In a new policy brief, the University of Minnesota Rural Health Research Center said 47% of rural transgender adults felt their families don’t emotionally support them. When compared to other adults, rural transgender adults are the least likely to report family support.
Having that familial support is an important part of transgender adults’ health, researchers said.
“This is a significant problem because rural individuals are less likely to have support and resources outside of their family just given the place where they live,” Bob Libal, lead author of the study, said in an email interview. “With this, suicidal attempts and ideation are higher among rural transgender individuals. Feeling unsupported can worsen existing health issues (especially mental health and chronic conditions) where support from family is oftentimes vital in care treatment and managing chronic diseases.”
Libal said data from the Centers for Disease Control and Prevention (CDC) shows that more than half of transgender adults (54%) live in the majority rural states. That equates to about 750,000 people, he said.
While the results of the study were expected, the differences between transgender adults and adults whose gender is the same as it was at birth, or cisgender, were not. Only 16.3% of rural transgender adults said they felt supported by their families, compared to 30.4% of urban transgender adults. A majority of cisgender adults (people who identify with the sex registered for them at birth) said they felt supported by their families.
“We expected there to be lower support for transgender individuals in both rural and urban settings, but we didn’t expect the differences (between support for transgender and cisgender individuals) to be as big as they are,” she said in an interview with the Daily Yonder. “That is really concerning given what we know about the connection between the gender identity and mental health outcomes, suicide risk, and all of the negative health outcomes. Knowing that someone doesn’t have familial support is a really big red flag.”
Libal said he hoped the study would help rural residents understand the importance of supporting their transgender family members.
“With this, it is my hope that it becomes more clear that supporting a family member, no matter their gender identity, is not only important but may very well save their life,” Libal said. “Especially, in this time of heightened transphobic political action and messaging, it is vital that people feel supported by their families.”
In the 2023 legislative session, more than 435 bills attacking LGBTQ rights have been introduced in 43 states. The rights of trans individuals—from access to healthcare to participation in sports—have been a major focus. In West Virginia, for instance, 12 bills were introduced. Examples include Senate Bill 517, which would allow doctors to refuse trans individual’s treatment if they object to it on moral grounds; House Bill 3001, which would prohibit school districts from punishing teachers who refuse to use pronouns inconsistent with a child’s sex; and House Bill 2007, which would prohibit doctors from providing gender-affirming health care to anyone under 18.
While the study found that both rural and urban transgender people don’t feel supported by their families, it may be harder on rural residents. Rural transgender people are at greater risk because they lack other avenues of support, Libal said.
“Even if rural populations receive similar levels of emotional and social support to their urban peers, it may be more difficult for rural transgender populations to access affinity groups and the social resources they need for better health and access to care,” the study said.
Finding support outside of one’s family for rural transgender people may require transportation or even technology support, both of which are harder to access in rural areas, the study said.
Additionally, research has shown that lack of family support is also associated with other mental and physical health outcomes like suicidal ideation and chronic conditions. The isolation of being transgender in a smaller population can exacerbate those issues, she said.
“To be the only one of anything is so hard,” said Carrie Henning-Smith, a co-author of the report. “And to be the only one of any group, especially at a time where we’re seeing hostile policies passed, and really hostile and harmful rhetoric in our state legislatures and societies at large, is particularly dangerous and worrisome.”
The research shows rural transgender adults may have social and emotional needs health care providers should address. That could mean education on transgender health issues or being sensitive to transgender health needs, the study said. Misgendering and deadnaming, or calling transgender individuals by the name associated with their previous gender identity, could increase distrust and impair provider-patient outcomes, the study said.
Henning-Smith said the study was based on data gathered between 2016 and 2018. Changes in the political and social landscape may have changed how transgender adults feel supported now, she said. Part of that may be due to the Covid-19 pandemic.
“I think Covid has changed some of the landscape in good and bad ways,” she said. “We know that mental health outcomes and physical health outcomes really deteriorated during the pandemic, and people felt more isolated than ever before. For a group of individuals, like transgender folks, who don’t feel supported by their families to feel even more isolated during the pandemic would have been especially challenging.”
But, she said, the rise in virtual support avenues during the pandemic may have helped transgender individuals connect with others in ways they may not have been able to do before. However, many rural transgender adults may not have had access to the connectivity required to interact with others virtually, she said.
The study shows that supporting transgender people is more important than ever given the current political climate, Henning-Smith said.
“The degree to which people feel unsupported and isolated is really amped up,” she said. “I think there’s a lot that can and should be done – we need to stop the hateful rhetoric we’re hearing in state legislatures right now. It’s harmful, it’s dangerous for mental health and it’s not doing anyone any good.”
But, she said, for rural transgender adults, having an adequate source of supply of support was just as important. Healthcare providers, social service agencies, and school programs that are gender-affirming and welcoming, can create safe spaces for transgender individuals, especially if their families are not supportive, she said.
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