Dear Feminist Women’s Health Center:
Once upon a time not long ago, I was struck by a car. Paramedics brought me to trauma care in critical condition. I was alert throughout. One of the questions an urgent care doctor asked was what medications I was taking. I mentioned to her an antidepressant and oestradiol.
One more question was asked a few hours later: another physician in the recovery ward double-checked my medications. He asked why I was on oestradiol. I replied truthfully: my body does not produce it on its own. I forgot what he wrote on the patient file. I think he jotted down that I had completed a hysterectomy at some indeterminate time in the past.
A couple of weeks later, just before I left, I carefully went through the 300-plus-page binder that had accumulated all the tests, the blood work, the scans, the vitals, and other remarks. There was nothing unusual about it, and its ordinariness is what taught me something profound.
Even after invasive surgical procedures and several days of recovery before discharge, there was nothing extraordinary (at least not to these physicians at a highly respected university research hospital) about my being prescribed oestradiol for life.
My endocrine system is exogenously assisted with the same 17β oestradiol molecule that the ovaries produce. I’m also a woman with a transsexual body. That means I was not born with ovaries.
That’s why the routine of this hospital convalescence felt so unprecedented, startling, and instructive. It’s because the already scary experience could have gone a lot worse through absolutely no fault of my own, but through the fault of a socially-embedded cissexism maintained by so many people with cissexual bodies.
I’ve been transitioned for more than half of my life. This is my entire adulthood. Experiential hindsight informs that, no — to the trauma specialists, doctors, and nurses who helped me when I was pretty badly banged up — I certainly would not have received as respectful, as dignified, or even as comparable a calibre of care had it been disclosed to them that my body was transsexual. Instead, I might have died.
Welcome to my reality. This is the unvarnished fear of every trans woman (and trans man) who seeks medical care from cis — that is, non-trans — healthcare providers. This barrier of dignity and access persists because the cisnormative clinicians who should be there for us instead reduce our health needs to a morphological history — treating us as conditional and elective women.
[side note: there is a PDF of that last link you can download without buying a subscription; I recommend that your staff earnestly read it].
As women with transsexual bodies, we are not conditional, and we are not elective. I want to remind you of this again of this inequity a little bit later.
Had I disclosed to any of those hospital physicians a summary of my body’s morphological history, it’s clear why the fear I have of saying anything about my being trans has not been borne in some vacuum.
I fear being reduced to another statistical Tyra Hunter — a trans woman of colour whose life-threatening injuries from being hit by a car killed her only because cis paramedics laughed at her body’s morphology while she succumbed to shock and haemorrhaging.
When you’re a trans person — and especially when you’re a trans woman — you fear the doubt, incredulity, and even horror lurking just under the surface which cis people around you are well known to express when they come into possession of privileged knowledge about your body. This is the kind of privileged knowledge whose discretion should be valued, respected and, most of all, understood no differently than with the privileged knowledge a cis body contains.
But it isn’t. That’s why so many medical facilities — hospitals, clinics, offices — bar trans women with the thinnest of equivocations. “We’re not equipped to treat your kind.” “We lack the knowledge.” “We don’t understand your bodies.” “Go see a gender clinic.” “We’re sure there’s another clinic for you.” “You lack ovaries and a uterus.”
All of these say the same thing:
“We would rather you die than for us to treat you. We really do know enough — we earned our medical licences somehow — but we’d like to tell you that we’re just not qualified to treat your kind of body or face your kind of person. We’re not being truthful, but we hold the power. Go away.”
This onus and responsibility of extending respect, expected without hesitation, must fall not to the person with the trans body, but to the cis people whom that vulnerable trans person must engage as a precondition for receiving equitable, routine, and ongoing medical treatment.
As a trans person, you don’t want cis people — the very caregivers whom you want to entrust with a basic ethics entwined with the Hippocratic oath — to be the key agents behind why you got sicker or why you succumbed prematurely. You want an advocate who takes the lead on assuring equitable care each and every time it is needed.
Primum non nocere. Do no harm.
So why this open letter?
