#041: Fighting for Bodily Autonomy: A Conversation on Health Equity and Project 2025

Liz Church and Miss Jai Smith discuss the implications of Project 2025 on bodily autonomy, particularly focusing on the LGBTQ+ community and reproductive health. They explore the erosion of gender-affirming care, the challenges faced by healthcare providers, and the importance of community support and advocacy. The conversation emphasizes the need for resilience and actionable steps to protect bodily autonomy in the face of legislative changes.

Miss Jai Smith, MPH, is an advocate for health equity and reducing barriers to care for gender-expansive communities. She holds a Master of Public Health, emphasizing health and wellness for Transgender and Non-Binary communities. Since 2011, she has worked with county and state health departments, universities, healthcare facilities, and community-based organizations to increase capacity for serving gender-expansive communities in public health and healthcare initiatives.

Ask Miss Jai, a program of Toadhenge Consulting, was founded in 2022 to help healthcare and public health professionals learn how to better serve Transgender, Non-Binary people through capacity-building training, technical assistance, and organizational coaching. 

Resources
Defeat Project 2025
Accountable.US
Fenway Health
ACLU
GLAAD
National LGTBQIA+ Health Education Center
HIPPA Violations by State Attorneys
Social Determinants of Health Series: Episode 1
Liz's Worried. Tired. Frustrated. Article

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- Liz Church, Host + Producer of The Atrómitos Way

Transcript

00:00:00:00 - 00:00:16:11
Liz Church
Hello, and welcome to the Atrómitos Way podcast. I am the host and producer, Liz Church. I am pleased to welcome back to The Andromeda's Way, Miss James Smith. She is an advocate for health equity and reducing barriers for to care for gender expansive communities. Hi, Miss Jai.

00:00:16:13 - 00:00:19:00
Miss Jai Smith
Hi. Thank you for having me back.

00:00:19:02 - 00:00:23:12
Liz Church
Of course. Absolutely. So to kind of set the stage of exactly what we're talking about.

00:00:23:12 - 00:00:42:10
Liz Church
For folks listening, maybe you've seen articles, social media posts or, or overheard conversations from friends, neighbors and colleagues about the far reaching and dangerous playbook of project 2025 aimed at seizing control. The United States government and dismantling the country into an authoritarian state.

00:00:42:13 - 00:01:08:01
Liz Church
And I wrote about the quotes written in this disastrous book and my worried, tired, frustrated piece for this year, 2024. And maybe you've heard the audio version a few weeks ago. And while this plan specifically targets and explicitly marginalized communities, it's an insidious attack on bodily autonomy, threatening the freedom and rights of all Americans. And we're not going to give a play by play of what this stupid thing says.

00:01:08:03 - 00:01:17:14
Liz Church
There are many other experts, and we have articles, podcast episodes of other people who've done a deep dive, and I will absolutely load those into the episode. Show notes.

00:01:17:14 - 00:01:27:17
Liz Church
But instead, miss Joy and I are going to talk about how this will broadly impact care and what we can do to fight back and protect our freedoms. So let's just jump into it.

00:01:27:18 - 00:01:30:17
Liz Church
I wrote the primary, my piece, what it was in the,

00:01:30:17 - 00:01:55:23
Liz Church
where retired frustrated was the attack on reproductive health, how it extends beyond cisgender women and impacting all individuals who seek reproductive care. And I give a little bit of snippet of how this will affect LGBTQ plus communities. And for where we're going to go back and forth on this, is that we've seen the attacks of abortion widely in the past few years, since the overturning of Roe versus Wade, by folks who were wholeheartedly against it.

00:01:56:01 - 00:02:08:06
Liz Church
Of course, you know, if you don't want to have it, that's perfectly fine. That is your choice. That is the reason for it being a choice. That is mentioned in abortion is mentioned in 60 pages, this 922 page document. And,

00:02:08:06 - 00:02:22:14
Liz Church
they really don't like cisgender women making choices on their own health care. But at the same time, they really don't like the LGBTQ community to exist, to have a choice of who they want to be and how they want to live.

00:02:22:15 - 00:02:31:11
Liz Church
So I wanted to give you the stage, miss Jai, to go ahead and give us a little bit of a breakdown of how this will affect the LGBTQ plus community.

00:02:31:13 - 00:02:50:01
Miss Jai Smith
Yeah. Thank you for having me. And thank you for highlighting that. This is really a much larger conversation about bodily autonomy and about our our ability to be self deterministic in the ways that we lead our lives and engage in our in relationships, in family building and family planning, etc.,

00:02:50:01 - 00:02:56:07
Miss Jai Smith
and in our wellness and our well-being. So for folks who aren't familiar with me, I am not a paralegal.

00:02:56:11 - 00:03:25:00
Miss Jai Smith
I don't have a legislative background. I don't have a background in political science or political policy. My background is in public health, and my background is in health care, and specifically public health and health care for LGBTQ communities, trans and non-binary communities, is where I spend a lot of my time and my focus of my energy. And so some places that I want to start around this, because the document is extensive, it covers most, if not all of the departments of federal government.

00:03:25:00 - 00:03:49:02
Miss Jai Smith
And regulation and infrastructure. And so I really want to focus in on some of the recommendations around sexual orientation and gender identity. I want to focus in on some of the recommendations around gender affirming care, and really show how this links back to this larger conversation of bodily autonomy and our ability, again, to be self-determined, mystic over our own well-being.

