RESEARCH PAPER
A social-ecological approach to exploring barriers in accessing sexual and reproductive healthcare services among Iranian transgender women
1
Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
2
Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
3
Tufts School of Medicine, Department of Public Health and Community Medicine, Boston, MA, USA
4
School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
5
Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
Submission date: 2022-11-21
Final revision date: 2023-01-17
Acceptance date: 2023-02-01
Publication date: 2024-02-22
HIV & AIDS Review 2024;23(1):76-83
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The availability and accessibility of sexual and reproductive health services for transgender women are very crucial. This population is deprived of healthcare and social services due to rejection, stigma, gender-based discrimination, confidentiality, and violence motivated by sexual orientation. This study attempted to provide information of the fundamental problems that female transgender individuals face regarding the access to sexual and reproductive health.
Material and methods:
A total of 22 transgender women and four healthcare providers were selected using snowball sampling method. Through in-depth interviews, participants were asked about their personal experiences of accessing sexual and reproductive healthcare. The study explored barriers encountered by transgender women to accessing sexual and reproductive health services with social-ecological model. Data were analyzed using framework analysis method.
Results:
The study findings identified barriers across four levels of the social-ecological model, indicating that the use of sexual and reproductive health services is influenced by diverse factors. The social-ecological model application illustrated the impact of personal, community, and social and regulatory factors on the condition of sexual and reproductive health among female transgender individuals.
Conclusions:
The findings revealed that there are multiple levels of factors that influence sexual and reproductive health of female transgender individuals. There is an urgent need for interventions addressing modifiable barriers to sexual and reproductive health education, and services to improve knowledge, informed choices, facilitate access to services, and provide better sexual and reproductive well-being for female transgender individuals.
The availability and accessibility of sexual and reproductive health services for transgender women are very crucial. This population is deprived of healthcare and social services due to rejection, stigma, gender-based discrimination, confidentiality, and violence motivated by sexual orientation. This study attempted to provide information of the fundamental problems that female transgender individuals face regarding the access to sexual and reproductive health.
Material and methods:
A total of 22 transgender women and four healthcare providers were selected using snowball sampling method. Through in-depth interviews, participants were asked about their personal experiences of accessing sexual and reproductive healthcare. The study explored barriers encountered by transgender women to accessing sexual and reproductive health services with social-ecological model. Data were analyzed using framework analysis method.
Results:
The study findings identified barriers across four levels of the social-ecological model, indicating that the use of sexual and reproductive health services is influenced by diverse factors. The social-ecological model application illustrated the impact of personal, community, and social and regulatory factors on the condition of sexual and reproductive health among female transgender individuals.
Conclusions:
The findings revealed that there are multiple levels of factors that influence sexual and reproductive health of female transgender individuals. There is an urgent need for interventions addressing modifiable barriers to sexual and reproductive health education, and services to improve knowledge, informed choices, facilitate access to services, and provide better sexual and reproductive well-being for female transgender individuals.
REFERENCES (38)
1.
Lusti-Narasimhan M, Cottingham J, Berer M. Ensuring the sexual and reproductive health of people living with HIV: policies, programmes and health services. Reprod Health Matters 2007; 15 (Suppl 29): 1-3.
2.
Witkin BR, Altschuld JW. Planning and conducting needs assessments. A practical guide. Sage Publishing, Newbury Park 1995.
3.
Deutsch MB, Green J, Keatley J, et al. Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group. J Am Med Inform Assoc 2013; 20: 700-703.
4.
Nadoushan AH, Bahramian A, Taban M, et al. High-risk sexual behaviors among transgender individuals in Tehran, Iran. Acta Med Iran 2021; 59: 113-117.
5.
Mehringer J, Dowshen NL. Sexual and reproductive health considerations among transgender and gender-expansive youth. Curr Probl Pediatr Adolesc Health Care 2019; 49: 100684. doi: 10.1016/j.cppeds.2019.100684.
6.
Mayer KH, Bradford JB, Makadon HJ, Stall R, Goldhammer H, Landers S. Sexual and gender minority health: what we know and what needs to be done. Am J Public Health 2008; 98: 989-995.
7.
Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot 1996; 10: 282-298.
8.
Romanelli M, Lindsey MA. Patterns of healthcare discrimination among transgender help-seekers. Am J Prev Med 2020; 58: 123-131.
9.
Janssen A, Voss R. Written on behalf of the Gender Development Program at the Ann and Robert H. Lurie Children’s Hospital of Chicago. Policies sanctioning discrimination against transgender patients flout scientific evidence and threaten health and safety. Transgender Health 2021; 6: 61-63.
10.
Grootens-Wiegers P, Hein IM, van den Broek JM, de Vries MC. Medical decision-making in children and adolescents: developmental and neuroscientific aspects. BMC Pediatr 2017; 17: 120. doi: 10.1186/s12887-017-0869-x.
11.
Meerwijk EL, Sevelius JM. Transgender population size in the United States: a meta-regression of population-based probability samples. Am J Public Health 2017; 107: e1-e8. doi: 10.2105/AJPH.2016.303578.
12.
Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis 2013; 13: 214-222.
13.
Luvuno ZP, Ncama B, Mchunu G. Transgender population’s experiences with regard to accessing reproductive health care in Kwazulu-Natal, South Africa: a qualitative study. Afr J Prim Health Care Fam 2019; 11: e1-e9. doi: 10.4102/phcfm.v11i1.1933.
14.
