Healthcare, What Health? What Care?

By Jordan Chanetsa


Blood clots, liver problems, breast cancer, etc. These are just some of the risks associated with taking government-approved birth control pills. These pills were created to provide women with a hormonal contraceptive that’s taken orally and is easy to stop or restart taking.

Birth control pills contain a high amount of a synthetic estrogen called ethinylestradiol. They also contain a high amount of a synthetic progesterone called levonorgestrel. These synthetic hormones prevent (unplanned or unwanted) pregnancies. When taken correctly, birth control pills are reported to be up to 99.9% effective. 

These oral contraceptives come with their own set of side effects on the body, some of which are long-term. It’s because of some of these effects that the pills are usually an option for trans women looking to use hormonal therapy to transition. 

In a country like Zimbabwe where the government is yet to legally acknowledge the validity of trans identities, trans people are left with little to no (quality) healthcare options for their health needs. When accessing public healthcare services, many trans people are subjected to misgendering and unfair discrimination due to the lack of information on trans identities and experiences.

The healthcare sector in Zimbabwe has only recently begun to acknowledge the relevance of men who have sex with men (MSM) within its quest to eliminate new HIV infections while ensuring those who are living with HIV or AIDS have access to treatment. 

Sad to note, trans women are lumped together with MSM. This erases our identity. By doing so, the healthcare system fails to adequately cater to the specific needs of trans women and the trans community at large. 

It’s good that the health sector is now considering the health needs of MSM as they intend to “leave no-one behind” in the fight to end AIDS by 2030. However, progress still needs to be made in ensuring that this and other initiatives are wholly inclusive of all gender or sexual identities.
 
Several healthcare professionals in Zimbabwe, mainly in the field of obstetrics or gynaecology, are aware of the existence of transgender people. Some may have received some education on transgender people during their training.  Despite this, few of them are willing to provide medical support to transgender patients who need medical services including guidance on hormone replacement therapy options. Those who do provide treatment are in the private sector. This usually means their pricey services are inaccessible to trans women who cannot afford their services.  

This situation leaves trans women with the risky option of having to self-medicate. They either go to the black-market where some vendors are selling feminising hormones or they use birth control pills which are ineffective if not taken in high dosage. These women often have to take up to double the dosage taken by cis women using the pills for contraception.

Given the risks of taking birth control pills, taking double the normal dosage automatically puts trans women at a greater risk of the earlier-mentioned health complications. The risk is even higher since there is no professional supervision which enables one to know which hormones, and in what amount, are compatible with each person’s bodily needs.

In addition to dealing with the physical implications of unsupervised self-medication, transgender people also endure the effects, on their mental health, of such harmful means to transition. Some may argue that these women willingly put themselves at risk when they choose to use birth control pills or hormones purchased illegally. What these people fail to understand is that these women have no other (accessible) choice. Also, these people fail to understand how the pills and black-market hormones still play a key role in alleviating gender dysphoria or body dysmorphia, which often results in suicide in the trans community.

When one considers all the above, trans women cannot continue to be blamed for the implications they risk facing while trying to achieve a more comfortable life for themselves. We should blame the government and our healthcare system for failing to acknowledge our rights as humans.