Elle Little (they/them) Graduate student at University of Maine Communication Department and Mabel Wadsworth Center Intern
Many discussions surrounding transgender healthcare include conversations around surgeries and hormones. People may be most familiar with the concepts of “top” and “bottom” surgeries, which can help align someone’s body with either masculine or feminine representations. Some people may also be familiar with hormone replacement therapy to begin seeing new effects such as decreased facial hair or deepening of the voice. While it is true that many transgender people engage in surgery or hormone replacement therapies to alleviate symptoms of gender dysphoria, these are not the only stories that should take the focus of trans-inclusive healthcare.
It is also important to note that gender-affirming care is not exclusively accessed by cis people, or those who identify with the gender they were assigned at birth. Dwayne “The Rock” Johnson is a great example of a cisgender man who got gender-affirming surgery. He has openly discussed how he dealt with a condition called gynecomastia. This condition causes enlarged breast tissue in men. He chose to remove the excess breast tissue so he was more aligned with his identity. This is very similar to gender-affirming top surgeries for transmasculine folks and shows us that all healthcare has the power to be gender-affirming. All healthcare, from primary care to getting the annual flu shot, has the power to affirm the person receiving the care simply by using a patient’s chosen name and pronouns.
Abortions are an example of healthcare stereotyped as something that only cisgender women have. Abortions can be initiated with medications, or can be performed in-office as a procedure that removes the products of conception from the uterus. Because we live in a ciscentric society that ignores the experiences of trans folks, binary and nonbinary alike, abortions are often thought of as only being accessed by women. However, we know that abortion care is accessed by anyone who can get pregnant, regardless of gender.
These two issues, the narrow view of trans healthcare and the narrow view of abortion healthcare, create disparities between which kinds of people need this care. This can mean that trans people might not know they have access to abortion care, and that cis people might not know they can access gender-affirming care as well. Gender-affirming care for cis people can include taking hormones to increase facial hair and getting surgeries that make them feel more like the gender they identify with, just like with trans folks. Abortion care for trans people should mean that they aren’t misgendered while receiving abortion care and that they are given adequate information on pregnancy risk.
Why is it important to talk about abortion as not just a cis-sue? By openly talking about who is having abortions we create a more inclusive environment for people having abortions. This continues to normalize this common experience and can help reduce stigma when we look at abortions as something that PEOPLE have, and not just women. We also further education in the field of healthcare and reproduction. Some people may start taking testosterone and cease to menstruate, but end up pregnant anyways. The more we include trans people in abortion stories, the more people we can reach who need this care.
Some easy ways to practice being inclusive when you talk about abortions is to start replacing “woman” with “people.” “People” is gender neutral, and allows for non-women to be included. Sometimes this is taken in a negative light when people argue that by doing this, women are now being excluded. However, women are people too and are included when we talk about people! Many catchy slogans that people use to advocate for abortion rights are also highly gendered. While the protest chant, “Her body, her choice,” might be popular, an easy switch can be, “Not the church/not the state/only we decide our fate.” This is inclusive and helps everyone who has had an abortion feel included.
Photograph from rally in downtown Bangor October 2021 in response to SB8 in Texas, courtesy of Aspen Ruhlin
Since our founding in 1984, Mabel Wadsworth Center has been dedicated to serving the Greater Bangor area and beyond as an independent feminist sexual and reproductive health center. Over the years, we’ve expanded our services to meet the needs of our community, and now provide a range of services including abortion care, prenatal care, STI testing and treatment, contraception, gender-affirming hormone therapy, vasectomies, and more.
We are not going anywhere.
As an independent clinic, we do not seek or receive restrictive state or federal funding. This means we can provide the care our community needs without meddling from politicians or having our funding suddenly pulled out from under us. It means we have to get more creative and lean on our supporters, but it is well worth it to provide normal, needed healthcare without overreaching government interference.
We are not going anywhere.
It is okay to feel afraid right now. This is true for everyone, and especially true for LGBTQ+ people, BIPOC folks, disabled people, and all other marginalized communities who have reason to fear for their rights. To quote Franklin D. Roosevelt, “Courage is not the absence of fear, but rather the assessment that something else is more important than fear.” We are, all of us, more important than fear. Working together for a kinder world and coming together as a community is more important than fear.
We are not going anywhere.
Maine has laws protecting abortion care and gender-affirming care. Maine has people dedicated to providing and protecting access to the whole range of sexual and reproductive healthcare across the state. Along with the staff at Mabel’s in Bangor, we have our friends at Planned Parenthood in southern Maine and Maine Family Planning throughout the state providing care and community engagement. We have legislators and advocates in Augusta fighting for laws that further strengthen protections for the care we provide. We have the people of Maine who recognize how essential all sexual and reproductive care is leading conversations in their communities. We have SAFE Maine funding abortion so people can get the care they need.