Your treatment policy and core values at the Feminist Women’s Health Center were recently brought to light online before several feminist communities — including fourth-wave trans feminists like me — on how your clinic adequately treats cis women and trans men.
Your clinic, in contradiction to its name, the Feminist Women’s Health Center, categorically treats men (trans men are still men), while it categorically refuses to treat women — that is, any woman who discloses that she has a transsexual body. Your core values categorically begin with this statement: “We provide quality healthcare and community education regardless of race, ethnicity, sexual orientation, gender identity, socio-economic or immigration status.”
But you categorically don’t.
As with my situation in triage, there are trans women who do not disclose their bodies as transsexual. Some have the affordance of not having to do so because their morphological transparency gets them placed as cis by other cis people. Because of this, these women also sometimes escape being denied treatment under structural systems like your clinic’s own.
That a woman must withhold useful knowledge to assure the best quality of care is a vetting of the days when women had to reach out to find Jane.
That’s where we, an entire populace of women — trans women and cis women (who advocate for trans women) alike — find ourselves at stark odds with your policy of declining women as patients whose bodies were not equipped at birth with ovaries or a uterus.
And yet, the endocrine needs of women with transsexual bodies are no different than cis women of their age: a healthy endocrine system not only facilitates proper bone density, but it also makes the difference between life and death. It is a holistic concern.
Let me repeat that: the endocrine needs of trans women are no different than cis women. The end objective is that women, for a great deal of our lives, require baselines for oestrogen in the body; progesterone for the regulation of much more than just menstrual cycling; and an assurance that free testosterone is kept to a nominal level.
Try this exercise:
Subject a cis woman to regular testosterone injections and wait to see how long it takes for her neurochemistry to shut down — that is, for her to slip into depression and even suicidal ideations. That’s because her neurological sex is incompatible with that exogenous endocrine intervention, or EEI for short. That’s what trans people face. Every day. (And no, you wouldn’t in your ethical mind subject a woman with a cissexual body to that kind of, well, torture).
The policy at Feminist Women’s Health Center fails not at the argument that your staff are not yet “qualified” or “equipped” to accept as patients those women whose bodies are transsexual. No. If that is the rationale for rejection of treatment your clinic is electing to advance, then that means your policy failed at pre-med and med school — namely, on those days when the endocrine system was reviewed.
When the Feminist Women’s Health Center uses the suspect language of “biological women”, it undermines everything taught in med school with a shifty language. This language’s entire raison d’être is to produce a separate-and-not-really-equal equivocation for which women are proper enough and which fall below this threshold. It is a cattle guard. It is a velvet rope. It is a moveable goalpost.
“Biological women/female/vagina”, as biologists will readily share, are the province not of the clinical sciences, but of the social sciences. In other words, “biological” as a qualifier is quite political and lacks both scientific and therapeutic basis. “Biological women/female/vagina” is spoken in one spirit: a harmful one. “Biological women/female/vagina” serves as a subjective device for the thinly-veiled exclusion of women and, as your clinic realized in the not-very-distant past, for men — that is, trans women and trans men, respectively. Where your clinic rose to the challenge of trans men at the expense of trans women is baffling and broken.
The same harmful spirit applies to “genetic” or “chromosomal” qualifiers as weapons of social-institutional exclusion, as we are well aware that probably 90 per cent of every person’s dimorphic morphology is dictated and shaped by what its endocrine receptors are tasked to do: the presence of sufficient oestrogen produces one dimorphic morphology, while the presence of sufficient testosterone produces another dimorphic morphology. And that morphology is quite malleable, especially if EEI begins early enough.
You see, much of what makes gynaecological care what it is is that healthy endocrine function informs quite directly the state of one’s entire body — holistically so. Yes, some of gynaecology addresses PCOS, pregnancy, birth control, and cervical exams (incidentally, sexually active trans women who have vaginas also require pap tests, and the procedure is pretty much the same — speculum, scrape, and all).
