Changes Are Needed in the Health Care System to Meet the Needs of Black Transgender and Gender Non-Conforming People

Changes Are Needed in the Health Care System to Meet the Needs of Black Transgender and Gender Non-Conforming People

Throughout history, Black transgender and gender non-conforming (TGNC) individuals have nurtured themselves and their communities. Black TGNC individuals have always been at the forefront of the movement for LGBTQ+ liberation and Black civil rights, including William Dorsey Swann and other early organizers of Drag Performances and Balls in the late 19th and early 20th century; to those who helped to lead the collective uprising for queer rights at Stonewall in 1969, including Stormé Delarverie, Marsha P. Johnson, Miss Major Griffin-Gracy, and Zazu Nova; to trans and gender non-conforming leaders in the Black Lives Matter movement, including Janaya Khan, Elle Hearns, and Jonovia Chase.

While Black TGNC people have historically led, and continue to lead, the movements for LGBTQ+ civil rights and to end anti-Black racism, too often it is their White and cisgender counterparts who are credited for their work. White and cis-led LGBTQ+ organizations are the public face of the movement yet have a history of excluding Black and TGNC people.

Black TGNC individuals have had to take care of themselves often because they could not rely on others to respect their needs. Resources like housing and employment that others, particularly cisgender, White people, might rely on are increasingly inaccessible to people at the intersection of race and gender. Yet Black TGNC individuals have shown resilience throughout history despite these structural barriers. They have created chosen family and community spaces for themselves. They continue to lead and fight for greater movements for LGBTQ+ equality and civil rights.

Because of the dedication and hard work of Black TGNC people, some states have adopted strong legal protections for TGNC people. But there is more work to be done. In 2020 alone, there are reports of at least 28 TGNC people (almost entirely BIPOC, predominantly women) having been murdered, while countless others continue to endure assault and harassment.

Since the Trump Administration’s recent regulations sanctioning discrimination against people based on gender identity and rolling back the requirement that plans provide gender-affirming care, many states, like California and New York, have passed laws to protect access to gender-affirming care and nondiscrimination against TGNC individuals.

Despite some state protections, health disparities persist for TGNC communities of color, including Black TGNC people. These disparities result from many factors throughout a long history of anti-trans and anti-Black bias and discrimination in health care. The current health care system is largely dominated by White, cisgender (and heterosexual) providers.

Health plans often deny gender-affirming care and many TGNC members accept the denials out of exhaustion with the bureaucracy involved or a lack of awareness about their rights. Due to a lack of accountability or consumer protections in the health care system, Black TGNC people face higher rates of health disparities and discrimination. Further barriers show up without culturally competent care and education about the health care needs of TGNC people.

Black TGNC people deserve respect, dignity, and autonomy in navigating their health needs. Transgender people make up approximately .6% of the population and heavily rely on other members in the community for inside knowledge about health plans and TGNC-friendly providers for their health care. In light of this, Black TGNC communities have long persisted to access competent care amidst discriminatory health systems.

It is critical for the health care system to implement education and accountability measures to address structural and interpersonal transphobia, homophobia, and racism. Such measures include provider education on gender identity and cultural sensitivity, integrating gender-inclusivity in historically binary and White medical fields, and ensuring access to gender-affirming services, among many others.

Meaningful change cannot be accomplished by Black TGNC people alone. Non-Black people, and cis-people, especially people in positions of privilege, must engage TGNC individuals in our health system, stop monopolizing power, and share resources to enable Black TGNC lives to thrive in our health care system free from discriminatory barriers. Prioritizing these efforts are crucial steps to creating a health care system that serves everybody.

* The authors acknowledge Unique Woman’s Coalition (UWC) as a thought partner in helping to inform the content of this blog. UWC is the first formalized organization in Southern California to be founded, organized for and by Black Transgender women. Learn more about UWC on the organization’s website, and consider making a donation to sustain its life-changing work.

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