00:03:49:04 - 00:03:53:15
Miss Jai Smith
So some of the pieces that I think are important for us to be aware of is,

00:03:53:15 - 00:04:14:18
Miss Jai Smith
in this documents, there are recommendations to strip away nondiscrimination policies to revise and stop following Bostock versus Clayton County, which expanded nondiscrimination in title seven to include sexual orientation and gender identity. Caveat to note with that is that courts have already stopped the enforcement of that.

00:04:15:00 - 00:04:19:23
Miss Jai Smith
Portions of this are also becoming moot points, but I think it's important for us to acknowledge anyways, that,

00:04:19:23 - 00:04:31:14
Miss Jai Smith
as exists now, workplace discrimination can occur for folks who are LGBT on the basis of their sexual orientation and gender identity. And unless the the state has a specific

00:04:31:14 - 00:04:37:22
Miss Jai Smith
restriction around it, or the city has a restriction or the organization has policy in place, then there is not necessarily,

00:04:37:22 - 00:04:41:05
Miss Jai Smith
a way for us to prevent that from occurring.

00:04:41:07 - 00:05:27:11
Miss Jai Smith
So this is recommending continuing to erode that ability, our ability to be employed and to show up fully in our work. This there's also recommendations from this document to remove language from federal policy, from grants, from regulations, removing words specifically like sexual orientation, gender identity, gender expression, diversity, equity and inclusion, abortion, and so actively trying to erase some of the the nuances that have been put into regulation and into grants in order to support and get funding into the communities that are that are often disproportionately impacted negatively by social determinants of health or have barriers to accessing care or accessing employment, etc..

00:05:27:12 - 00:05:52:19
Miss Jai Smith
So we're seeing an active push to remove language from from federal spaces that advocates like myself, have worked really hard to include, because we know that when left in a more vague sense, oftentimes those who are most marginalized are the ones that are left out, and from access to resources, from equitable services that are coming into our communities in ways that we need them.

00:05:52:21 - 00:06:22:04
Miss Jai Smith
So those are some of the the big pieces that I'm particularly concerned about. I'm also concerned about the fact that they are a characterization of gender affirming care as inherently dangerous, and to remove and restrict gender affirming care support from a governmental standpoint, including no longer allowing gender affirming care coverage via medicaid, which, as we know in terms of social determinants of health and the health and well-being of trans and non-binary folks, and the treatment of gender dysphoria.

00:06:22:06 - 00:06:47:21
Miss Jai Smith
Gender affirming care is one of the ways that we treat gender dysphoria, gender dysphoria, and it's going to look different for each person. It might include medical transition, but for those who are undergoing medical transition, it is to treat gender dysphoria and gender dysphoria, when untreated, is linked to suicidal ideation, depression, anxiety, mental health and concerns, and also physical challenges in our bodies as well, and physical health concerns as well.

00:06:47:21 - 00:06:56:06
Miss Jai Smith
So there's this characterization that's occurring that all gender affirming care is inherently dangerous. And as we have seen with,

00:06:56:06 - 00:07:28:02
Miss Jai Smith
with anti-trans legislation pushes over time, we're seeing this ramp up going from just restricting gender affirming care for minors, for those under the age of 18 to now attempts to restrict gender affirming care for adults as well. So we're also seeing, again, the stripping away of bodily autonomy, our ability to make informed decisions about our medical needs and our health and well-being with the specialists who and the clinicians and medical providers who are aware of how to treat and serve our community.

00:07:28:04 - 00:07:33:20
Miss Jai Smith
So we're we're seeing some real concerns around that. And so that's all just like the health piece.

00:07:35:00 - 00:07:52:17
Miss Jai Smith
One of the other big pieces that I think is important for us to not only highlight, but to be really aware of the implications of is the way that trans people are talked about in the document, as trans people are referred to as this transgender ideology. And something I really want to make clear is that there's no such thing as a transgender ideology.

00:07:52:19 - 00:07:59:11
Miss Jai Smith
Trans people exist, and what they're talking about is affirming trans people and trying to equate affirming trans people,

00:07:59:11 - 00:08:17:18
Miss Jai Smith
and being supportive of trans people as somehow infecting other people with trans ness. But we know that that's not reality. Social contagion isn't a real thing when it comes to trans identity. And so the way that it's being characterized in this document is that trans people, because I'm not going to say trans ideology because it's trans people.

00:08:17:18 - 00:08:45:07
Miss Jai Smith
They're talking about that trans people are equated to pornography and that pornography should be criminalized. And so there's this push to criminalize pornography. And as a result, and in effect, to also criminalize trans people and criminalize those who support trans people. And so they make a point to put to point to librarians and educators who support or propagate pornography, in this case connected to trans affirmation,

00:08:45:07 - 00:08:47:04
Miss Jai Smith
as having to register as sex offenders.

00:08:47:04 - 00:08:59:18
Miss Jai Smith
So there's this real clear connection with how they're trying to actively criminalize trans people out of existence and push trans people out of services so that we are not able to get our health needs met.

00:08:59:20 - 00:09:27:05
Liz Church
It's the it's an unfortunately, it's a flashback of history in America where othering is it's coming back, but it's coming back to dangerous, right where it's going to affect on a public health scale, where you are going to see mass harm to not just the LGBTQ plus community, but associated communities, women who support, you know, other men who support the LGBTQ plus community.

00:09:27:07 - 00:09:32:15
Liz Church
Another thing that I wanted to point out, too, is that whenever they're putting these in,

00:09:32:15 - 00:09:37:13
Liz Church
for people seeing visually, I have this mandate on my screen that the screen must be,

00:09:37:13 - 00:09:38:16
Liz Church
that's why I'm just doing this way.

