial’s OB/ Gyn clinical space. Although the care of SGM patients—especially that of transgender and gender expansive (T/GE) youth—currently serves as a major topic of public discourse, the research continues to lag behind.

Outside of HIV testing and health disparities linked to minority stress research, a literature search revealed that little has been published on how SGM patients experience health care. In particular, there is a dearth of research on the systematic inclusion of SGM patients in the clinical space or how health care providers should alter their clinical environment and practice in order to best promote the health, well-being, and comfort of LGBTQIA+ patients and families.

What does exist are a few guidelines outlining the major tenets of inclusivity promotion in the physical clinic environment, developed by leading experts in the field of LGBTQIA+ health such as The Fenway Institute and the Center of Excellence for Transgender Health of UCSF. Such tenets include, but are not limited to: involving community stakeholders in the development of any intervention; identifying a space champion for the cause; updating clinic signage, intake forms, consent forms, and any other patient facing documents or platforms to be inclusive of all SGM identities; collecting sexual orientation and gender identity (SOGI) data on all patients; referring to patients by their pronouns and preferred names; ensuring labels for lab specimens have correct names and pronouns; regular inclusivity training for staff, faculty, learners, and anyone else interacting with patients; posting a non-discrimination policy and mission statement in public view; investing in artwork and informational posters that are inclusive of the spectrum of patient identities; avoiding exclusive use of gendered color palettes for wall colors, patient gowns, and medical equipment, and any other fixtures of the clinic space. In short, there exist many ways in which we as providers can support all of our patients and make them feel welcome in any clinical environment, regardless of gender identity, presentation, or sexual orientation.

The next step, of course, is action. After selecting the Community Women’s Care OB/Gyn resident clinic and the Levine Obstetrics and Gynecology space as our pilot sites, our group—led by Dr. Kumaraswami and made up predominantly of clinic staff, faculty, and residents—has begun the work of improving the clinical space. So far, we have designed new gender neutral restroom signage, collaborated with local artists to begin the process of updating the artwork in the clinical space, and developed an inclusivity statement written by the OB/Gyn residents to be posted in the clinical spaces. Future work includes, but is not limited to, continuing the process of improving staff training and updating intake forms, consents, and any other patient-facing documents.

A special thank you to Dr. Yasmin Carter, Dr. Tara Kumaraswami, Dr. Jules Trobaugh, Dr. Luu Ireland, Dr. Zarah Rosen, Dr. Brittney Gaudet, Christy Bassett, Carol Tudhope, Gwendolyn Bultron, and Shannon Lyons. This work would not be possible without you.

Olivia Buckle, BA, is a third-year medical student at UMass Chan Medical School and the student representative to the Editorial Board. Olivia.buckle@umassmed.edu