But as the Feminist Women’s Health Center clinical staff are I’m sure quite aware, a woman’s health is only partly informed by the activity of a reproductive-age uterus, ovaries, or cervix. There is so much more to what a woman faces which a clinic like your own is charged to address. A women’s clinic is a source point of education for women to make healthy choices for their lives — including keeping themselves safe from social relationships which could otherwise harm them.
There’s an essay I want each of your staff at the Feminist Women’s Health Center to read. It’s pretty short — much shorter than this letter is. Astrid Lydia Johannsen’s essay marks the inextricable relationship between reproductive medicine and trans medicine since their inceptions. They are two halves of the same endocrinological whole. They are both medicines birthed in the 20th century. One cannot be wrested from the other.
Once you’ve read that, then come back. We’ve more to talk about.
Clinics by and for women share their historic urgency in the poor, obstructed, and even nonexistent quality of care which women have long been forced to confront time and time again.
When the Feminist Women’s Health Center denies health care for an entire class of women, it wilfully betrays the integrity of clinic’s name. When it then proceeds to treat men while continuing to deny care for those women, it flatly contradicts any kind of feminist mandate. When women are denied care, it is inherently misogynistic and deeply counter-feminist.
And yet, the very systems of obstruction — which women-oriented and reproductive care clinics were organized to put a halt to such barriers — are the same systems of obstruction which your clinic is now actively facilitating when you reject known trans women from your care. The master’s tools are still the master’s tools regardless of who holds them.
What your present mandate is actually doing is treating only those people who have (or had) a uterus. You are no longer just treating some women. In short, your clinic is only open to people coercively assigned female at birth. This is CAFAB. You’re going to have to get used to hearing this and the complementing CAMAB (coercively assigned male at birth) and CASAB (coercively assigned sex at birth).
The Feminist Women’s Health Center must understand that by excluding all non-CAFAB women, it is validating and perpetuating a specific, complicit violence towards these women — these CAMAB women — which has been branded onto their bodies for their entire lives. Women’s health, in its holism, is to advocate the stoppage of abuse, to stop the systemic social and institutional harm.
This is not what the Feminist Women’s Health Center is doing.
Other women-oriented clinics have begun to realize the faults of this obstruction on which your clinic is now being challenged by both feminists and women — in both Atlanta and far, far afield. In the last couple of years, Planned Parenthood updated their care policy to provide at a national level to open their clinics to all women — irrespective whether they were CAFAB or CAMAB, and irrespective whether their bodies are cissexual, transsexual, or intersexed.
This isn’t progressive medicine. This is a best practice. This is an affirmation that womanhood is not reducible to a handful of reproductive organs on a checklist — the same checklist which men in medicine used to bar women so systemically that an entire generation of women-oriented clinics were chartered by necessity.
Planned Parenthood, as with an increasing number of women’s clinics, are now recognizing with less and less difficulty the inextricable, sinister relationship between a history of back-alley and coat-hanger abortions, and a living history of black-market hormones of questionable provenance; back-alley silicone injections; and the many complications arising from a clinical depression brought on by a neurochemically incompatible endocrine system.
Planned Parenthood and others affirm that women’s blood is continuing to pour. They recognize that women’s bodies are continuing to appear on cold metal slabs as a direct function of the systemic barriers which women face when they cannot access woman-positive health care.
When your clinic, the Feminist Women’s Health Center, then goes out of its way to provide endocrine care for men — for men who, yes, started their life with a uterus — but not for a class of women you refuse to receive as clients, it begs the question: how do you reconcile your feminist mandate?
Why are you called the “Feminist Women’s Health Center”, when your clinic does not prescribe or administer oestradiol, which is not a controlled substance, to neurologically female women with transsexual bodies?
Why are you even called the “Feminist Women’s Health Center”, when your clinic readily prescribes and administers testosterone, a Schedule III controlled substance, to your neurologically male clients?
How is it that you purport that your clinicians are “less qualified” to treat trans women? The only way they could be less qualified is if some of them bombed med school because of that day they skipped out on endocrinology 201, 301, and 401.