00:09:38:16 - 00:09:48:07
Liz Church
They they talk about the gender affirming care in a negative way. But the thing is, is that the way they map this out, it affects gender within cisgender men.

00:09:48:13 - 00:09:51:20
Liz Church
If you are seeking gender affirming care, this affects you, too.

00:09:51:21 - 00:10:12:18
Miss Jai Smith
The first thing I'll say is that I think fear is used oftentimes to manipulate us into being. We are often taught to fear the other, and fear is often used as a tool or as a tactic to manipulate us and groups of people to do specific things. And I think because we're in an election year, we're hearing a ramp up of fear tactics, really on both sides of the political spectrum.

00:10:12:18 - 00:10:41:16
Miss Jai Smith
And one thing that comes up for me around this specifically, and what I've seen from my work, is that there is this fear of gender affirming care is not well understood, is not well researched, is not clear, and that gender affirming surgeries are happening on folks who are under the age of 18. And so that's been used as a way to push this anti-trans legislation, especially for minors, but now is being used to extend that up to folks ages up to the age of 24.

00:10:41:16 - 00:10:44:12
Miss Jai Smith
So again, we're talking about adults now,

00:10:44:12 - 00:11:12:22
Miss Jai Smith
or folks who are able to legally give consent. So there's this push now to say like, oh, well, surgeries are taking place or surgeries are taking place. And the reality is, is that most surgeries and I think we talked about this on the last episode that I was on, that most surgeries that are taking place on folks under the age of 18, for the purposes of reforming genitalia are happening nonconsensual, and they're happening to intersex infants.

00:11:12:22 - 00:11:41:08
Miss Jai Smith
And actually all of the legislation that's been pushed forward that is banning gender affirming care for minors has carve outs to still continue to perform surgeries on intersex infants to form their genitalia into what would be expected of a male or female infant. And so I think it's important for us to really point out that there's a lot of there's a lot of inconsistency, and it really is rooted when we want to talk about ideology.

00:11:41:12 - 00:12:09:10
Miss Jai Smith
It's really rooted in this idea that gender can only be one immutable thing that is directly linked to a person's sex at birth and is directly related to their biology. And when their biology doesn't match, then we will make their biology match what we want their gender to be. So it really becomes clear to us that there's just this, this cognitive dissonance around understanding the diversity of gender and even like biological sex for human beings.

00:12:09:12 - 00:12:31:23
Miss Jai Smith
And I think that that's one of the reasons this becomes so challenging as a playbook. Like it's it's really being tried and tied to Trump and the Trump presidency and, and the next conservative president. But I think it's also important for us to keep in mind that this is this is clearly outlining a conservative ideology that can be used down ballot, that can be used across spaces.

00:12:31:23 - 00:13:07:01
Miss Jai Smith
And so where I wouldn't be surprised if bits and pieces of this start to get implemented in places across the country, even if it's not happening on a federal scale. And I don't say that to be to stoke fear, but I say that because I think that that means that for those of us who feel sometimes hopeless in these spaces, that there are things that we can do to prepare for ourselves and that we can do to take care of ourselves in our communities, in order to make ourselves, to help ourselves become a little bit more resilient when changes do occur or if they do occur.

00:13:07:01 - 00:13:31:17
Miss Jai Smith
And really, this is getting back to and I really want to focus this back on this is this is related to bodily autonomy. And so we've talked a lot about gender identity. But parts of this document also talk about the expectation of family structure in a home that a family structure has to return to a nuclear family, that a man and a woman need to be present as parental figures within a household.

00:13:31:17 - 00:13:54:09
Miss Jai Smith
And so we start to see this erosion of lesbian, gay, bisexual families. We start to see this erosion of fostering of same sex parents. And so, like we we know that there's like shifts that are occurring that are impacting cisgender people as well within the LGBT community as a way to push away from supporting LGBT people in general.

00:13:54:09 - 00:14:14:02
Miss Jai Smith
And you mentioned at the beginning a little bit about the discussion that you had shared on abortion and the ability to choose and all of these pieces. And I think it's important for us to again link this all back to bodily autonomy and our ability to to be self deterministic in the ways that we build our lives and the ways that we,

00:14:14:02 - 00:14:19:03
Miss Jai Smith
support that our own health and well-being and cultivate families for ourselves.

00:14:19:09 - 00:14:29:13
Miss Jai Smith
And one of the things that happens with bodily autonomy, especially around abortion, is that we're seeing that there are recommendations to reinforce the Comstock Act, act,

00:14:29:13 - 00:14:53:15
Miss Jai Smith
which is an old and obscenity law, and to prosecute providers and distributors of abortion medications via mail that we see a banning of mythic Stone. I think I'm mispronouncing that medications have wild names for Preston, which may lead to additional medication bans for other medication used for abortion, which we might also see is there's other medical like gender affirming care medications.

00:14:53:15 - 00:15:16:00
Miss Jai Smith
We might see that there are more restrictions that take place as well, to prevent folks from being able to have access to their medications. And we're, we're also seeing that states are that there's a push for states to report how many abortions are provided within their state lines, the gestational age of the fetus, reason for abortion, the mother's state of residence and the method and any complications from abortion.

00:15:16:00 - 00:15:34:06
Miss Jai Smith
And now I want to say that it makes sense to me that we would want to collect surveillance information to better understand the health and well-being of the communities that we are serving. And if we are seeing trends that, for example, we're seeing more mortality or more severe side effects or symptoms from what is occurring in our state.

