How biological essentialism limits transgender people’s autonomy in public policy

Abstract

There is a growing population of transgender and nonbinary (trans) people in the United States (US) who face significant health and healthcare disparities due to a history of marginalization and discrimination, particularly in the realm of gender-affirming care and reproductive health. The current political climate is actively pursuing legislative restrictions to limit or eliminate access to these services. These limitations continue the long history of active eugenic practices, including forced sterilization for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people. These eugenic policies and practices are designed to reinforce social norms that determine who should and should not reproduce and are justified by biological and genetic essentialism--the idea that an individual’s phenotypic characteristics and social identity are solely determined by their biological (genetic, hormonal, anatomical, etc.) makeup. Biological essentialism often serves as the frame of reference for public policies that limit trans individuals’ access to services, public accommodations, and legal recognition. As an example, current policies in the US and abroad explicitly require that trans persons first demonstrate they are incapable of having children or have had “sex reassignment surgeries” before they may change their legal gender marker on identification documents (IDs). The purpose of this work is to understand how a history of eugenics has led to biological essentialism that is weaponized against trans people in public policy. This study uses a social-ecological approach to investigate how eugenics limits access to reproductive healthcare for trans people in modern America at both the macro and micro level using three different datasets and analytic methods: (1) a policy analysis examining how trans individuals’ capability to have children is impacted by changing legal gender marker or name on IDs; (2) multi-level analysis of survey data to identify associations between anti-trans policies and parental desire; and (3) key informant interviews with trans people about their perspectives on biological essentialism and public policy. I argue that eugenics continues to target trans people in the modern day through biological essentialism, resulting in limitations to bodily autonomy and self-determination for transgender individuals. To improve the health and well-being of trans individuals, it is first necessary to step away from medicalized and biological definitions of trans identities.