Pope C, Ziebland S, Mays N. Qualitative research in health care: analysing qualitative data. BMJ 2000; 320: 114-116.
15.
Tishelman AC, Sutter ME, Chen D, et al. Health care provider perceptions of fertility preservation barriers and challenges with transgender patients and families: qualitative responses to an international survey. J Assist Reprod Genet 2019; 36: 579-588.
16.
Fontenot HB, Cahill SR, Wang T, et al. Transgender youth experiences and perspectives related to HIV preventive services. Pediatrics 2020; 145: e20192204. doi: 10.1542/peds.2019-2204.
17.
Graham LF, Crissman HP, Tocco J, Hughes LA, Snow RC, Padilla MB. Interpersonal relationships and social support in transitioning narratives of Black transgender women in Detroit. Int J Transgend 2014; 15: 100-113.
18.
Rhodes SD, Alonzo J, Mann L, et al. The ecology of sexual health of sexual minorities in Guatemala City. Health Promot Int 2015; 30: 832-842.
19.
Cahill SR, Geffen SR, Fontenot HB, et al. Youth-serving professionals’ perspectives on HIV prevention tools and strategies appropriate for adolescent gay and bisexual males and transgender youth. J Pediatr Health Care 2020; 34: e1-e11. doi: 10.1016/j.pedhc.2019.09.003.
20.
Clark JL, Perez-Brumer AG, Reisner SL, et al. Social network organization, structure, and patterns of influence within a community of transgender women in Lima, Peru: implications for biomedical HIV prevention. AIDS Behav 2020; 24: 233-245.
21.
Newcomb ME, Feinstein BA, Matson M, Macapagal K, Mustanski B. “I have no idea what’s going on out there:” Parents’ perspectives on promoting sexual health in lesbian, gay, bisexual, and transgender adolescents. Sex Res Social Policy 2018; 15: 111-122.
22.
Bowling J, Dodge B, Banik S, et al. Perceived health concerns among sexual minority women in Mumbai, India: an exploratory qualitative study. Cult Health Sex 2016; 18: 826-840.
23.
Boyce S, Barrington C, Bolaños H, Galindo Arandi C, Paz-Bailey G. Facilitating access to sexual health services for men who have sex with men and male-to-female transgender persons in Guatemala City. Cult Health Sex 2012; 14: 313-327.
24.
Wilson EC, Iverson E, Garofalo R, Belzer M. Parental support and condom use among transgender female youth. J Assoc Nurses AIDS Care 2012; 23: 306-317.
25.
Fix L, Durden M, Obedin-Maliver J, et al. Stakeholder perceptions and experiences regarding access to contraception and abortion for transgender, non-binary, and gender-expansive individuals assigned female at birth in the US. Arch Sex Behav 2020; 49: 2683-2702.
26.
Knight RE, Shoveller JA, Carson AM, Contreras-Whitney JG. Examining clinicians’ experiences providing sexual health services for LGBTQ youth: considering social and structural determinants of health in clinical practice. Health Educ Res 2014; 29: 662-670.
27.
Sun CJ, Anderson KM, Mayer L, Kuhn T, Klein CH. Findings from formative research to develop a strength-based HIV prevention and sexual health promotion mHealth intervention for transgender women. Transgender Health 2019; 4: 350-358.
28.
Wingo E, Ingraham N, Roberts SC. Reproductive health care priorities and barriers to effective care for LGBTQ people assigned female at birth: a qualitative study. Womens Health Issues 2018; 28: 350-357.
29.
Lindroth M, Zeluf G, Mannheimer LN, Deogan C. Sexual health among transgender people in Sweden. Int J Transgend 2017; 18: 318-327.
30.
Lefkowitz AR, Mannell J. Sexual health service providers’ perceptions of transgender youth in England. Health Soc Care Community 2017; 25: 1237-1246.
31.
Nemoto T, Bödeker B, Iwamoto M. Social support, exposure to violence and transphobia, and correlates of depression among male-to-female transgender women with a history of sex work. Am J Public Health 2011; 101: 1980-1988.
32.
Melendez RM, Pinto RM. HIV prevention and primary care for transgender women in a community-based clinic. J Assoc Nurses AIDS Care 2009; 20: 387-397.
33.
Rich A, Scott K, Johnston C, et al. Sexual HIV risk among gay, bisexual and queer transgender men: findings from interviews in Vancouver, Canada. Cult Health Sex 2017; 19: 1197-1209.
34.
Morrison MA, Bishop CJ, Gazzola SB, McCutcheon JM, Parker K, Morrison TG. Systematic review of the psychometric properties of transphobia scales. Int J Transgend 2017; 18: 395-410.
35.
Mkhize SP, Maharaj P. Structural violence on the margins of society: LGBT student access to health services. Agenda 2020; 34: 104-114.
36.
Mendieta A, Vidal-Ortiz S. Administering gender: trans men’s sexual and reproductive challenges in Argentina. Int J Transgend 2020; 22: 54-64.
37.
Tan KK, Treharne GJ, Ellis SJ, Schmidt JM, Veale JF. Enacted stigma experiences and protective factors are strongly associated with mental health outcomes of transgender people in Aotearoa/New Zealand. Int J Transgend 2021; 22: 269-280.
38.
Divan V, Cortez C, Smelyanskaya M, Keatley J. Transgender social inclusion and equality: a pivotal path to development. J Int AIDS Soc 2016 Jul 17; 19 (3 Suppl 2): 20803.
| eISSN: | 1732-2707 |
| ISSN: | 1730-1270 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