00:15:34:06 - 00:15:52:04
Miss Jai Smith
Right. We want to we want to see those things so that we can address them. It is a public health model, but this is being connected specifically to abortion tourism because medical restrictions are taking place in different states. And we see the same trend happening for gender affirming care. And so what ends up happening is there's this big fear,

00:15:52:04 - 00:16:11:06
Miss Jai Smith
that, ultimately we will be trying to get our medical needs met in this case, someone might be seeking an abortion and that they will end up on a list where they're where their information is being disclosed to an entity to that will put them at further risk of the like, destabilization of employment, challenges

00:16:11:06 - 00:16:41:18
Miss Jai Smith
of legal repercussions, etc.. And I don't think that that is far fetched from reality, even though we have HIPAA laws and our medical records are supposed to remain confidential. And I say that I don't think it's far from reality because at the end of 2022, for states Tennessee, Missouri, Texas and Indiana, their attorneys general all requested health records, medical records from health centers and hospitals on folks who were receiving gender affirming care.

00:16:41:18 - 00:17:06:18
Miss Jai Smith
And though a lot of those health centers and hospitals pushed back or refused to provide that information or actively said like this is in violation of HIPAA or sued the attorney general around it, we know that Vanderbilt University Medical Center disclosed and sent over over 65,000 medical records and disclosed the identities of 82 trans and non-binary people who are receiving gender affirming care.

00:17:06:20 - 00:17:23:23
Miss Jai Smith
So we know that this is something that is not outside of the concept of reality, that there there could be very much like real world, implications to our health and well-being, our stability, our ability to continue to get our needs met and our safety as well.

00:17:24:01 - 00:17:48:01
Liz Church
And talking about this. So moving on to the next thing up, continuing the broadly impact of marginalized communities. So when we were preparing for this discussion, we were talking about how when new legislation is introduced, even if it doesn't pass, it can create confusion among health care providers and leading them to believe that they can't offer certain types of care and, you know, gender affirming care, hormone therapy, so on and so forth.

00:17:48:03 - 00:17:48:15
Liz Church
And,

00:17:48:15 - 00:17:59:01
Liz Church
despite their ability to continue to continue to do so. So can you talk about how this affects providers and their confidence in being able to provide those that care for those folks?

00:17:59:03 - 00:18:23:06
Miss Jai Smith
Yeah, absolutely. Well, the first thing I think of is that if we are constantly seeing new legislation being introduced, that saying we can or can't do something, then it becomes even more confusing to us about what we are legally required to do or restricted from doing in terms of providing care. And one of the things I think about with gender affirming care is that sometimes gender affirming care is discussed as specifically medical transition related care.

00:18:23:11 - 00:19:03:13
Miss Jai Smith
So gender affirming hormone therapy, gender affirming surgeries. But we also know that there is a lack of foundational knowledge about trans and non-binary people within health environments, with our providers, with our support staff, with our clinical care teams. And so it is also not outside of the realm of possibility that trans people will attempt to receive medical care for some other reason, such as an emergency room visit or diabetes management or what have you, and be denied care if there is a perspective and understanding or a misunderstanding that serving a trans person is providing gender affirming care.

00:19:03:15 - 00:19:06:00
Miss Jai Smith
And we see this sometimes it's called also,

00:19:06:00 - 00:19:25:19
Miss Jai Smith
trans broken arm syndrome, when trans people will come in for some sort of health condition and everything will be related back to their gender affirming hormone therapy or gender affirming surgeries. And so if we're already making this, miss connection to, well, it must be because of your hormones that this medical condition has occurred.

00:19:25:21 - 00:19:47:14
Miss Jai Smith
Then again, I don't think it's outside of the realm of possibility that a provider might be like. And I can't do anything about your gender affirming care because it's illegal within the state for me to do X, Y, or Z. So I think that there. Undermines the therapeutic relationship with our patients and our and our patient provider relationship with patients.

00:19:47:16 - 00:20:09:10
Miss Jai Smith
I think that it will make it harder for providers to engage trans and non-binary patients and retain trans and non-binary patients and care. I think it will make it will increase barriers for trans and non-binary people to get their care, because we know for a lot of trans and non-binary people, part of the incentive for care is getting access to gender affirming hormone therapy.

00:20:09:10 - 00:20:15:06
Miss Jai Smith
And so that's one of the reasons why a lot of linkage to care programs focus on,

00:20:15:06 - 00:20:16:21
Miss Jai Smith
holistic care.

00:20:16:21 - 00:20:30:21
Miss Jai Smith
Are we getting you your, your medication for, for example, for someone who might be HIV positive, are we getting you your antiretrovirals? And also, are we able to connect you with and help you monitor your hormone levels and get gender affirming hormone therapy?

00:20:31:03 - 00:20:55:09
Miss Jai Smith
So there's a lot of interconnection that happens because it helps to retain focus and care. But the reality is, if this continues to to move in the direction that it's moving, that it's going to become harder for providers to retain folks and care to engage their trans and non-binary patients. And I think you're going to see even more fear from your trans and non-binary patients around disclosing or talking about what's going on with their health.

00:20:55:09 - 00:21:28:03
Miss Jai Smith
I think you're also going to see more trans and non-binary patients who are seeking gender affirming therapies. So surgery and hormones for medical transition, specifically from places that are less reputable or that don't have as much like regulation and oversight for those services. So I wouldn't be surprised if you start if you serve trans and non-binary folks, if you started seeing folks who were getting a hormone replacement therapy from a third party sources and were taking those hormone therapies without like lab work or,

00:21:28:03 - 00:21:31:05
Miss Jai Smith
management of their hormone levels.