Your differential treatment of men with transsexual bodies against the rejection of women with transsexual bodies is a double contrariety: by denying some women and admitting some men, you not only contradict the “Women’s” component of your name. You also advocate for and perpetuate a misogyny which contradicts the “Feminist” component as much as men who pine for a return of women to the kitchens of Atlanta, America, and the world.
Yes. This kind of misogyny is transmisogyny. Cis women are no less susceptible to being misogynistic than men are. The key difference is that with women — cis or trans — that misogyny is deeply internalized, and it still hurts other women.
In the end, that misogyny hurts all women — both cis and trans.
The Feminist Women’s Health Center exists to be there for women. It’s in your name. But you’re not actually there for women, and this is a fundamental problem.
Should the Feminist Women’s Health Center maintain that it is there for women, then trans women should be no exclusion to your mandate. Should the Feminist Women’s Health Center continue to categorically exclude known trans women under whatever reasoning you please, then you are operating in poor faith — even deception — under your clinic’s present name. In this case, call a spade a spade, then: you are simply a Uterine Health Center — nothing more.
I don’t have a specific investment in turning to the Feminist Women’s Health Center for holistic health care, because Atlanta is nowhere near where I live. But I would be remiss to ignore how other women — my sisters in struggle — are continuing to needlessly struggle in what amounts to an abusive policy of exclusion.
I’ll end this open letter as it began: on my medical narrative.
A dozen years prior to my accident, I sought out health care services at a women’s clinic in upstate New York. It was my very last option in a region which was extremely hostile to the medical treatment of women with transsexual bodies.
I was more naïve then. Having been on EEI for a few years, I thought it was the “right thing to do” to voluntarily disclose to the clinic before my first visit that my body was transsexual. That voluntary disclosure resulted in the clinic sending a terse letter, via post, one week before the appointment — some five weeks after the appointment was first made by phone. The letter informed that the clinic had taken it upon itself to cancel my appointment without further comment.
A respected friend — a cis lesbian woman — referred me to that clinic. It’s where she went for routine health care. Upon hearing the cancellation, she was stunned to learn that her clinic had treated me so crudely (her word, not mine).
This non-consensual cancellation meant I had to forcibly halt my EEI regimen for several months until I was able to move to a new region and have it prescribed again. The disruption resulted in a lowered bone density, which was the probable contributor to a micro-fracture of one of my toes about six months later.
That experience taught me a sharp lesson: for a woman like myself, I had to shut up to live, or I could speak up to hurt myself further. This is why I was dead silent in trauma care on the day of my accident, and this silence is probably why I was able to recover fully from my life-threatening injuries.
Holistic care should never have to come down to conditional humanity, under any circumstance.
The Feminist Women’s Health Center, as it now operates, advocates for a conditional humanity. This is neither a feminist precept, nor is it beneficial for a lot of women whose numbers are too small to produce exclusive clinics locally, but far too great to simply be barred at the door of a purportedly feminist-forward women’s health resource.
The Feminist Women’s Health Center has made a mistake which it can remedy. Please do so posthaste. Please do so, knowing that women like me are never going to go away.
If anything, more and more of us as trans people are voicing ourselves in earlier cisnormative corridors. It behooves your clinic to admit, treat, and respect all trans women under a best practices care model of informed consent so long as you publicly maintain that you’re a feminist women’s health resource.
Try to use this as an opportunity to take the lead, to educate, and to advocate for some of the most vulnerable, most underserved women you’ll ever know in your locality: CAMAB women. Stop worrying and learn to accept and embrace the plurality of our experiences as women.
We bleed, too.
Sincerely striving for feminist social justice,
|||| Patience Newbury
Cisnormativity 
I don’t like how nasty this letter gets at one of the few progressive health organizations in an otherwise absolute desert (the Southeast) for such things. The Feminist Women’s Health Center is trying to do a lot with a little (in many ways – funding, time, crazy-ass anti-women policymakers who want to beat down the door of places like this every legislative session). Down here we really, really need solidarity over more divisions, and this letter doesn’t leave much space for that.
Yes Claire, because in your mind — as in others who share similar world views to what you did here — trans women’s lives are fully expendable, disposable, and sacrificial.
