JMIR Publications

ABSTRACT

Background:

Research on transgender health, particularly in reproductive health, has expanded exponentially over the past decades. However, previous studies frequently highlight perceived inaccessibility and gender-exclusivity of reproductive and perinatal care for transgender people.

Objective:

This cross-sectional content analysis examined online obstetrics, labor and delivery, and pregnancy-related materials from purposive sample of 180 online hospital resources across the United States to understand the extent to which they use gender-inclusive and gender-exclusive language, imagery, and other inclusive symbolism.

Methods:

Two hundred U.S. hospitals were purposively selected from the most populous cities per state; 20 lacking obstetrics pages were excluded, yielding 180 across all 50 states. Four coders assessed obstetrics websites (Oct-Dec 2025) for trans-specific resources, inclusive language, second person language, exclusive language, inclusive imagery, and symbols/statements. Hospitals were categorized by U.S. Census region, trans-specific legal protections, and university/religious affiliation.

Results:

Across the U.S., presence of gender-inclusive elements were relatively rare, while most hospitals utilized second-person or gender-exclusive elements consistently. These patterns persisted across geographic regions, university affiliations, religious affiliation, and variation in state-level transgender-specific legal protections, although hospitals in more protective states and university-affiliated institutions showed somewhat higher rates of inclusive content. Importantly, even on websites that included gender-inclusive language, such content co-occurred with gender-exclusive terms, raising questions about how TGD patients interpret these mixed signals when deciding where to seek care.

Conclusions:

Findings underscore the need for hospitals to develop clear, service-specific standards for gender-inclusive obstetric communication and to ensure that online materials visibly and consistently signal readiness to care for TGD patients across the perinatal period.