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LGBT-INCLUSIVE OBSTETRICS and NURSING SUPPORT (L.I.O.N.S.) a Program for Healthcare Providers, Staff, and Students

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4/14/2017 LGBT-INCLUSIVE OBSTETRICS AND NURSING SUPPORT (L.I.O.N.S.) A program for healthcare providers, staff, and students Brought to you by: INTRODUCTIONS Kelli Selwyn, BHS Jennifer Evans, PsyD Abigail Fletcher, LM l.i.o.n.s.webinar dr.jenniferevans @gmail.com @gmail.com OUTLINE Cultural- Healthcare Inclusion Competency Terms101 Research Materials & Marketing Conception & Sex & Gender SOGI Data Collection Pregnancy Behaviors & Identity Post-partum Wellness Support Pathology Nursing Resources 1 4/14/2017 LEARNING OBJECTIVES Explain at least 3 differences between gender identity, sexual identity, and sex assigned at birth Identify 2 obstacles to providing care to LGBT patients and clients List 3 ways to provide more inclusive care to LGBT patients and clients CONTINUING EDUCATION CREDITS Suwannee River Area Health Education Center is a Florida Board of Nursing, Dietetics and Nutrition, Dentistry, Psychology, Respiratory Care, CAN, Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling approved provider of continuing education, CE Broker #50-1922. Credits available: 1.0 LGBT CULTURAL-COMPETENCY 2 4/14/2017 DECIPHERING THE RAINBOW Sexual Orientations Gender Identities Lesbian Transgender Gay Non-Binary Bisexual Intersex Queer For more identities, see downloadable resource sheet. SEX AND GENDER • Sex: Assigned at birth by • Transgender: All encompassing term for anatomy/physiology using those whose birth-assigned sex and chromosomes, hormones, sex gender are not congruent. Not all non- characteristics, and binary people consider themselves genitalia…examples: male, female, transgender. intersex • Transman: Someone who was • Gender: Social organization and assigned female at birth, but who construct distinguishing the relationship identifies as male between sexes • Transwoman: Someone who was assigned male at birth, but who • Cisgender: A person whose birth- identifies as female assigned sex is congruent with their gender identity • Intersex: A person with reproductive or sexual anatomy that doesn’t seem to fit • Non-Binary: A person who does not the typical definitions of female or identify with a particular gender (man male, or who develops secondary sex or woman) characteristics during puberty that are incongruent with birth-assigned sex PERSONAL PRONOUNS Feminine Masculine Non-binary She He They Her Him Them Hers His Their For more gender pronouns: http://forge-forward.org/2010/02/01/gender-neutral-pronouns/ 3 4/14/2017 SEXUAL IDENTITY AND SEXUAL BEHAVIORS • Some men who have sex with men (MSM) and women who have sex with women (WSW) consider themselves to be straight, or not part of the lesbian, gay, or bisexual spectrum • It’s important to remember that making assumptions about someone’s sexual behaviors based on their sexual or gender identities may mean important health information is not being gathered. • Being thorough in your health intake can help you avoid missing important medical information GENDER PATHOLOGY Gender Identity Disorder Gender Dysphoria Gender identity disorder (GID) is The dysphoria (distress) a person used to describe a male or female experiences as a result of that feels a strong identification the sex and gender they with the opposite sex and were assigned at birth. In these cases, the assigned sex and gender experiences considerable distress do not match the person's gender because of their actual sex identity WHAT CAN YOU DO? • You can ask a patient/client what • You can refrain from making name and pronouns they would like assumptions about a for you to use. patient/client’s sexual identity and • You can refer to a patient/client by behaviors. their preferred name • You can use the resources and • (no matter what name is on their handouts provided whenever you chart/ ID/ insurance card) need a reminder. • You can use a patient/client’s • You can share what you learn preferred pronoun about LGBT cultural-competency • (may prefer he, she, they, or with your professional networks and another pronoun) colleagues 4 4/14/2017 LGBT HEALTHCARE RESEARCH HEALTHY PEOPLE 2020 • “Healthy People provides science- based, 10-year national objectives for improving the health of all Americans.” • “Research suggests that LGBT individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights.” www.healthypeople.gov HEALTHY PEOPLE 2020 OBJECTIVES LGBT-1: LGBT-2: • Increase the number of population- • Increase the number of states, based data systems used to monitor territories, and the District of Healthy People 2020 objectives that Columbia that include questions include in their core a standardized that identify sexual orientation and set of questions that identify lesbian, gender identity on state level gay, bisexual, and transgender surveys or data systems populations 5 4/14/2017 NIH – SEXUAL AND GENDER MINORITY RESEARCH OFFICE COULTER, KENST, BOWEN, SCOUT EVALUATION (2014) • NIH-Funded • 86.1% focused on sexual minority men • January 1, 1989 to December 31, 2011 • 6.8% focused on transgender health • 628 LGBT health studies • 1 study focused on the health of transmen IOM REPORT ON LGBT HEALTH • The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding (2011) • Some of the barriers to accessing quality health care for LGBT adults is a lack of providers who are knowledgeable about LGBT health needs, as well as a fear of discrimination in health care settings. 