If the concern is, as you framed it, that significant a political worry for the Atlanta area, then the optics of differential disposability for certain kinds of women would have been been properly considered by clinic administration/leadership before going forward with administering EEI for trans men only but not so for trans women — and, additionally, turning away women with transsexual bodies at a feminist women’s resource. Doing so affirms the perception in my previous paragraph: trans women are the most disposable women there are.
In short, your remark is nasty and it is inhumane to pretend like some women’s lives (cis women) are more worthy than others (trans women). The blood has to stop for all women, all at once. The care must begin and be defended for all women, all at once. And this is the invaluable lesson a woman remembers whenever she — such as myself starting in my teens — has stood outside women’s clinics to make their doors stayed open in the onslaught of misogynist, religiously fundamentalist entities which want nothing less than to blockade and shut them down and see all women be just as disposable as the trans women you advance here.
Where are you getting that I think “trans women’s lives are fully expendable, disposable, and sacrificial”? Criticisms of institutions are necessary for things to change, but the point of my comment was that I didn’t like your approach – because it frames the center as a lot less human than they are – just a bunch of idiots, or some amorphous distant enemy, right? In actuality, they are a small, striving organization that has very real potential to be good allies and to follow through with the important concerns you’ve brought up. The tone of this piece would be more understandable if it was an open letter to, say, Georgia government institutions that continually refuse to protect trans folks from discrimination under the law. FWHC, on the other hand, is a relatively easy source of solidarity, so why hate on them so much?
Claire, start thinking about the needs of trans women not being met by a women’s clinic. That’s cognitive dissonance: “we’re a women’s clinic, but we reject a class of women.”
Show good-faith initiative to address the exclusion of survival-level and wellness-level health care for trans women by a “feminist women’s” clinic. Once you do, then this will make a world’s more sense. Until then, your commenting affirms that you regard trans women as lesser women — if women at all.
Would it help you grasp this a little better if we looked to a Georgia clinic in 1962 which wouldn’t see black women, but because it saw white women, it was badly needed during a hostile place/time toward women’s health needs? Based on your remarks and clearly not getting the basic gist of this open letter, probably not.
Unless you’ve anything newly insightful to add to this, I think we’re done here.
Claire, imagine if the clinic was rejecting a different class of women– one for which the progressive and feminist community more consistently includes. Imagine this self-proclaimed “Feminist” clinic refusing to see women of color, or lesbian women. A letter levying a critical challenge to that clinic would probably not be seen as “divisive” but as a letter written in “solidarity.” Ciswomen need to stand in solidarity with ALL women, not just some. (In fact, we should be writing these letters too!) By saying that this letter is “divisive” rather than written in the spirit of “solidarity,” your comment excludes transwomen from the groups of women with whom we stand in solidarity.
I don’t detect “hate” in this letter, but disappointment, criticism, and honest pain. It took bravery to write and is the kind of contribution necessary to create a critical community focused on justice. If we cannot provide thoughtful, constructive criticism to organizations that position themselves as allies to a feminist community, then the title of “ally” becomes worthless as organizations claim the title without actually supporting the community.
Thank you, Patience, for taking the time to write and share this piece. Hopefully it contributes some cultural competency to the folks at FWHC. It definitely helped expand my understanding of transwomen’s experiences seeking health care.
That was, quite simply, one of the most eloquent explanations I’ve ever read.
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Patience,
In your response to Claire, you speak of trans women being excluded from survival-level and wellness-level health care at FWHC. However, FWHC *does* happily offer their available services to trans women. Further FWHC does not exclude nor reject trans women as women. Unfortunately, FWHC offers limited services & can not meet ALL the health care needs of the community, trans or otherwise.
So, why are you hating on FWHC so much?
Why are you derailing the discussion by focusing on the emotional tone of a trans woman’s *reaction* to oppression, rather than on the cis women who are *perpetrating* oppression? I’m pretty sure that basically accusing a woman of being “emotional” (“hating on”) is patriarchal thinking, not feminist thinking. Master’s tools, and so on.
