A qualitative study on healthcare providers’ biases towards transgender and gender diverse people accessing contraceptive care

Bias in sexual and reproductive health care (SRH) undermines the quality and delivery of essential services. For transgender and gender diverse (TGD) patients, barriers to care may be acute when seeking gendered services, such as contraception. Few studies have assessed providers' perceptions of TGD patients in SRH. Our objective was to examine bias in contraceptive providers' attitudes towards and experiences with TGD patients. We conducted in-depth interviews, from August 2022 to August 2024, with 41 healthcare providers located throughout the US and attending CME-accredited trainings on contraceptive counselling. We utilised deductive thematic analysis to identify the domains of implicit and explicit bias specific to TGD patients. Many providers struggled to understand gender diversity and had difficulty using gender-inclusive frameworks in care delivery. Explicit biases were exemplified in the pervasiveness of gender binarism within the healthcare system and providers' lack of experience with TGD patients. Providers demonstrated implicit biases through their deficits in knowledge regarding TGD patients' medical needs and culturally insensitive approaches. They offered suggestions to mitigate bias, including institutional changes to make clinics more trans-inclusive and affirming. Biases and disparities specific to TGD patients are perpetuated through a lack of awareness and stigmatisation in healthcare settings. Our findings highlight areas to improve awareness of bias, dispel confusion with evidence on gender-inclusive care, and integrate structural changes within clinics to reduce the burdensome impacts of bias on TGD patients. Advocacy at both the provider and institutional levels is needed to offer quality contraceptive care for TGD patients.