This mixed-methods study will examine how contraceptive care and gender-affirming policies impact contraceptive access and decision-making among transgender and gender-diverse (TGD) individuals in two contrasting policy environments: Washington and Texas. The study will explore how access to hormone replacement therapy (HRT) and gender-affirming surgeries – either restricted or supported by state policy – affects contraceptive use, and how policy and clinical environments shape TGD individuals’ experiences navigating contraceptive care.
We will convene an advisory committee of TGD individuals with lived experience to advise on research tools, recruitment strategies, and policy recommendations. A comprehensive policy analysis will identify and categorize relevant federal and state-level legislation. These findings will inform the creation of policy-specific variables to stratify primary data and uncover structural drivers of inequity.
Primary data collection will include an anonymous, bilingual (English/Spanish) online community survey distributed in partnership with trusted community organizations in Washington and Texas. Survey questions will explore contraceptive history, access to gender affirming care, provider experiences, and perceived policy impact. Interested participants may opt in to participate in qualitative interviews.
Quantitative data will be analyzed using descriptive, bivariate, and multivariate models in R; qualitative interviews will undergo thematic analysis using Dedoose. Findings will be synthesized to generate equity-focused policy recommendations, analyzed using criteria co-developed in partnership with the advisory committee. The study’s community-led design will ensure that results inform practical improvements to contraceptive care policy for TGD populations.