We are not going anywhere.
Mabel’s has been here for 40 years. We are unquestionably dedicated to providing the care our community needs. We will weather the storm. We know that abortion care, contraception, and gender-affirming care are particularly under attack, and we will not stop providing or advocating for these essential, normal services.
Comments Off on Providing care to people who use drugs
by Eva White (she/her) University of Maine Social Work student and Mabel Wadsworth Center intern
Take a moment to consider the following scenario…
A person calls a health clinic and tells the front desk associate they’d like to have an abortion. They estimate their gestation at around eight weeks, they were assigned female at birth, and when asked about prior health conditions, they share that addiction runs in their family. They disclose their insurance information, birthday, address, and any other information required to establish them as a patient at this health center. They tell the clinic they’d prefer a procedural abortion instead of a medication abortion, and they thank the front desk person for their time. On the day of their appointment, the clinical assistant calls them from the waiting room and engages in typical pleasantries before beginning the pre-abortion counseling routine.
During the portion of the counseling wherein the patient is expected to disclose any prior medication use, the patient reveals to the clinical assistant that they injected heroin an hour prior to their appointment. When asked further about their heroin use, it becomes understood that the patient is a regular, recreational user of heroin and other opioids. The clinical assistant asks a few more patient- and condition-specific questions and the counseling portion of the appointment is finished. The clinical assistant leaves the patient to wait for a few minutes while she consults with the doctor about the best course of action. During this discussion, the CA and doctor determine how to safely proceed with the appointment while considering the patient’s individual needs. Now, it is time to administer medications if necessary and continue with the procedure.
Some people may feel judgmental after considering the above scenario. Some may feel shocked that the clinical assistant didn’t abruptly show the patient the door when they revealed their drug use. Some may feel nervous, because if a health center is offering care to someone that uses drugs, they cannot be legitimate and safe…..right?
Now, please consider the following scenario….
A person calls a health clinic and tells the front desk associate they’d like to have an abortion. They estimate their gestation at around eight weeks, they were assigned female at birth, and when asked about prior health conditions, they tell the associate that dangerously high blood pressure runs in their family. They tell the clinic they’d prefer a procedural abortion instead of a medication abortion, and they thank the front desk person for their time.
During their pre-abortion counseling, the clinical assistant takes the patient’s blood pressure and finds it to be quite staggering. The CA asks the patient a few patient- and condition-specific questions, leaves them to wait for a couple minutes, and finds the doctor. She consults with the doctor about the client’s current condition and together, they develop a plan for how to safely continue the patient’s appointment. After a conclusion is reached, it is time to administer medications if necessary and continue with the procedure.
How are these two scenarios different? How are they the same? It is reasonable to assume that for many people, the latter scenario is quite normal. In fact, it would be considered malpractice for the clinical assistant to show this person the door after they disclosed a prior medical condition and still expected to receive care. In fact, it is any medical professional’s responsibility to cater to their patient’s needs. If a patient has an allergy, this is accounted for in their care. If a patient has staggeringly high blood pressure, this is accounted for in their care. If a patient has a pacemaker, this is accounted for in their care. If a person uses recreational drugs, this is accounted for in their care.
The point of this exercise in consideration is twofold. The first intention is to dig up the fact that many people are affronted and almost personally offended by the idea that someone who uses illicit substances has the exact same right to healthcare as someone who has never touched a pipe, needle, or pill. The second intention is to describe exactly why it is safe and legitimate for healthcare workers to serve patients that use substances. It is understandable for someone to wonder if it is safe for a patient to undergo an abortion procedure while on heroin. Are they truly able to consent to the procedure? Is the procedure impossible to carry out because of the drugs in their system?
When any patient is served by a medical facility, the implication is that their care will be catered to them as an individual. If they have high blood pressure, an allergy, a heart condition, depression, or any other medical condition, it is expected they disclose that information to their provider. This is not so that they may be shamed for a lack of exercise, family history of diabetes, or drinking too much coffee; it is because some medications, surgeries, or medical practices are contraindicated when certain conditions are present. For example, in a study on female military Veterans, it was found that 29% of the women presented with a medical contraindication to combined hormonal contraceptive use (Judge et. al, 2018). The contraindications listed were smoking, hypertension, and migraines. The point of this study was not to indicate that people who smoke should be turned away at the door of a sexual health clinic. The point was to illustrate the myriad options these people have other than CHC and how to use these other options safely. Just as with any other contraindication, it is possible to work with and around a person’s drug use to offer them services safely.
