Stu Marvel

Bio: Stu Marvel is an academic researcher from University of Leeds. The author has contributed to research in topics: Service provider & Queer. The author has an hindex of 5, co-authored 10 publications receiving 152 citations. Previous affiliations of Stu Marvel include Emory University & York University.

Trans people's experiences with assisted reproduction services: a qualitative study

Abstract: Study question What are the experiences of trans persons (i.e. those whose gender identity does not match the gender assigned to them at birth) who sought or accessed assisted reproduction (AR) services in Ontario, Canada, between 2007 and 2010? Summary answer The majority of trans persons report negative experiences with AR service providers. What is known already Apart from research examining desire to have children among trans people, most of the literature on this topic has debated the ethics of assisting trans persons to become parents. To-date, all of the published research concerning trans persons' experiences with AR services is solely from the perspective of service providers; no studies have examined the experiences of trans people themselves. Study design, size, duration Secondary qualitative research study of data from nine trans-identified people and their partners (total n = 11) collected as part of a community-based study of access to AR services for sexual and gender minority people between 2010 and 2012. Participants/materials, setting, methods Trans-identified volunteers (and their partners, when applicable) who had used or attempted to access AR services since 2007 from across Ontario, Canada, participated in a 60-90 minute, semi-structured qualitative interview. Qualitative analysis was performed using a descriptive phenomenological approach. Emerging themes were continually checked against the data as part of an iterative process. Main results and the role of chance The data highlight barriers to accessing AR services for trans people. Participant recommendations for improving AR service provision to better meet the needs of this population are presented. These recommendations address the following areas: (i) AR service provider education and training; (ii) service provider and clinic practices and (iii) clinic environment. Limitations, reasons for caution The majority of study participants were trans people who identified as men and who resided in major urban areas; those living in smaller communities may have different experiences that were not adequately captured in this analysis. Wider implications of the findings While existing literature debates the ethics of assisting trans people to become parents through the use of AR, our study demonstrates that they are already accessing or attempting to access these services. This reality necessitates a shift toward exploring the ways in which AR services can be improved to better meet the needs of this population, from the perspectives of both service users and service providers. Study funding/competing interests This project was supported by the Canadian Institutes of Health Research-Institute of Gender and Health, in partnership with the Assisted Human Reproduction Canada: Catalyst Grant: Psychosocial Issues Associated with Assisted Human Reproduction (FRN-103595). S.M. was supported by a Canada Graduate Scholarship from the Social Science and Humanities Research Council, as well as research funding from Osgoode Hall Law School, York University. S.J.-A. was supported by an Ontario Graduate Scholarship funded by the Province of Ontario and the University of Toronto. Trial registration number N/A.

Sexual and gender minority peoples' recommendations for assisted human reproduction services.

Abstract: Objective To determine what recommendations lesbian, gay, bisexual, trans, and queer (LGBTQ) people have for provision of assisted human reproduction (AHR) services to their communities. Methods Using a semi-structured guide, we interviewed a purposeful sample of 66 LGBTQ-identified individuals from across the province of Ontario who had used or had considered using AHR services since 2007. Results Participants were predominately cisgender (non-trans), white, same-sex partnered, urban women with relatively high levels of education and income. Participants made recommendations for changes to the following aspects of AHR service provision: (1) access to LGBTQ-relevant information, (2) adoption of patient-centred practices by AHR service providers, (3) training and education of service providers regarding LGBTQ issues and needs, (4) increased visibility of LGBTQ people in clinic environments, and (5) attention to service gaps of particular concern to LGBTQ people. Conclusion Many of the recommendations made by study participants show how patient-centred models may address inequities in service delivery for LGBTQ people and for other patients who may have particular AHR service needs. Our results suggest that service providers need education to enact these patient-centred practices and to deliver equitable care to LGBTQ patients.

The Evolution of Plural Parentage: Applying Vulnerability Theory to Polygamy and Same-Sex Marriage

Abstract: Much of the legal debate surrounding the challenge to “traditional” heterosexual marriage has involved questions of liberty, discrimination, and equal treatment. Similar moves have now been made by advocates for polygamous marriage, indicating that polygamous families may be on track to follow in the rainbow contrails of same-sex marriage. This Article argues that such an evolution is indeed likely, but for different reasons than commonly held. Instead, it applies the emerging paradigm of vulnerability theory to a recent suite of polygamy and same-sex marriage rulings, with particular focus on the figure of the “vulnerable” child. At the same time, this Article will also consider the legal and social consequences of the mechanics of reproduction within both same-sex and polygamous families. It will ask what the lessons of same-sex parents using assisted reproductive technology (ART) might offer in thinking through the future of polygamy. Plural forms of parentage indicate that we are in a period of marriage evolution, wherein multiple adult caregivers may have a potential claim on the right to parent a given child. These contemporary struggles are already transforming the legal landscape in other countries. The vulnerability analysis will shed light on why it is only a matter of time before they also shift the two-parent mode of care taking in the United States, given the overlapping vulnerabilities of dependent children, the state, and the institution of marriage itself.