00:21:31:07 - 00:21:35:16
Liz Church
Gosh, it's kind of like going back into the dark ages.

00:21:35:18 - 00:21:43:06
Miss Jai Smith
Yeah. Well, and I think about it too. So it's also the way that I'm going to phrase this is,

00:21:43:06 - 00:22:05:17
Miss Jai Smith
in the way that I'm going to phrase this might come off a little trite, so stick with me. But it is also a privilege for us to be talking about what it means to lose access to these services, because there are lots of folks within the trans and non-binary community who don't have access, even when it is legal to receive gender affirming hormone therapy and gender affirming surgeries.

00:22:05:17 - 00:22:25:09
Miss Jai Smith
Often, not all trans and non-binary people are interested in medical transition. But for those who are interested in medical transition, there are lots of additional barriers to receiving that care within in the United States, including the fact that there are financial barriers to receiving health services. Lots of providers don't know how to treat us as trans and non-binary people.

00:22:25:12 - 00:22:29:01
Miss Jai Smith
And I mean treat in the medical sense, but also just treat us as human beings.

00:22:29:01 - 00:22:46:17
Miss Jai Smith
And so there's lots of ways that we are pushed out of care. And I know we focused on that during pride month, but there's lots of ways that we are pushed out of care in general. And the folks who are who experienced that disproportionately within the trans and non-binary community are black, Latina and indigenous, trans and non-binary people.

00:22:46:19 - 00:23:12:02
Miss Jai Smith
And so and folks who are also lower on the socio economic scale, folks who are in more rural areas. So we know that this is something that isn't even available to all trans and non-binary people who are looking for this kind of medical support. And so talking about it restricting or going or as you mentioned, like going back to the dark ages for some of our community.

00:23:12:02 - 00:23:22:16
Miss Jai Smith
That's where they already are. And so I think what we are seeing right now is a push back from us trying to create more avenues to,

00:23:22:16 - 00:23:36:04
Miss Jai Smith
equitable care within our community and trying to create more avenues for getting folks to a space where they are able to maximize their health potential and not just survive a system.

00:23:36:06 - 00:24:00:09
Liz Church
And this kind of goes back to when you were saying when you said privilege, I it just occurred to me that like my sibling had the privilege to be able to have access to all of these resources to support him through his journey. And I forgot for a brief moment, I really did. I forgot that the house much of a struggle it is for others and that's that's terrible to do.

00:24:00:09 - 00:24:19:08
Liz Church
I don't I don't mean to do it because I'm seeing it from my my experiences is based off of somebody else's experience who had it easy. So, you know, I'm not exposed to those stories. And I think we have a tendency to forget that, maybe people like myself, you are like in the in the shadows, on the ground.

00:24:19:10 - 00:24:24:12
Liz Church
You're doing the good stuff. So, you know, you're the superhero in the cape in this sense.

00:24:24:14 - 00:24:30:17
Miss Jai Smith
Thank you. I think sometimes this can become really heady and theoretical. And so I want to give an example,

00:24:30:17 - 00:24:34:03
Miss Jai Smith
to illustrate kind of what I'm talking about when I mean that,

00:24:34:03 - 00:24:47:21
Miss Jai Smith
that overall we're going to start seeing folks like, we're going to see the health of our community start to deteriorate because when we have lack of access to services, when we have services that don't treat us in an equitable way.

00:24:47:21 - 00:25:15:09
Miss Jai Smith
And what I mean by equitable is giving us what we need in order for us to maximize our health potential. So, yeah, you and I, for example, we might be given the exact same medication for a let's say we both have cholesterol issues. We might be given the exact same medication and that might be equality, right? We're given the exact same thing, but you might experience challenges with picking up the medication from the pharmacy.

00:25:15:11 - 00:25:36:04
Miss Jai Smith
You might have barriers to transportation. Maybe you don't have a car. Maybe the cost for your copayment is too high. Whereas I have a vehicle, I'm able to get a pharmacy. I have health insurance that allows it to be mail order, right. So even though we're given the exact same thing the way that it actually is used and,

00:25:36:04 - 00:25:42:13
Miss Jai Smith
consumed by us, or the way that it actually is going to be of service to us is different.

00:25:42:13 - 00:26:12:15
Miss Jai Smith
And so I might see my cholesterol levels go down and you might not, but the if we were both given equitable care, then it would be I'm given the, the medication in a way that I'm able to receive it. And you are given the medication in a way that you are able to receive it. So it might mean helping you get on to a program that covers the cost of the medication, and connecting with a pharmacy that's able to mail the medication to you even though you don't have a mail order pharmacy with your health insurance, if you're insured at all.

00:26:12:17 - 00:26:45:19
Miss Jai Smith
Helping get that medication prescription sent to a pharmacy that's within walking distance to you, as opposed to the hospital pharmacy. Right. So we're talking about giving folks what they need to maximize their health potential. And I, in the previous comment on how this is going to impact trans and non-binary people's care overall, I was just talking to one of my best friends two nights ago about their experience with being diagnosed with epilepsy, and they had had they were we were at a camp together,

00:26:45:19 - 00:26:51:10
Miss Jai Smith
and had been there for a few days, and they had a seizure and it was the first time they'd ever experienced a seizure, and they had to go to a

00:26:51:10 - 00:27:13:14
Miss Jai Smith
primary care physician in order to be sent to a specialist to be evaluated. And when they saw the primary care physician, without asking a question, without providing assessment, the physician said, well, you're confused about your gender. You think that you're a man and you're drinking like a man would drink, and you can't drink like that. And that's why you had a seizure.

