Pregnancy for Trans Women May Be On the Horizon, but Not Without a Fight

Lucia Blayke reports on the growing research around uterine transplantation for trans women, and argues that a strong trans-led movement is needed to fight pushback.

WORDS Lucia Blayke
ILLUSTRATIONS Ella Devi Dabysing

The actions of the far right have long damaged any movement towards progressing the rights of transgender women, which includes their ability to posess wombs and carry their own children. However, now that uterine transplantation is slowly becoming available to cisgender women across the globe, medical professionals are starting to advocate for the right to pregnancy for transgender women. While this would be a significant step forward in the fight for autonomy for trans women, it also raises a number of questions: is it possible? Should it be possible? How will the world react if, for the first time in the evolution of humanity, someone who was not born biologically female becomes pregnant?

Since the first contemporary partial success in 2000 in Saudi Arabia, womb transplants have been trialled across the world. The treatment involves placing a donor uterus in the mother-to-be, who then begins a course of immunosuppressants, as is standard in any organ transplant. At least a year later, embryos conceived through IVF are placed in the womb to grow over the course of an ordinary, but carefully monitored, nine-month pregnancy, following which the baby is delivered via a standard C-section. This full process has been carried out 11 times since the 2014 birth of the first baby from a transplanted womb in Sweden.

How will the world react if, for the first time in the evolution of humanity, someone who was not born biologically female becomes pregnant?

However, there is, in fact, a recorded case of a uterine transplantation that predates Saudi Arabia’s 2000 success –  the case of transgender painter Lili Elbe, who was controversially portrayed by Eddie Redmayne in The Danish Girl. As with contemporary discussions around uterine transplantation, the biopic omitted the fact that Lili Elbe was the recipient of the first medically recorded womb transplant, focussing instead on her “sex change.” Elbe’s surgery was carried out in 1931 by world-renowned sexologist Marcus Hirschfeld, using the methodology of early transplant surgery (the first successful solid-organ transplant, a kidney, did not occur until 1954). Tragically, Lili Elbe died three months after her surgery due to the lack of necessary post-surgery care.

Much evidence related to this early foray into womb transplants for trans women was destroyed when, during the Second World War, all trans-related medical research was burned to ashes in the 1933 Nazi attack on the Institute for Sexual Research. Dr. Hirschfeld was also later exiled from Germany to France, where he died of a heart attack two years later. If it was not for this dire loss of knowledge, would we have pregnant trans women today? Would such widespread transphobia still exist without the argument of definition by womb?

Despite the success of these crucial first steps, no medical teams have made attempts at this surgery on trans women over the last ninety years later. However, with promising surgeries on cis women over the last decade, more experts in the field have been calling for a collective and global movement towards expanding this research to accommodate the specific needs of trans women.

Last year, London Transgender Clinic’s Dr. Christopher Inglefield made national press when he said that, “the transplant into a trans female is essentially identical to that of a cis female.”

Dr Richard Paulson, former president of the American Society for Reproductive Medicine also made similar public declarations, saying: “I personally suspect there are going to be trans women who are going to want to have a uterus, and will likely get the transplant.”

Moreover, Dr. Jacques Balayla, a pioneer in ethical criteria around uterine transplantation published an academic paper in February 2021 entitled The Montreal Criteria and uterine transplants in transgender women, in order to bring forth the inclusion of trans women in the medical movement.

“There isn’t an ethical reason why they [trans women] should be denied access to the procedure,” he states. “It is evidently clear that the medical profession is moving towards performing this surgery on trans women – not only is it possible, it is fast becoming inevitable.” 

We deserve to be treated the same as everybody else.

Charlie Craggs, author and trans activist

We all have milestones that we feel will define our lives and give us a sense of fulfillment – for some trans women, this is the imagined experience of pregnancy. While not all want to experience pregnancy, or even become a parent at all, there is a communal understanding that the surgery could largely benefit the trans community.

A study from the Jama Network Open, which surveyed 182 trans women, found that nearly all respondents (99%) “believed that uterus transplant would lead to greater happiness in transgender women.” Moreover, out of the respondents aged 20 to 29, “most did not have children prior to transitioning” (92%), and “expressed a desire to have children in the future” (94%). The study also found that “most respondents agreed or strongly agreed that the ability to gestate and give birth to children (94%) would enhance perceptions of their femininity”, thus reducing potential gender dysphoria.

“I would get a womb transplant if I knew it was safe and available for me,” says Olivia Nutton, a 22 year old trans woman and fashion designer. 

Having transitioned in her early teens, Olivia has “experienced every aspect of womanhood,” but is left with “the longing desire to be a yummy mummy.” She also notes that not being able to be pregnant is “often the one argument people have against [her] validity as a woman.” 

“We deserve to be treated the same as everybody else,” adds author and trans activist Charlie Craggs. “…it would be nice because it would shit all over transphobes who use trans women not having wombs as the basis of their reasoning that we aren’t real women, despite many cis women not being able to conceive naturally.”

We need a trans-led movement to secure the future of this surgery, which possesses the potential to drastically improve the lives of countless trans women, before it is demonised and legislated against by transphobes in positions of power.

Uterine transplantation becomes more of a reality with each passing day, as Womb Transplant UK, the charity leading the movement in the UK, has recently been granted permission to carry out trials in NHS transplant centres, led by Dr. Richard Smith. However, their sole patron, Baroness Caroline Cox – also the first person shown on their ‘Meet The Team’ page – is a far-right and openly homophobic member of the House of Lords. She is also a patron of the Christian Institute, which lobbies against gay and lesbian rights; she contributed to the homophobic, racist book ‘Great Britian has Fallen’; and openly supported Section 28, among other “achievements”.

It is deeply worrying, and frankly upsetting, that the only charity providing wombs to women in the UK has such a hateful, discriminatory person as the face of their organisation –  a person who has knowingly and deliberately contributed to mass prejudice and suffering for marginalised individuals. Moreover, this is not only concerning for trans women who want access to this treatment, but also for people who are non-white and not from a Christian background. How can we expect equal access to the surgery provided by Womb Transplant UK if their only patron is a right-wing, Christian extremist?

As transgender womb transplants come closer to materialisation, so does the potential backlash from transphobes and religious fanatics across the globe as they find a new arena in which to debate and oppose the rights of transgender people. This will be an ethical debate that could fundamentally change society’s perceptions of gender and parenthood in our generation. In order to provide trans women with the same bodily autonomy that is currently reserved for cis women, we must make sure that the reproductive movement for womb transplants is non-discriminatory, and prepare for the inevitable pandemonium and shaping of culture that will come with it. We need a trans-led movement to secure the future of this surgery, which possesses the potential to drastically improve the lives of countless trans women, before it is demonised and legislated against by transphobes in positions of power.

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