“Hating on” was the exact correct terminology. It ends up that FWHC is being rejected from positive mentions on Feministing.com because of this letter. FWHC tries to provide low-cost, quality care in the a red state in the *bible belt* and does not receive any government funding, federal or state, and most services are not reimbursed by insurance. Recently legislation is making it a struggle just to keep the doors open. Expanding services costs money, when FWHC can’t get a plug in a Feminist blog for a fundraiser, the likeliness services will expand get smaller.
The problem is, this letter is wrought with inaccuracies, accusations, and very little actual fact about FWHC. To date, Patience makes NO mention that she has directly called, emailed, or visited the center. This is irresponsible journalism and I can’t believe that editors have allowed it to influence the professional feminist blog-o-sphere.
Gwen said: “This is irresponsible journalism and I can’t believe that editors have allowed it to influence the professional feminist blog-o-sphere.”
I’m not a journalist, nor was this a journalistic piece.
In light of my piece and the subsequent comments from 2012, it is now incumbent upon the clinic to show they are now operating in good faith toward all women — and this includes women who are trans as well as women who are cis. If you believe it’s bad enough for cis women to find access to health care in a “red state”, then try to imagine how inordinately more difficult it is for a trans woman in the same state to do the same. Or imagine if that trans woman wasn’t white. I can speak to trying to find health care in a red state as a trans woman, and it makes trying to find a clinic equipped for delivering abortion services seem easy by comparison.
That’s what we’re talking about here. FWHC are welcome provide a good rebuttal to Feministing or wherever, or FWHC may continue to have people like yourself defend a questionable policy and practice which was brought to light in this essay piece (and by first-hand experiences by trans women who’ve, in confidence, shared with me that they’ve dealt with resistance to their being trans when going to the FWHC).
That’s all which really needs to be said for now.
I’ll start with the last:
There is no hate on calling out systemic discrimination. That should be fairly self-evident, but in case it isn’t, I’ll re-iterate: turn your attention toward the source of systemic discrimination — as carefully outlined in this blog post — and approach them. Ask them. What not to do: attack a class of victims who are the class being systemically excluded from essential health care.
On the former: FWHC does not offer parallel services to trans women which both cis women and trans men are offered. That is a differential exclusion of holistic health needs. As you subtly have worded here, you qualified this with “available”. “Available” is not congruent to “parallel”. And it requires little effort to comprehend just how necessary access to holistic health needs is for women generally, but for trans women especially.
For a women’s clinic to select which kind of women merit essential health access — of which EEI for trans women (& trans men), and reproductive medicine for cis women are mutual-priority cornerstones of holistic care — and which do not is to create a caste of womanhood in health. We should have been working past this a long time ago, but this is still happening.
I re-encourage you and others to thoroughly read the Bauer, et al. piece mentioned earlier in this essay to understand why what the FWHC is advancing is harmful to a lot of women, and ultimately it undermines the mandate of providing holistic health care to all women — regardless whether their bodies are cissexual, transsexual, or intersex.
Until then, to admonish a woman for speaking up on this systemic discrimination is far closer to an act of hate than for her to speak out on an selective exclusion being an act of systemic discrimination.
Re-calibrate your world view.
You assume there is systemic discrimination, except you’ve have stated that you have never been to the center. Have you ever spoken to the people who work there, who are not all cis women? If you look at their website, http://www.transhealthinitiative.org, you can see where they have listed MANY services available for trans women, which includes this statement:
“Other services: We are currently working to expand our services and other services may become available before this list is updated. We are working towards providing HRT for trans women and post-meopausal women.”
There are other providers in the Atlanta area for Trans folks & they have great referral relationships to help ALL folks. It just kills me that one of the few organizations fighting for equality in the South is not getting a fair assessment. This blog has influenced many people and as you state, you are not a journalist and there was no fact checking.
I was searching for resources and I bumped into this, and I just have to reply. First of all, this article is a few years old and the website has been updated since then. I know trans women that were asking questions about these services and voicing their concerns long before 2012, only to be ignored or given a chilly response. THI only came forward to address this publicly and clarify their policies AFTER this gained traction on social media. So I would credit any changes to how they do things, to the bad press. Unfortunate as that is, it’s clearly necessary and it’s keeping the issue alive years later when it would have otherwise gone ignored.