Are people that use drugs able to give consent to their healthcare providers? There are forms to sign, medications to take, and pokes and prods that must all be understood and consented to when someone visits any doctor. Sometimes, being high on some kind of substance prevents someone from giving informed consent; their cognition may be impaired, their physical ability to sign something might be hindered, or their emotional state is so heightened that they are unable to listen to and absorb important information. This is not always the case when someone is on substances. Peoples’ capacity to make informed decisions may not actually be affected by their substance use. In fact, if people regularly use or misuse substances, they may not be impaired by those substances and find that they become impaired when sober from that substance. For example, it has been found that regular THC (marijuana) users do not experience acute neurocognitive impairment when given a set of tasks to complete while high on the substance. (MacCallum et. al, 2021). In another study that researched assessments designed to test someone’s decision-making capacity, it was found that in most cases of substance misuse, it is entirely unnecessary to assess their capacity and actually violates ethical principles (Kumar et. al, 2022).
People that use drugs are humans. Humans deserve healthcare and kindness. At any healthcare facility, doctors; practitioners; nurses; and social workers should be trained to serve all populations, including people that use drugs. Doctors are expected and able to work with patients with diabetes, liver failure, blindness, deafness, borderline personality disorder, eczema, coronary heart disease, and PTSD. They spend hours deliberating with nurses about the best course of treatment for patients with contraindications and ask question after question to patients about their needs. They try new medications, use hypoallergenic supplies, and implement trauma-informed practice with patients. Why is substance use any different from another medical need? Substance use is stigmatized to an extent that prevents people from seeking healthcare services because they are afraid of being turned away, they are abused by providers, or their needs are not otherwise met. This is unacceptable, inhumane, and something that must shift in the healthcare field.
Judge, C. P., Zhao, X., Sileanu, F. E., Mor, M. K., & Borrero, S. (2018). Medical contraindications to estrogen and contraceptive use among women veterans. American Journal of Obstetrics and Gynecology, 218(2), 234.e1-234.e9. https://doi.org/10.1016/j.ajog.2017.10.020
MacCallum, C. A., Lo, L. A., & Boivin, M. (2021). “Is medical cannabis safe for my patients?” A practical review of cannabis safety considerations. European Journal of Internal Medicine, 89, 10-18. https://doi.org/10.1016/j.ejim.2021.05.002
Kumar, R., Berry, J., Koning, A., Rossell, S., Jain, H., Elkington, S., Nagaraj, S., & Batchelor, J. (2022). Psychometric properties of a new decision-making capacity assessment tool for people with substance use disorder: The CAT-CAT. Archives of Clinical Neuropsychology, 37(5), 994-1034. https://doi.org/10.1093/arclin/acac010
Comments Off on Improving essential contraception access in Maine
By Lydia Townsend (she/her) University of Maine Women’s, Gender, and Sexuality Studies student and Mabel Wadsworth Center intern
Ensuring that all people have access to contraceptives is crucial in supporting reproductive autonomy. Providing individuals with contraceptives that best suit their needs allows them to be in control of their future – deciding when and if they wish to be pregnant. Not only does access to contraception provide autonomy, but it is also key to the health and safety of all individuals involved. Contraceptives are important tools in preventing unintended pregnancies and, in the case of barrier methods like condoms, sexually transmitted infections (STIs).
Contraceptives come in many forms, ranging from barrier methods, to pills, to injections, to intrauterine devices (IUDs). This variety in forms is necessary and essential, as each person’s needs differ, and some contraceptives may be better suited for them than others. Condoms and dental dams, for instance, reduce the transmission and spread of STIs, and condoms can be utilized for penetrative sex. The hormonal contraceptive injection, Depo-Provera, can be especially important for individuals who are experiencing reproductive coercion. It is a form of contraception that cannot be removed or as easily withheld by an abusive partner or parent. IUDs are beneficial for individuals who do not want to have to remember to take a pill each day and/or who want a form of birth control that lasts numerous years. Birth control pills are a good option for those who may not want to be on birth control for an extended period of time or will easily remember to take a daily pill. Additionally, both IUDs and pills come in varying ratios of hormones, some even without hormones, providing an option to individuals who may be more sensitive to hormonal changes. While some people don’t tolerate hormonal contraception well, others may see benefits ranging from reduced acne to improved mood.
Just recently, the FDA approved the first ever over-the-counter hormonal birth control option in the US, known as the Opill. This is a progestin-only oral contraceptive that will now be accessible without a prescription, a crucial step in ensuring reproductive autonomy. Over the counter oral contraceptives are already accessible in over 100 countries, the United States is just now following suit. Not only will the Opill be available at local pharmacies, but also for purchase online, which helps to eliminate access barriers.
The approval of the Opill helped to inspire a bill (LD2203) here in Maine, a bill that would expand access to contraceptives for all. The bill, put forth by Representative Poppy Arford, specifically calls for health insurance companies to cover the cost of over-the-counter contraception, including condoms, emergency contraception, and the newly approved Opill. In providing these options to individuals, without having to pay out of pocket or receive a prescription, reproductive autonomy is being protected. This bill would help to ensure that Mainers have access to over-the-counter contraceptives, helping to eliminate potential financial barriers.