00:27:13:16 - 00:27:27:18
Miss Jai Smith
And so then they had to go and find another physician in order to get sent to the specialist. And by that point they had had a second seizure. So it was clear that there was actually something underlying going on neurologically. And they ultimately were,

00:27:27:18 - 00:27:34:16
Miss Jai Smith
diagnosed with epilepsy. But if we have these connections, that gender identity is,

00:27:34:16 - 00:27:36:14
Miss Jai Smith
it is the pathology.

00:27:36:14 - 00:27:55:17
Miss Jai Smith
Gender identity is the issue. And all of these other things are happening because of gender identity, then we are doing a disservice to the overall health and well-being of the person. And so if we're being told we can't treat trans and non-binary people for their gender identity, then if we are a lead at relating,

00:27:55:17 - 00:28:04:04
Miss Jai Smith
seizures to gender identity, then we are not going to be able to treat that seizure in our mind, potentially because we might think to ourselves, why can't treat gender identity?

00:28:04:04 - 00:28:10:17
Miss Jai Smith
I can't treat gender dysphoria, right. So I think that this illustrates how quickly this becomes,

00:28:10:17 - 00:28:31:08
Miss Jai Smith
a challenge for providers and how convoluted it becomes when it doesn't need to be this complicated. Like, yes, gender is complicated, and the theories around these things are complicated, but serving our patients isn't actually very complicated. We just have to take a trauma informed approach to providing care and an equitable approach to care.

00:28:31:10 - 00:28:41:18
Liz Church
Amen to that. We can't close on that. But I loved that response perfectly. Said they're human. At the end of the day we can't don't

00:28:41:18 - 00:28:47:09
Liz Church
we don't need to have any questions about it. Like yes you treat humans the way you would want to be treated with care and.

00:28:47:14 - 00:29:04:19
Miss Jai Smith
Treat treat humans the way that they want to be treated because, for example, I don't lots of people mispronounce my name all the time. People mispronounce my name all the time. And it's not necessarily a big deal for me because it happens a lot and I'm in a place now in my life where I can just correct it.

00:29:04:21 - 00:29:25:20
Miss Jai Smith
But I might be seeing someone who, for the first time is going by an affirming name for them. And if I default to a legal name, for example, then that might be much more intense for them than it is for me. So I don't want to just brush it off as like, oh well, it's not a big deal for me, so it's not a big deal for them.

00:29:26:01 - 00:29:31:14
Miss Jai Smith
I want to meet that person where they're at. I want to treat people the way that they would like to be treated.

00:29:31:16 - 00:29:53:21
Liz Church
Yeah. The patient patient centered approach. Just patient first. It's absolutely. So to close this out let's talk about the fun things we can make. If they can make them fun you can throw in your hands and stuff. The actionable steps for protecting bodily autonomy. So yeah you had a beautiful way of how you put it out for I'm calling these the four pillars.

00:29:54:22 - 00:30:03:02
Liz Church
The individual level, the organizational level, community advocacy and then empowerment. Would you like to lay down each one for us?

00:30:03:04 - 00:30:31:19
Miss Jai Smith
Yes. So some of the things that I would like to well, what I would like to mention first is that when we are talking about and I'm just pulling up my note over here because I want to make sure that I'm really clear and what we're talking about. But one of the the things that often comes up when we talk about the our communities harms, right, or the the way that our community is treated or what's happening when it's larger than us, what's happening when it's federal, right?

00:30:31:21 - 00:30:57:08
Miss Jai Smith
Is there's this feeling of hopelessness. There's this this feeling of like and everything is becoming awful. Everything is becoming terrible. Everything is shifting in these ways that are going to harm me. And I think that we can hold that right. We can hold the reality of that fear and also acknowledge that we have control over the ways that we are going to move, and we have control over the ways that we are going to prepare.

00:30:57:10 - 00:31:01:21
Miss Jai Smith
So what I mean by this is really taking a,

00:31:01:21 - 00:31:19:13
Miss Jai Smith
an approach of resilience building when it comes to big news like this. Because the reality is I don't have control over what the federal government decides as an individual. I don't have control over that. I don't have control over what the elected city officials decide. I don't have control over what is happening in my state necessarily.

00:31:19:13 - 00:31:25:07
Miss Jai Smith
Right. So I have to lean into what do I have control over and what can I,

00:31:25:07 - 00:31:48:17
Miss Jai Smith
support or how can I support myself, my siblings, my family, my community? And so I hope that this section is helpful in terms of showing you that even if it is starting to feel hopeless, that there are still ways that you can you can support yourself and the people that you care about and the communities that you care about, and that we are actually a lot more resilient than we than we realize.

00:31:48:17 - 00:32:12:20
Miss Jai Smith
I was actually talking to a friend this morning about how one of the things that helped me to feel more resilient when I started doing this work in public health over a decade ago, was learning about the history of what folks had to navigate during the late 80s, early 90s, during the HIV crisis. And so so I could get a better conceptualization of like, we have worked through these things and we have made progress.

00:32:12:20 - 00:32:23:21
Miss Jai Smith
So it doesn't feel all doom and gloom. So at the individual level, there are things that we can do to protect ourselves. There are things that we can do to,

00:32:23:21 - 00:32:39:16
Miss Jai Smith
prepare as well. And so it might include identify doing health care ways that we can continue to have our health care managed and have received the health care that we deserve, and that that is dignified and is affirming.