The Evolution of Plural Parentage: Applying Vulnerability Theory to Polygamy and Same-Sex Marriage

Abstract: Much of the legal debate surrounding the challenge to “traditional” heterosexual marriage has involved questions of liberty, discrimination, and equal treatment. Similar moves have now been made by advocates for polygamous marriage, indicating that polygamous families may be on track to follow in the rainbow contrails of same-sex marriage. This Article argues that such an evolution is indeed likely, but for different reasons than commonly held. Instead, it applies the emerging paradigm of vulnerability theory to a recent suite of polygamy and same-sex marriage rulings, with particular focus on the figure of the “vulnerable” child. At the same time, this Article will also consider the legal and social consequences of the mechanics of reproduction within both same-sex and polygamous families. It will ask what the lessons of same-sex parents using assisted reproductive technology (ART) might offer in thinking through the future of polygamy. Plural forms of parentage indicate that we are in a period of marriage evolution, wherein multiple adult caregivers may have a potential claim on the right to parent a given child. These contemporary struggles are already transforming the legal landscape in other countries. The vulnerability analysis will shed light on why it is only a matter of time before they also shift the two-parent mode of caretaking in the United States, given the overlapping vulnerabilities of dependent children, the state, and the institution of marriage itself.

Listening to LGBTQ People on Assisted Human Reproduction: Access to Reproductive Material, Services, and Facilities

Abstract: This chapter aims to demonstrate a series of issues faced by lesbian, gay, bisexual, trans and queer [LGBTQ] people seeking assisted human reproduction [AHR] services. We write this as members of a qualitative, community-based study that has aimed to shed light on the experiences of LGBTQ people in Ontario, Canada who have used or have considered using AHR services to have biologically related children. In line with community-based research principles, this study was guided by an advisory committee of AHR service providers and service users. In total, sixty-six LGBTQ people from across Ontario were interviewed about their experiences with AHR services. Representing to our knowledge the largest project of its kind, this pilot study was conducted collaboratively by researchers at the Centre for Addiction and Mental Health, the Sherbourne Health Centre, and Osgoode Hall Law School.Based on this research, we point out the gaps and limitations in the current regulatory framework and offer suggestions to ensure a more equitable access and utilization of AHR services by LGBTQ people in Canada. The chapter draws upon data from the “Creating Our Families” study to demonstrate how reproductive policy affects LGBTQ people in distinctive ways. Although there are other areas of law that impact how LGBTQ people access and use AHR services, this chapter takes up the pressing consideration of access to reproductive materials, services, and facilities. Our research shows that questions of access pose unique challenges for LGBTQ people accessing AHR, few of which have been addressed within Canadian case law or legislation. In highlighting these areas of inequality and differential access to reproductive assistance and materials, we hope to encourage future developments in AHR legislation to take into account the specific concerns of LGBTQ parents and parents-to-be.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Abstract: Abstract Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

