A social-ecological approach to exploring barriers in accessing sexual and reproductive healthcare services among Iranian transgender women

Abstract

Introduction: The availability and accessibility of sexual and reproductive health services for transgender women are very crucial. This population is deprived of healthcare and social services due to rejection, stigma, gender-based discrimination, confidentiality, and violence motivated by sexual orientation. This study attempted to provide information of the fundamental problems that female transgender individuals face regarding the access to sexual and reproductive health. Material and methods: A total of 22 transgender women and four healthcare providers were selected using snowball sampling method. Through in-depth interviews, participants were asked about their personal experiences of accessing sexual and reproductive healthcare. The study explored barriers encountered by transgender women to accessing sexual and reproductive health services with socialecological model. Data were analyzed using framework analysis method. Results: The study findings identified barriers across four levels of the social-ecological model, indicating that the use of sexual and reproductive health services is influenced by diverse factors. The socialecological model application illustrated the impact of personal, community, and social and regulatory factors on the condition of sexual and reproductive health among female transgender individuals. Conclusions: The findings revealed that there are multiple levels of factors that influence sexual and reproductive health of female transgender individuals. There is an urgent need for interventions addressing modifiable barriers to sexual and reproductive health education, and services to improve knowledge, informed choices, facilitate access to services, and provide better sexual and reproductive well-being for female transgender individuals.