00:32:39:20 - 00:33:06:22
Miss Jai Smith
So for gender expansive folks. And this can look like, for example, if you're living in a state that is starting to move towards anti-trans legislation or restriction of gender affirming care services, look at where's the closest county where you'd be able to potentially go and receive gender affirming care, or are there any mail order pharmacies or telehealth providers that are still working within your in your state that are able to still provide those services?

00:33:07:00 - 00:33:18:05
Miss Jai Smith
Are there any organizations locally that are advocating for gender affirming care or developing peer support spaces? So these are all individual things that we can do to start to prepare,

00:33:18:05 - 00:33:23:16
Miss Jai Smith
for how we will support ourselves if you are, if you're receiving,

00:33:23:16 - 00:33:28:22
Miss Jai Smith
medications, if you're on testosterone, or if you're on estrogen and testosterone blockers,

00:33:28:22 - 00:33:31:04
Miss Jai Smith
are you able to refill your medications,

00:33:31:04 - 00:33:36:00
Miss Jai Smith
as early as possible so that you can have sort of a little stockpile for yourself?

00:33:36:02 - 00:33:41:10
Miss Jai Smith
I and I actually recommend this for all medications for folks. Really. I receive medication

00:33:41:10 - 00:33:58:12
Miss Jai Smith
like a daily medication that's a 30 day. And at day 25 I can refill it. So every month, a day 25, I refill it until I have about a 60 to 90 day supply. So that way if something happens, if my insurance and if I can't afford to fill my medication, if,

00:33:58:12 - 00:34:12:07
Miss Jai Smith
policy changes and there's an issue with getting my prescription from the pharmacy because it needs like a new authorization from my doctor or something, or if even just like, as a medication, like a lack of medication manufactured.

00:34:12:07 - 00:34:32:19
Miss Jai Smith
And so they're pharmacies all over the country are having challenges getting the medication that I'm not potentially breaking my cycle. I'm not I'm not missing out on my medication. And so I recommend that really any medication, because our system is set up in such a way that it can be very difficult when we do have those breaks and medication to restart or to get back on it quickly.

00:34:32:23 - 00:34:58:17
Miss Jai Smith
And that's a lot of additional stress and worry and fear and anxiety on ourselves. So where we can prepare ourselves is to develop, is to start now with that process so that you have a little bit of a stockpile in case something does happen. Like I have 90 days of my medication right now, and I'm about to get a refill because I know that if something were to happen, about three months would be enough time for me to find a new pharmacy, a new physician,

00:34:58:17 - 00:35:07:11
Miss Jai Smith
to find a mail order pharmacy, etc. so those are some of the ways that we can prepare for ourselves and take care of ourselves at the individual level.

00:35:07:13 - 00:35:17:01
Miss Jai Smith
At the organizational level, it gets tricky. Lots of organizations are, well, some health care organizations do lobby,

00:35:17:01 - 00:35:38:06
Miss Jai Smith
some for profit health care organizations do lobby lots of nonprofit agencies. Part of receiving the funding means that they are not eligible for lobbying, and that if they are lobbying, they can lose federal and state funding. And so it's identifying like where is what is our scope and how are you the experts and providing resources and information around that expertise.

00:35:38:08 - 00:35:46:01
Miss Jai Smith
So for example, you might advocate for policies within the workplace that maintain protections regardless of federal role

00:35:46:01 - 00:35:59:03
Miss Jai Smith
rollbacks. So we mentioned before that there's this push to remove sogi from sexual orientation, gender identity from federal regulations, from nondiscrimination policies to no longer connected to title seven.

00:35:59:03 - 00:36:05:03
Miss Jai Smith
With those talk versus Clayton County. So as an organization, you can advocate to include those,

00:36:05:03 - 00:36:08:18
Miss Jai Smith
sexual orientation and gender identity as part of your nondiscrimination policy.

00:36:08:20 - 00:36:41:14
Miss Jai Smith
You can work internally to develop policies that support trans and non-binary people in being hired and retained as talent in transitioning on the way in the workplace and being supported in the workplace, and being referred to by the name pronouns that they go by. These are all things you can do within your organization. If you're an organization that works in public health or health care, you can also do things like write research briefs and and provide white papers on things like abortion and gender affirming care, and the health and well-being of the sexual orientation and gender,

00:36:41:14 - 00:36:42:13
Miss Jai Smith
gender minorities.

00:36:42:13 - 00:37:06:19
Miss Jai Smith
Right. So there's ways that you can still use your expertise to then support the folks who are eligible to do lobbying. And really, that is your expertise, right? So if I'm working at an HIV organization, which I have have in the past, I'm working at an HIV community based organization, and our goals are to prevent HIV, prevent hepatitis C and prevent substance use and all these other things.

00:37:06:19 - 00:37:21:03
Miss Jai Smith
As a public health agency, then we might release a white paper talking about what the research shows around the these experiences for gender expansive communities and some of the facilitators to care having affirming providers, having an organization,

00:37:21:03 - 00:37:31:04
Miss Jai Smith
medical provider that provides both substance use treatment services as well as gender affirming care. So these are ways that we can use our expertise.

00:37:31:06 - 00:37:49:23
Miss Jai Smith
Not in a lobbying sense, but to provide information out to our communities that is reputable and credible, and that they are able to then institute in their own organizations, which really gets us into the the next level, which is the community, community advocacy. So doing things like supporting state level legislation that can buffer against those federal changes.

