Objectives: This multi-phase study aimed to identify barriers and facilitators to sexual and reproductive health (SRH) care, and assess knowledge, attitudes, and experiences related to family planning for transgender, non-binary, and gender-expansive (TGE) people assigned female at birth (AFAB).

Methods: Together with a community advisory team, we developed an affirming and customizable electronic survey of the SRH needs and experiences for TGE people AFAB. We fielded the survey nationally between May and September 2019, and analyzed survey data in Stata.
Results: 3,580 participants responded to the survey, of whom 2,147 (60%) identified as TGE, 44 (1%) were “questioning” their gender identity, 1,385 (39%) identified as cisgender sexual minority women, and 4 (0.1%) participants were unclassifiable. Among respondents to questions on gender-affirmation, 144 (28%) reported having had a hysterectomy. Of TGE respondents with a uterus, 186 (13%) reported a desire for future pregnancy, while 182 (12%) considered themselves at risk for an unintended pregnancy. 210 (13%) TGE participants had ever been pregnant; of those, 89 (42%) had ever had an abortion, and 40 (19%) reported a self-managed abortion. Among respondents, 703 (48%) TGE participants indicated that if they needed an abortion today, they would prefer medication abortion, versus 217 (15%) who preferred surgical abortion. Cost, time off from work and school, and fears about mistreatment as a LGBTQ+ person were frequently reported barriers to abortion care.

Conclusions: TGE people have unique contraception and abortion care needs. SRH care and research needs to be inclusive of the range of identities and experiences lived by these populations.