This bill is particularly important for marginalized people who want contraception but face barriers in access. These barriers are compounded by factors such as socioeconomic status, race, ethnicity, and gender and sexual identity. Through expanding coverage to these additional forms of contraception, individuals will now be able to access the contraception they wish to without having to worry about issues such as cost. Additionally, this bill is important to Mainers as we currently face a healthcare shortage here in the state. In recent times, it has become extremely difficult to find a provider who does not have a month(s)-long wait list, let alone one who is actually accepting new patients. In specifically expanding coverage to include the Opill, individuals who desire to be on the birth control pill are able to do so without having to wait months to be given a prescription. As we also know, Maine is a relatively rural state and therefore without a car or method of transportation, accessing a healthcare provider can prove to be a difficult task. The framework of this bill helps remove these potential barriers, allowing people to access an oral contraceptive at their nearest pharmacy. In having insurance cover the costs of these contraception options, autonomy will be given to individuals, allowing them to make decisions regarding their own reproductive health.
By Katie Card (she/they) University of Maine Women’s, Gender, and Sexuality Studies student and Mabel Wadsworth Center intern
At the time of writing this, it’s the fall of my junior year in college. Five semesters down, three more to go (at least, that’s the hope). I’m over halfway to the “real world,” where I’ll spend the rest of my life… working. That thought looms over me, that something that has been part of my life since I was four– school– will be over soon, and that I’ll be more or less on my own from there on out. For some, the idea of finishing up schooling and doing something with all they’ve learned, making a change in the world, is exhilarating. We’re expected to know what we want our life to be like far too early. But what about those who don’t know, who can’t for the life of them make a decision, especially one so important as a career?
I’m a Women’s, Gender, and Sexuality Studies major, with a minor in Media Studies (which is within communication and journalism; not New Media, which it is commonly confused for). Every time I’m asked the standard, “So, what are you studying?”, I almost immediately know how that conversation will go:
“Huh, what’s that?” Either genuine confusion or just not even attempting to process it.
“Oh, um, ok,” usually with disgust and/or disappointment.
Or, the most common, “What are you going to do with it?”
I’m sure most of the people who respond with the latter don’t mean any harm with that question. Sure, some may be, because it is a field often looked down upon by others, seen as useless or stupid or some SJW bull (growing up in rural Maine, I’ve gotten that vibe more times than I can count). Others are genuinely curious– it’s not a prevalent major by far, and sometimes people have just never heard of it. To answer that question with a Liberal Arts field is to open up a Pandora’s Box of questions about what you want to do with your life once you graduate. Apparently majoring in something not business, education, or STEM related is abnormal to some.
I grew up with the expectation that I would attend higher education. College and university may not be the right fit for everyone, but access should not be based on privilege. I had, and still have, that privilege– white, middle class, able-bodied, had educational and extracurricular opportunities that others were not afforded. I don’t want to brag (I hate attention), but I was a good student, and teachers expected certain things from me. So, when I said I would be attending my state school to study Women’s, Gender, and Sexuality Studies, the discomfiture was palpable. Why didn’t I try to get into “better” schools? (They’re too costly, too far from home, I didn’t want that stress, state schools are not bad schools.) Why didn’t I want to go into engineering, mathematics, computer science, biology, chemistry, law, medicine? (Because I’m just not interested in those fields.)
Why did I choose WGS? Because it interests me. Because the concepts that these courses focus on directly apply to and impact my life. Because I grew up confused, knowing I was different from those around me but too scared to find out why. I chose Women’s, Gender, and Sexuality Studies because I wanted to.
WGS to me is liberating, it puts words and theories to experiences that I, and people like me around the world, have lived through. It creates a space where I know my identities will be accepted, even if I can’t put words to them all the time. These are not topics that I was taught growing up, and I have chosen this for myself.
I know that others don’t have the liberty to feel the same: Some go on to higher education so they can find a good career path, something that can support them financially, even if they don’t enjoy it, because they need to. It’s how you get by in our messed-up, capitalist society. But I didn’t want that. I don’t want that. I didn’t want to be in a field of work that I despised, even if it paid well. There’s more to life than work, right?
Do I know what I’ll do once I graduate? I won’t lie to you and say yes. I haven’t the faintest idea what I want to do with my life, and at times it’s incredibly nerve racking. But why should I be expected to have my life all planned out at the age of 21? I didn’t go into WGS expecting to get a massive payout at the end: I went into it because I knew I would enjoy it, that I would spend my 4 years here studying a topic I genuinely love and am interested in.
So, what am I going to do with it? I don’t know. And isn’t that beautiful? To have all those possibilities ahead of me?