6 4/14/2017 EXAMPLES OF LGBT HEALTH DISPARITIES • Approximately 20% of transgender • Individuals with minority identities are at individuals have been denied services risk for pre-term birth and lower by a doctor or other provider due to birthweight babies their gender and this percentage increases among people of color • Minority stress, stemming from real or perceived discrimination and • Transgender individuals have a higher homophobia, can often intersect with prevalence of HIV/STIs, but are less other minority identities based on race, likely to have health insurance than ethnicity, or social class to exacerbate cisgender individuals other medical conditions • LGBT populations have higher rates of • Lesbians are less likely to get preventive tobacco, alcohol, and other drug use services for cancer than their heterosexual peers 2015 U.S. TRANSGENDER SURVEY (USTS) Report on Health and Health Care (2015) : • 27,715 transgender individuals in the U.S. participated in the survey • Conducted by the National Center for Transgender Equality and the National Gay and Lesbian Task Force • The report can be viewed at: http://www.ustranssurvey.org/ KEY FINDINGS FROM 2015 USTS • 33% reported having at least one negative experience with a doctor or other health care provider related to being transgender, including having to teach the provider about transgender people in order to receive appropriate care • 23% of respondents reported that they did not seek the health care they needed in the year prior to completing the survey due to fear of being mistreated as a transgender person, Robert Eads (1945-1999) KS1 7 Slide 21 KS1 was repeatedly refused care for his ovarian cancer. The documentary “Southern Comfort” is about his story. Kelli Selwyn, 4/7/2017 4/14/2017 KEYS FINDINGS CONTINUED • 24% report being asked invasive • 17% of respondents had an or unnecessary questions about insurer refuse to change their being transgender not related to name and/or gender in their the reason for the visit insurance record when requested • Respondents were three times more likely to have to travel • 13% reported that they were more than 50 miles for denied coverage for services transgender-related care than often considered to be gender- for routine care specific LGBT HEALTHCARE DELIVERY CONCEPTION FOR CISGENDER WOMEN • Cisgender women (CW) may • CW may choose home or provider- identify in a number of different assisted donor insemination, ways, including but not limited to: adoption, surrogacy, or other bisexual, lesbian, queer, gay, methods of conception. straight, and asexual. • CW may or may not have a partner • CW may choose a variety of or partner(s) they want closely options for conception, based upon involved in their prenatal care. their fertility, socioeconomic status, These partners may have any sexual orientation, relationship variety of sexual and gender status, among other factors. identities. 8 4/14/2017 WHAT CAN YOU DO? • You can refrain from making • You can ask if any partner(s) will be assumptions about the fertility of your involved in the process and you can be patient/client. welcoming of their inclusion if there are. • You can remember that pregnancy • You can assist them in determining does not dictate sexual orientation or when they are most fertile or what gender identity. might be needed to increase fertility. • You can provide resources to LGBT- • You can ask your patient/client which friendly support groups for those trying methods of conception they are to conceive. interested in learning more about. FERTILITY, CONCEPTION, AND TESTOSTERONE • Not all transmen or non-binary individuals take hormones. Not all transmen and non- binary individuals have surgery. • After taking cross-hormones, future fertility may be extremely difficult for some people. • Sometimes fertility is regained after several months off of hormones. • Some transgender and non-binary individuals may undergo procedures to harvest and store their eggs prior to starting cross-hormones. FERTILITY, CONCEPTION, AND TESTOSTERONE • All transmen or non-binary
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