00:37:49:23 - 00:37:53:05
Miss Jai Smith
So doing things like codifying protections into state law,

00:37:53:05 - 00:38:01:01
Miss Jai Smith
there's also discussion about rolling back same sex marriage. And so like that has raised a lot of red flags for LGBT couples.

00:38:01:01 - 00:38:10:22
Miss Jai Smith
And queer folks in general as well. It should. But if that is being talked about rolled back in a federal way, then the default would be to state levels again.

00:38:10:22 - 00:38:27:09
Miss Jai Smith
And we saw this with Roe v Wade. Right. So we know that it's not outside of the realm of possibility, especially because we know that over felt is less. It has not been around as long as Roe v Wade was for example. So we know that this is not outside of the realm of possibility. So what can we do as an,

00:38:27:09 - 00:38:34:14
Miss Jai Smith
a community advocacy agency or as an individual to advocate at the community level for codification into law?

00:38:34:14 - 00:38:35:17
Miss Jai Smith
So, for example,

00:38:35:17 - 00:39:02:07
Miss Jai Smith
I currently live in Colorado, and there's now a push and an initiative to codify same sex marriage into law, because when it was in the process of being voted on, the federal ruling came out. And so suddenly every state had same sex marriage. And so as a result, that never got passed. So if it were if that were to get overturned at the federal level, there wouldn't be same sex marriage protections or options in Colorado.

00:39:02:07 - 00:39:33:02
Miss Jai Smith
So it's identifying where we can kind of get ahead or prepare again for if this changes, we are still protected. And then in terms of this like fourth thing, which is the more nebulous empowerment, right? We still have control over our own bodies, even when we are being told we don't have control over our own bodies. So we still individuals and organizations have control over certain aspects of your act of advocacy, and we have control over ourselves.

00:39:33:04 - 00:39:54:21
Miss Jai Smith
And I mentioned earlier, like what privilege looks like in this as well, part of what we are taught. And part of the reason why some of this feels hopeless is because we're taught to work separate from one another, that our needs are not the same. The needs of abortion rights activists are not the same as the needs of gender affirming care activists, for example, and not even activists, but like folks who support,

00:39:54:21 - 00:39:56:02
Miss Jai Smith
our pro-choice.

00:39:56:02 - 00:40:22:01
Miss Jai Smith
Those needs are not the same as those who support gender affirming care. But the reality is, because these are all about bodily autonomy and our ability to receive the medical care that we deserve and health and wellness that is in connection with the professionals that we hire to support us. With that right, medical professionals that actually we have a lot more in common than than we have dissimilar.

00:40:22:01 - 00:40:40:02
Miss Jai Smith
And the other reality is that our communities also overlap. There are trans and non-binary people who are in need of reproductive health services, and that might be abortion services. It also might be family planning services and contraception and a fertility services,

00:40:40:02 - 00:40:44:01
Miss Jai Smith
etc., etc.. Right. So there's overlap. There are cisgender,

00:40:44:01 - 00:40:47:19
Miss Jai Smith
women who are able to conceive who are also doing,

00:40:47:19 - 00:40:56:06
Miss Jai Smith
pro-choice work, who may also need access to gender affirming care, like gender affirming surgeries or hormone replacement therapy.

00:40:56:08 - 00:41:10:07
Miss Jai Smith
So there is there's more similar than there is dissimilar from one another. And I think what we can do in terms of this empowerment piece is figure out where our similarities lie, so we can focus on,

00:41:10:07 - 00:41:26:10
Miss Jai Smith
community mobilization and how we can stand together to support across our community. Because the resources that I have in the work that I do are going to help fill the gaps in resources that other communities have and vice versa.

00:41:26:12 - 00:41:57:05
Miss Jai Smith
And the ways that we we do that is by coming together and again, recognizing those similarities and those commonalities. And one thing I really like to lean on is the parable of the choir. When I'm doing any of this work, because we can feel so isolated and so siloed so frequently. But the parable of the choir is that a choir can sustain a need for however long you need it to be sustained, because individual voices might drop out to take breaths and then come back in, or they might become fatigued and they might need a short rest and then come back in.

00:41:57:09 - 00:42:27:15
Miss Jai Smith
But the choir as a whole can maintain that note for as long as possible. And so I like to remind myself and remind other members of my community that when we lean on one another, that's us taking those breaths. It's us helping to support one another so that when we are, when we need to drop out and catch our breath and reset and refocus and center and take care of our mental health or our physical well-being, then we're able to reenter.

00:42:27:15 - 00:42:56:13
Miss Jai Smith
When we are, when we are prepared and we are in a more grounded and stable state. And so I think the what I hope to leave folks with is that even when these things are occurring, even when we are experiencing like these really intense pushes, and even when we're being taught the fear aspect of it, to remember that, like, we still have a lot of control over what we can do and that we are not doing this work alone, and we are not caring for our communities or our patients alone.

00:42:56:15 - 00:43:14:17
Liz Church
That's a beautiful way to end it. I love that I say that a lot with a lot of these things, but that was beautifully put. Thank you so much, miss Jai, for coming and speaking to me with me about this. It's hard to talk about these things, but that last note, I do hope as well that this gives everybody that empowered push.

00:43:14:17 - 00:43:19:01
Liz Church
Like we can do this, we can get through this. So yeah.

00:43:19:03 - 00:43:33:09
Miss Jai Smith
I believe in us. Thank you for having me. Listen for for highlighting these pieces. I it's been in the it's been in the news a lot and I there's a lot of concern around it. But I really appreciate it. And tying in the broader picture of how this is related to our bodily autonomy and what we deserve.