Transgender men's experiences of fertility preservation: a qualitative study

Abstract: Study question How do transgender men experience fertility preservation (FP) by cryopreservation of oocytes? Summary answer The procedures required prior to oocyte cryopreservation, such as hormonal ovarian stimulation and transvaginal ultrasound (TVS), have a negative impact on gender dysphoria as they are closely linked to the men's female assigned sex at birth, which is incompatible with their current status. What is known already Transgender persons often have high dissatisfaction with assigned sex-specific body features, such as the genital organs and androgen/oestrogen-responsive features. Thus, undergoing FP that requires genital-specific examinations, aimed at obtaining oocytes to cryopreserve, could be distressing. As no previous studies have investigated transgender men's experiences of FP involving cryopreservation of oocytes, little is known about their experience of the procedures. Study design, size, duration This is a prospective study among adult transgender men referred for FP between March 2014 and December 2015. Individual in-depth qualitative interviews were conducted shortly after FP treatment. The interviews lasted between 62 and 111 min (mean 81 min) and were digitally recorded and transcribed verbatim. Participants/materials, setting, methods Participants were recruited on their first visit to the assisted reproduction clinic for reproductive counseling. There were 15 men, scheduled for FP, who chose to participate in the study (age 19-35); none had given birth and eight had a partner. Data were analyzed by thematic content analysis. Main results and the role of chance The analysis resulted in three main categories: the journey to FP, reactions to the FP proceedings and strategies for coping. The referral for FP was an important part of the assessment and diagnosis and sometimes lined with frustrating waits and doubts. The reaction to the FP proceedings revealed that the genital examinations and the physical changes associated with discontinuation of testosterone or hormonal stimulation treatment triggered gender incongruence and dysphoria. However, for some, the negative expectations were not met. The participants used several coping strategies in order to manage the procedure, such as focusing on their reasons for undergoing FP, reaching out to friends and family for support and the cognitive approaches of not hating their body or using non-gendered names for their body parts. The results demonstrate the importance of contextual sensitivity during FP procedures. Limitations, reasons for caution The authors have strived to be reflective about their pre-understanding of the phenomenon. The majority of the participants resided in large urban areas; it is possible that transgender men living in rural areas have different experiences. Wider implications of the findings As the results are based on qualitative data from 15 transgender men, the results cannot readily be generalized to larger populations. However, the results are suggested to be applicable to other transgender men who want to undergo FP by cryopreservation of oocytes. The results show that transgender men's experience of FP places may elicit gender incongruence and gender dysphoria. However, health care personnel can alleviate distress by using a gender-neutral language and the preferred pronoun. Also, reassuringly, the men also have coping strategies of how to handle the situation. This knowledge is important to ensure adequate professional support for patients with gender dysphoria during FP. Study funding/competing interests Swedish Society of Medicine, Stockholm County Council and Karolinska Institutet (to K.A.R.-W.). Trial registration number N/A.

Trans people's experiences with assisted reproduction services: a qualitative study

Abstract: Study question What are the experiences of trans persons (i.e. those whose gender identity does not match the gender assigned to them at birth) who sought or accessed assisted reproduction (AR) services in Ontario, Canada, between 2007 and 2010? Summary answer The majority of trans persons report negative experiences with AR service providers. What is known already Apart from research examining desire to have children among trans people, most of the literature on this topic has debated the ethics of assisting trans persons to become parents. To-date, all of the published research concerning trans persons' experiences with AR services is solely from the perspective of service providers; no studies have examined the experiences of trans people themselves. Study design, size, duration Secondary qualitative research study of data from nine trans-identified people and their partners (total n = 11) collected as part of a community-based study of access to AR services for sexual and gender minority people between 2010 and 2012. Participants/materials, setting, methods Trans-identified volunteers (and their partners, when applicable) who had used or attempted to access AR services since 2007 from across Ontario, Canada, participated in a 60-90 minute, semi-structured qualitative interview. Qualitative analysis was performed using a descriptive phenomenological approach. Emerging themes were continually checked against the data as part of an iterative process. Main results and the role of chance The data highlight barriers to accessing AR services for trans people. Participant recommendations for improving AR service provision to better meet the needs of this population are presented. These recommendations address the following areas: (i) AR service provider education and training; (ii) service provider and clinic practices and (iii) clinic environment. Limitations, reasons for caution The majority of study participants were trans people who identified as men and who resided in major urban areas; those living in smaller communities may have different experiences that were not adequately captured in this analysis. Wider implications of the findings While existing literature debates the ethics of assisting trans people to become parents through the use of AR, our study demonstrates that they are already accessing or attempting to access these services. This reality necessitates a shift toward exploring the ways in which AR services can be improved to better meet the needs of this population, from the perspectives of both service users and service providers. Study funding/competing interests This project was supported by the Canadian Institutes of Health Research-Institute of Gender and Health, in partnership with the Assisted Human Reproduction Canada: Catalyst Grant: Psychosocial Issues Associated with Assisted Human Reproduction (FRN-103595). S.M. was supported by a Canada Graduate Scholarship from the Social Science and Humanities Research Council, as well as research funding from Osgoode Hall Law School, York University. S.J.-A. was supported by an Ontario Graduate Scholarship funded by the Province of Ontario and the University of Toronto. Trial registration number N/A.

Determining Legal Parentage: Between Family Law and Contract Law

Abstract: The last few decades have witnessed dramatic changes affecting the institutions of family and parenthood. If, in the past, the classic family was defined sociologically as a pair of heterosexual parents living together under one roof along with their children, different sociological changes have led to a rapid and extreme transformation in the definitions of family, marital relations, parenthood, and the relationship between parents and children. Dr Yehezkel Margalit explores whether and to what extent there is room, legally and ethically, for the use of modern contractual devices and doctrines to privately regulate the establishment of legal parentage. This book offers intentional parenthood as the most appropriate and flexible normative doctrine for resolving the dilemmas which have surfaced in the field of determining legal parentage. By using the certainty of contract law, determining the legal status of parenthood will be seen as the best method to sort out ambiguities and assure both parental and children rights.