Victory Congressional Fellow White Paper June 2019 Queering Reproductive Justice: How to Ensure LGBTQ Access to Sexual and Reproductive Health Care on the Federal Level By Aliya Bean, David Bohnett Victory Congressional Fellow LGBTQ Victory Institute Abstract I. Introduction: defend the rights of women of Reproductive Justice color and other marginalized women and transgender This white paper will explore why and LGBTQ Sexual and reproductive justice is an LGBTQ people.4 Consequently, the issue and outline the federal policy Reproductive Health term reproductive justice and the steps lawmakers must take in accompanying movement was born. order to ensure access to inclusive, LGBTQ rights are Rooted in the comprehensive, and affordable inextricably linked with internationally-accepted reproductive health, rights, and human rights framework sexual and reproductive health 1 for LGBTQ people. This paper will justice. More often than not, the created by the United Nations, explain why a series of intersecting same forces working to restrict reproductive justice combines factors increase the vulnerability and sabotage everyone’s access reproductive rights and social of the LGBTQ community in to sexual and reproductive health justice. SisterSong, a national accessing such care, putting care are the same people who membership organization want to deny legal recognition dedicated to improving the particular emphasis on the barrage 2 of attacks on LGBTQ people, and rights to LGBTQ people. It is reproductive lives of marginalized reproductive justice, and health for this reason that reproductive communities, defines care more broadly by the Trump justice is such an important reproductive justice as “the administration. This paper will framework to discuss and analyze human right to maintain personal go one step further and pinpoint LGBTQ access to sexual and bodily autonomy, have children, four federal policy solutions to reproductive health care. not have children, and parent help ensure access to inclusive, Reproductive justice the children we have in safe comprehensive, and affordable was first established as a and sustainable communities.”5 sexual and reproductive health care framework in Chicago in June SisterSong goes on to say, that for LGBTQ people: repealing the 1994 by a group of prominent reproductive justice is “[a]bout Hyde Amendment, funding Title X Black women, including Loretta access, not choice” and that it is: and eliminating the domestic gag Ross, co-founder and the first national coordinator of the Not just about abortion. rule, guaranteeing access to the 3 full range of contraceptive options, organization SisterSong. This Abortion access is critical, and safeguarding the Affordable group of women recognized and women of color and other Care Act’s LGBTQ protections and that the broader women’s rights marginalized women also gender-affirming care. movement, because it was led often have difficulty accessing: by and representing middle contraception, comprehensive class and wealthy white women, sex education, STI prevention could not sufficiently secure or and care, alternative birth options, adequate prenatal factors make it more challenging II. The State of Sexual and and pregnancy care, domestic for the LGBTQ community to Reproductive Health for violence assistance, adequate access sexual and reproductive wages to support our families, health care, calling particular LGBTQ People safe homes, and so much attention to the onslaught Unlike other marginalized more.6 of attacks on LGBTQ people, communities, evaluating the reproductive rights, and health health needs and barriers In other words, reproductive care more broadly by the Trump to care for LGBTQ people is justice not only encompasses administration. This paper will go particularly challenging. This reproductive health and rights, one step further and identify four is in part due to the lack of but also economic security, approaches federal policymakers formal data collection on sexual criminal justice, domestic should adopt to ensure access orientation and gender identity violence, and the full spectrum to inclusive, comprehensive, in major health surveys and of issues that affect women and and affordable sexual and studies. Where data is available, marginalized communities. reproductive health care for it mostly focuses on smaller When we approach LGBTQ people: repealing the sample sizes, same-sex couples, sexual and reproductive health Hyde Amendment, funding Title and lesbian, gay, and bisexual care access with a reproductive X and eliminating the domestic people rather than transgender justice lens, we acknowledge that gag rule, guaranteeing access to individuals.9 However, the certain groups—including women the full range of contraceptive National Center for Transgender of color, transgender people, options, and safeguarding the Equality does conduct an annual and queer communities—have Affordable Care Act’s (ACA) U.S. Transgender Survey,10 a more difficult time accessing LGBTQ protections and gender- which is the largest—and only— care than others. Reproductive affirming care. survey devoted to the lives and justice centers women of color, Throughout this paper experiences of transgender LGBTQ people and other “LGBTQ” and “Queer” will be people. In order to fully assess historically oppressed groups used as umbrella terms for the health needs and limitations and their right to make their own the Lesbian, Gay, Bisexual, to care for LGBTQ people, we decisions about their bodies and Transgender, Non-Binary, need more routine and more their families. By centering and Intersex, Asexual, Pansexual, substantive data collection. uplifting the most marginalized, Queer community. This is in With the data we do we in turn are uplifting us all. In no way an exhaustive list. have available, it is clear that other words, by implementing Expressly, LGBTQ and Queer not only do LGBTQ people have policy solutions focused on aiding will refer to everyone who does unique sexual and reproductive the communities most at harm, not identify as cisgender (not health care needs, but that a we improve the lives of every transgender) heterosexual. While variety of issues work together community. This intersectional there is no single definition to increase the vulnerability of approach to LGBTQ rights and of the “LGBTQ community”— the LGBTQ community in this sexual and reproductive health is because it is such a diverse area of health. For example, a essential because marginalized and multidimensional group of high percentage of the LGBTQ communities face multiple, individuals with unique identities community is low-income and intersecting oppressions. We and experiences, with variations living below the poverty line.11 can only make effective policy by race, ethnicity, income, and LGBTQ young people, particularly decisions and best serve these other characteristics—LGBTQ queer and transgender youth, communities if we understand individuals do share the are disproportionately homeless and address how these common experience of being and housing insecure and oppressions impact one another. stigmatized due to their actual consequently are more likely to As Audre Lorde said, “There is or perceived sexual orientation, engage in survival sex work (sex no such thing as a single-issue gender identity, and/or gender work engaged in by a person in struggle because we do not live expression.8 This paper will order to survive or to supplement single-issue lives.”7 It is therefore also use the term “sexual and low incomes, due to systemic through a reproductive justice reproductive health” to refer to factors and extremely restricted framework that we can best and encompass reproductive options),12 which may result in tackle the issues of sexual and health, rights, and justice unintended pregnancy or sexual reproductive health care access more broadly. In other words, assault.13 LGBTQ people are for LGBTQ people. sexual and reproductive health also more likely to be uninsured Using reproductive justice will signify the full range of and rely on federal programs as a lens, this paper will explain intersectional issues that are a like Medicaid and Title X.14 This why a series of compounding part of the reproductive justice framework. 2 combination of factors makes level in this year alone.21 That the Congressional appropriations affording and gaining access means that more than half of all bill in 1977 for the Department to comprehensive health care a reproductive-aged cisgender of Health and Human Services significant challenge. women—and even more people (HHS). Since then, the Hyde In addition, LGBTQ if you include transgender and Amendment has been renewed people—and youth in particular— non-binary people that also need annually by Congress. The lack inclusive and comprehensive abortion care—live in states that Hyde Amendment’s reach not sex education and health care.15 are hostile or extremely hostile only includes Medicaid but also This lack of sex education to abortion rights.22 And with the includes the Indian Health Service, coupled with stigma is part newly conservative makeup of the Medicare, and the Children’s of what makes LGBTQ people Supreme Court, national access to Health Insurance Program. In at greater risk of unintended abortion is under unprecedented addition, language similar to that pregnancy, sexually transmitted threat.23 in the Hyde Amendment has been infections (STIs), sexual violence, Given the unique health incorporated into a range of other and high-risk activities