Telehealth Improves Abortion Care Experience for Some Trans, Nonbinary Patients—New Research

Transgender and nonbinary people faced fewer barriers to medication abortion when they get care through telehealth, according to a new paper in Contraception, a journal of the Society of Family Planning.

The peer-reviewed article, which was published as a pre-proof online on Sept. 19, 2025, analyzed interviews with 15 people who got a telehealth medication abortion between April 2021 and May 2024.

All participants identified as gender-expansive, including transmasculine, nonbinary and genderqueer (meaning they don’t identify with the gender binary and related societal expectations). Other participants were agender, which can mean they have no gender or describe their identity as gender neutral, or gender non-conforming (which means they do not adhere to the norms imposed on their gender).

The research, which was conducted as part of a larger project called the California Home Abortion by Telehealth Study (CHAT), found that many patients avoided common negative interactions with health-care workers, like being misgendered, stigmatized, or discriminated against. Researchers have linked these experiences to health-care disparities. And for some patients, the study found, the telehealth experience improved their overall relationships with the health-care system.

Rewire News Group spoke with Dr. Andréa Becker, an assistant professor of sociology and the paper’s lead author, about what the research means for providing abortion care to marginalized communities.

“The top takeaway,” Becker said, is “that trans and nonbinary patients can benefit greatly from having a telehealth option for their abortion.”

The original interview was conducted by phone. It has been edited for length and clarity, and includes information from emailed follow-ups.

What do you think explains your findings?

In our past research on telehealth abortion, we found that telehealth allows people to circumvent abortion stigma in various ways. But when it comes to trans and nonbinary people, they’re coming against abortion stigma as well as the potential for transphobia. So the two are magnified and can lead to barriers to care.

Having this telehealth option allows trans people to avoid the structural and interpersonal elements of abortion stigma. It can also allow them to avoid transphobia in a medical setting.

What does that mean for patients?

When a patient appears gender expansive or just gender queer—not cis or not normative—it can lead to worse health care. LGBT people in general, but trans and nonbinary people in particular, have high barriers to medical care and have a high degree of health-care avoidance. So with telehealth, it lowers the barriers, and it can lead to these patients not avoiding the health-care setting.

A barrier that really stuck out to me as a cis woman was reading the aspects of your article where patients were really concerned about entering into a space that’s branded as “women’s health.” Why was that branding so detrimental?

That’s a really great example of how transphobia and abortion stigma combine for trans patients. I would say most, if not all, people who are women who want to get an abortion don’t want to be called “mama” either.

It’s also really common when you go to get a pregnancy test that the provider assumes that you want the pregnancy. And it’s very common and normalized to immediately say “congratulations,” or to prescribe prenatal vitamins. So that’s what all abortion patients typically are up against in the first place.

But then to be called “mama,” and you’re trans or nonbinary, then it’s a double whammy. You’re being invalidated in your abortion and in your gender. So another reason why telehealth abortion is so great is because it circumnavigates in-person testing.

For a really long time, the health-care establishment was adamant that in order to have a safe abortion, you needed an in-person pregnancy test and an ultrasound. But what we found through the CHAT Study more broadly is that it is as safe and effective to have a medication abortion without those requirements.

And having an ultrasound—[when] it’s trans vaginal, they’re highly invasive, even if you’re cis. So say you’re a trans man or nonbinary [person] having to have that sort of testing done, [it] can be even more invasive and can cause [symptoms of] gender dysphoria.

Why is this research important?

Within abortion research spaces, trans people are often forgotten about altogether. … And we see that translating to the way that doctors treat their patients.

Trans and nonbinary people’s reproductive health needs are forgotten about across every domain—from starting desired families to terminating unwanted pregnancies. This becomes especially clear when we compare trans experiences to the promotion of cis women’s fertility in medicine, public health, and politics.

We need to invest in abortion access now more than ever, but we can’t forget trans patients in the process. If we create a world in which a trans patient can have an affirming abortion experience that’s free of barriers, this improves all abortion experiences. Inclusivity benefits us all.

A lot of reproductive justice spaces consider themselves inclusive but might have, at various points, fallen into that trap of centering gender in the way that they provide care.

The majority of abortion patients are women, and the majority of people in these spaces are going to be women. (Editor’s note: A 2023 Guttmacher Institute survey found that about 1.1 percent of more than 6,600 abortion patients “identified as something other than woman or female.”)

But just because it’s a majority doesn’t mean that trans and nonbinary patients don’t also matter, and their safety and their comfort also matters.

So [providers should consider] just being more attuned to how gendered the space is. The walls don’t have to be pink. Female patients will be fine if they go to a doctor’s office and the walls aren’t pink, or if it doesn’t say “ladies” everywhere, or if it’s only “women’s” bathrooms.

Also, at the very least, training receptionists to expect gender diversity. Even if it’s a small number, it’s still substantial. They’re going to encounter trans or nonbinary people. Trans and nonbinary people need abortion care. They have abortion care. They’re going to be showing up in these spaces, and if we’re going to be talking about reproductive justice, and patient-centered care and inclusive abortion care, then we need to have conversations about trans inclusivity.

What’s a question you had unanswered or a variable you couldn’t control for that you think would be a fruitful area for later research?

This sample was quite small, so I would love to look more into the role of race and how it combines with gender in terms of access to abortion [and] how telehealth allows people to maybe circumvent some form of medical racism as well.

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