Also you’re right about there being other provider options. But none of them are informed consent. This is important for a few reasons: 1) for low income and uninsured trans peeps, informed consent removes some big economic burdens. Therapy can be expensive. Because of how insurers negotiate contracts with providers, blood work at a private practice/specialist off-insurance can cost a fortune (I’m not sure from the website if THI will still check hormone levels; if so I’m not sure what extra resources writing out a prescription entails. It just seems kind of spiteful). Often these costs are too much to overcome and people just self-med. Atlanta is in a region where trans women especially TWOC face a lot of systemic discrimination. While I don’t doubt that the intentions of the hormone program were positive, it just reinforces existing disparities. This is something they need to be aware of. Your reply to the effect of “tough shit, find another provider” is completely insensitive to that reality 2) there is an additional barrier in having to “prove” to a therapist that you’re really trans. If you have been self-medding or have to find a new provider, that’s basically telling you to go back to square one and be evaluated. THI has enabled trans men to forgo that barrier, but “refers” other trans people to therapists. When you say “We can’t give you informed consent. It’s too complicated for us at this time, but I can recommend a good therapist,” that sort of indicates a different, more pathological view of trans women/non-binary vs. trans men. That they are somehow deficient or less able to consent to medical care than trans men. I don’t know what relationship you have to THI but I hope your attitude of “they can recommend you a therapist so it doesn’t really matter” isn’t one that they share. It doesn’t help the perception that they see trans women as less-than. I don’t see any effort to help people overcome gatekeeping, just sort of walk people through it. And that’s great, but it isn’t enough, and until they admit that it’s not enough and acknowledge the inequalities here, people clearly aren’t just going to be cool with this. Clearly, if it’s still coming up two years later, there’s still an issue.
Yes! I am a trans woman who used to work as a case manager/social worker for abortion clinics (including patients of AFWHC) and I brought up this specific issue to AFWHC five or six years ago, multiple times. They know better. So fuck them. There is NO excuse for them.
(After much frustration and many failed attempts to speak in person with them — they would literally leave me on hold for hours when I asked to speak with the people in charge, who had otherwise been friendly to me before I outted myself as trans — I wrote them a letter too. They never wrote back. So good luck.)
This is an awesome and well thought out piece. And I really appreciate all the sources and links to stuff, because otherwise I would have no idea what you were talking about :). Thank you.
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I know I am very late to comment on your post, but I would like to know- did the Feminist Women’s Health Center ever respond in any way? Change their policies? Release a statement?
I’m starting my Public Health Master’s in the Fall, and searching for places to work/volunteer. The FWHC was high on my list until I found this. I’m shocked and outraged at these misogynistic practices, and I thank you for bringing them to light.
No, FWHC never directly responded to this letter, but did respond to other letters on http://fwhc.tumblr.com/ last year – changes have been made & you can see the details on http://transhealthinitiative.org/
However, this letter, while very well written, is not an accurate representation of FWHC’s services, their Trans Health Initiative, and the clients they treat. They do not discriminate, their services for all people are limited, they can’t even do HRT for cis women let alone trans women, though they are working towards providing both.
I am not sure it Patience has ever visited the center or has spoken with anyone. I imagine a personal visit or phone conversation would change everything.
Dear Patience,
I’m about to undergo an elective abortion at FWHC in a couple of weeks. I’m going to be driving over a hundred miles to do it, but unfortunately it’s the closest clinic to my home. And I’m going to be paying basically 100% out of pocket for the procedure, because my insurance doesn’t cover abortions, and Georgia Medicaid doesn’t either.
We women don’t have a lot of resources in Georgia. I personally thank GOD for the wonderful people at places like FWHC, because without them I would have absolutely no where else to turn.
The bottom line, for me anyway, is that although it’s great that you’ve decided to embrace your need to be a women, you do not have female reproductive organs. You’ve never had to live with the curse of getting pregnant, so that makes it a little difficult for me to empathize with you.
