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CITIZEN SCIENCE: Gender inclusive maternity care

Te Pūkenga and the Ministry of Health recently (27 July) released their research on trans and non-binary inclusive maternity care and, tucked away in the back as if to avoid scrutiny, guidelines for maternity health providers. The guidelines recommend the removal of “cisnormativity” from maternity healthcare in New Zealand and cost $180,000 of your money.


The research comprised “qualitative semi-structured interviews with 20 trans whānau” followed by a survey of just under 450 maternity care providers, around a quarter of whom registered without actually filling in the survey (a notably high level of non-engagement that remains unexamined). Answers from those who did complete the survey reveal a picture of midwives who are too busy to have thought very much about trans maternity care, don’t see it as a priority, and think the Ministry of Health should provide direction if it does.


Be careful what you wish for, because trans rights activists in the Ministry and the midwifery profession will almost certainly attempt to socialise the guidelines based on what they will portray as endorsement from this flimsy, fig-leaf research that bears no resemblance whatsoever to the guidelines that supposedly result from it.


The guidelines are based on a model provided by “co-investigator” MP Elizabeth Kerekere in her capacity as a member of the Tīwhanawhana Trust (because apparently representing New Zealanders in Parliament is a part-time job) and include the recommendation that midwives “Avoid assuming how trans people’s bodies work”. It would be interesting to see evidence that the biology of pregnancy and childbirth is different for those who imagine they are men, but there is none. The guidelines also heavily emphasise a decolonising, te ao Māori approach, despite the fact that researchers recruited only two Māori participants and the survey contained no questions on the decolonisation of maternity care.


“We …explicitly position the needed improvements in perinatal care for trans people and whānau as part of the broader task to achieve equity for all communities who are currently underserved, which necessarily starts with addressing Te Tiriti o Waitangi breaches and improving the perinatal care system for Māori.”


In a crazy-making feedback loop, gender identity is used as a pretext for prioritising Māori maternity care over all other minorities or needs, and the Treaty is used as a pretext for shoe-horning gender identity into everything. A striking absence from the research is any analysis of the needs of other minorities or how they might be impacted by gender inclusive maternity care. For example there is no discussion or analysis about whether migrant women may struggle to understand when they are asked for their pronouns, or what they want to call their body parts (also in the guidelines) let alone the possibility that they might be offended by those questions. They must wait for the trickle-down effect of building a system that prioritises Māori and trans people. It is a classic example of the forced-teaming that has allowed transgenderism to reach deep into our public institutions. Grafting it onto attempts to address racial inequality, mixing them together as much as possible, exposes those who object to gender identity ideology to accusations of racism and all the shaming that ensues.


Kerekere has done it again in a Bill she introduced into Parliament last week (3 August) to amend the Human Rights Act “to uphold Te Tiriti o Waitangi by taking steps towards ending discrimination against takatāpui and rainbow (LGBTQ+) people.” Setting aside the forced teaming for a minute - is this Bill a back door to breaking down single sex spaces for women? Is anyone planning on taking it up when Kerekere leaves Parliament? Will any journalist ever do their job and find out?


Back to the maternity care guidelines. It almost goes without saying that they recommend maternity care providers use “inclusive language” in their interactions, publications and even office signage. To be fair, they recommend an either inclusive or additive approach (e.g. “women and birthing people”) but one suspects that is only because it appears that an attempt to erase the words woman and mother from the Midwifery Council failed last year.


Most of all, the report emphasises again and again that midwives and doctors must approach trans people with humility.


“..participants valued providers who were self-reflective and culturally humble in their practice with trans people and their whānau.”


The level of care expected - and recommended - by both authors and participants for trans people’s feelings, their pronouns, their intersecting identities leaves the word “precious” in the shade:


“I wouldn’t need my midwife to be overt about my personal identity but I would need them to be overt that whoever’s coming into my birthing space is an ally […] because if you’re coming into my birthing space with very heterosexual cisgendered ideas, you’re going to interrupt my birthing process.”


Despite the level of pro-trans spin in the report, occasionally the exasperation of maternity carers breaks through:


“I’m not saying that this isn’t important…. However, I believe it is worth noting that the workplace/the system is broken, care providers are burnt out and leaving the profession in droves, the service is barely holding on/non-existent in some areas.”


Any woman who has given birth in New Zealand in the last 15 years knows this is true. Women are regularly discharged from hospital within 24 hours of giving birth, regardless of how long or painful their labour was, as long as their injuries are not life-threatening. They often return home to immediately resume care of older children. Post-natal care is on its knees, women flounder through the days and weeks of early infancy alone, while their poor bewildered partners have to return to work and pretend it was like any other sick leave. All better now.


Pregnancy, childbirth and the care of infants are the most biologically determined experiences of womanhood. To prioritise trans men - a group of women who reject this material reality even as they experience it - over the enormous unmet needs of all others, is just laughable. To quote another respondent to the survey:


“I feel there are many other groups who are marginalised. I would like to see a unified Healthcare [sic] system, one where we don’t have to group people into pigeon holes.”


Indeed. The entitlement of trans activists must be visible from space, but it is no larger than their influence over this government.



Citizen Science is a pseudonym

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