Title: Beyond Cisnormative Feeding Frameworks: A Comparison of Parent and Provider Perspectives on Affirming Perinatal Care for Transgender and Gender-Diverse Families

Background and Purpose:
Perinatal and lactation care is often organized through cisnormative and heteronormative assumptions about bodies, feeding, and family structure. For transgender and gender-diverse (TGD) parents, these systems can produce misgendering, dysphoria, limited clinically relevant guidance, and inadequate support for diverse feeding pathways. Although affirming care is increasingly discussed, less is known about how TGD parents and lactation support providers define affirming practice and identify barriers within current systems of care. This qualitative comparison study examined how TGD parents and lactation support providers describe affirming care, identify obstacles within perinatal and lactation systems, and define the changes needed to advance equity-oriented, family-centered, transgender-affirming support.

Methods:
This qualitative comparison study drew on two related interview-based samples. One included 10 TGD parents in the United States who had fed their babies with their bodies. The second included 11 lactation support providers with experience supporting queer and/or TGD families. Across both groups, semi-structured interviews explored feeding goals, clinical encounters, dysphoria, institutional barriers, family dynamics, and recommendations for practice. Data were analyzed using thematic analysis, with attention to both convergence and divergence across parent and provider perspectives.

Results:
Parent and provider accounts converged in four major areas. First, both groups described affirming care as requiring more than inclusive language; it also involved consent-based, trauma-informed engagement, individualized goal-setting, and practical knowledge of diverse feeding pathways, including induced lactation, co-feeding, pumping, donor milk, and formula supplementation. Second, both groups challenged narrow biomedical definitions of feeding success, emphasizing outcomes such as gender affirmation, bodily autonomy, family connection, and infant nourishment. Third, both identified substantial provider- and system-level unpreparedness, including noninclusive documentation, rigid “mother-baby” assumptions, misgendering, and inconsistent clinical competency. Fourth, both described community and informal supports as filling gaps left by formal systems, although parents emphasized these networks as survival resources while providers framed them as compensatory supports in the face of institutional failure. Overall, findings suggest that the central barrier to transgender-affirming perinatal care lies not only in individual encounters, but in cisnormative assumptions embedded in clinical practice, training, and organizational systems.

Conclusions and Implications:
This study positions transgender-affirming perinatal support as a social work issue of relational justice, institutional inclusion, and family self-determination. Findings suggest that improving care for TGD families requires more than symbolic inclusion; it requires trauma- and stigma-informed practice, competency-based workforce preparation, inclusive documentation systems, and service models that recognize diverse bodies, identities, and family forms. Social work is well positioned to advance transgender-affirming care through interdisciplinary advocacy, provider education, and systems reform centered on dignity, safety, and client-defined outcomes.