And before you make the case that by my logic, I also can’t empathize with women who are infertile– they are still tragically burdened with 40+ years of menstruation, so they too hold a special place in my heart. I’m sorry for your struggles, but let’s get real.
You have other places to turn, but places like these are the ONLY option for “cis” girls and women (as you call them) like me, so your post makes me a little angry.
– Allison
You should be angry, Allison. I’m angry.
You should be angry for needing to travel over one hundred miles for repro health care. No one should have to do that. I’m angry that women like myself must also travel over one hundred miles for basic health and repro health care. Or, as the case has been, over eight hundred miles.
To be precise, it was two states. It was the necessity to take a train to a Planned Parenthood clinic in California, some 850 miles from her home in the Pacific Northwest. That’s because no doctor in the Pacific Northwest would see a woman of colour without health insurance.
Her fault? She was trans. This next point shouldn’t matter, but to dispel whatever strawman your sordid imagination spun up, she transitioned during her early teens, well over two decades ago. She didn’t mean to, but she was the vanguard of what’s becoming a permanent fixture of our social fabric.
There was also the woman who couldn’t access basic health care to even have her blood pressure checked anywhere in Western New York state, because the one clinic she was referred to (by another patient of that clinic, a lesbian cis woman) pre-cancelled her appointment when intake staff learnt she was trans. She had to wait until she could move to a state in the Midwest before she could locate a doctor who would see her.
One woman suffered massive bone density loss and bone microfractures before a doctor finally tended to her; the other went into premature menopause and experienced nearly every symptom suffered during menopause before she could obtain care. She was 24 years old. Both paid out of pocket.
Each woman withstood nearly a year of medical neglect by a medical philosophy (an unethical pathologizing, more accurately) which rejected the legitimacy and urgency of their basic health needs on what amounts to an original social sin propped up in 1973, the day after 25 million Americans were cured instantly of another dubious pathology: homosexuality. That rejection became normalized, and it’s mixed in the foundation of your argument.
Allison, your conjecture is reducible to one idea: the presence of certain reproductive organs at time of medical need must be the basis to apportion medical resources at a women’s clinic — to the exclusion of all other women. It’s cruel. It’s unusual. It’s punitive. It harms women.
To redress your grievances, it would require reorganizing every women’s clinic as “uterine and ovarian clinics”, lest we forget how several thousand women in the U.S. alone, assigned female at birth, lack the privilege of being equipped with the organs your argument prizes as a golden ticket for health access. Then there are several thousand more women like myself who lack the same golden ticket. Should we set that bar to facilitate harm, neglect, and to slam the door on women in need?
I say no. You may say otherwise.
Rather than deign yourself to grab for the same tools which cis men (the ones with mighty reach-around inside legislatures and boardrooms, and often as white as spring lilies) rely on to slash health welfare funding, shutting down clinics for women of colour, poor women, trans women, teenage girls (both cis and trans), and all women save the most economically (st)able, there’s a choice you can make at these crossroads.
You can take the high road: strive to assure that no woman, no matter her particular and unique health needs, is ever shut out from clinics intended to serve women. That takes a lot of political and social work.
Or you can go low: grab those tools and commit your energy, money, and rage toward the chartering of clinics geared solely for uteruses and ovaries. Divide and exclude. Knowing what you do, this road demands your bile and spite in its paving. (For all I know, maybe you have enough of both stored up). These clinics will solely serve women like yourself and seahorse papas (trans men who have babies) — doing so to the unapologetic exclusion of all other women and girls. May you never endure an oophorectomy or hysterectomy, or you too will be shut out from these clinics.
What should matter less to you or me, Allison, is the nature of health care being served to women behind the clinician’s door and more that every woman is being served equitably behind that door. Being trans isn’t elective, and neither is being cis (what you prefer to call as “normal”, but it isn’t). No woman should be forced to forgo repro health care, and no woman should have to travel to a different area code, county, or state to obtain it.
These are our lives. Stop trying to bargain with them.