Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Gender, Sexuality & Women’s Studies

Supervisor

Knabe, Susan

Abstract

This dissertation explores the systemic challenges faced by trans and gender-diverse (TGD) individuals navigating institutional pathways of care, with a specific focus on gender-affirming care in New Brunswick (NB), Canada. Employing institutional ethnography (IE) as a methodological framework, this work investigates the care landscape shaped by administrative policies, geographic barriers, and institutional failures that impact TGD individuals' access to affirming healthcare. This study also highlights the importance of examining how social determinants of health intersect with gender identity to affect healthcare outcomes for TGD individuals. The closure of Clinic 554 is used as a central case study to highlight the gaps in formal care services and the resulting care deserts created in NB, emphasizing the significance of geographies of care in determining accessibility and quality. Furthermore, I examine the historical trajectory of trans medicine, the evolution of trans medical ethics, and how dominant medical narratives have shaped the treatment of TGD individuals. It also addresses the emergence of community-driven care models, including mutual aid networks, as a response to the failures of institutional systems. The "Code of Ethics and Community Guidelines for Trans Mutual Aid Group NB" exemplifies how alternative care systems are developed, emphasizing principles like inclusivity, consent, and community accountability. This grassroots mobilization, based on radical care practices, aims to dismantle oppressive systems and foster affective solidarity and collective well-being. By centring community knowledge and experiences, this work emphasizes the value of lived expertise in shaping effective and responsive care models. The findings reveal that TGD individuals and care providers encounter persistent systemic barriers, ranging from the undertraining of providers to the administrative violence embedded in institutional practices. These challenges necessitate reimagining care that centers marginalized communities' needs and experiences and goes beyond institutional structures. Overall, the dissertation contributes to the emerging discourse on transfeminist care ethics, advocating for an ethos of trans care that emphasizes relationality, interdependence, and community-led initiatives. By grounding care in transfeminist ethics, this work aims to build a future where care is accessible, just, and rooted in solidarity and mutual flourishing for all TGD individuals.

Summary for Lay Audience

Trans and gender-diverse (TGD) individuals in New Brunswick face significant challenges accessing healthcare. The system often prioritizes cisgender experiences, negatively affecting both TGD individuals seeking care and providers trying to support them. This study uses a transfeminist care ethics approach to show that these barriers are rooted in societal biases that view TGD identities as less valid. Transfeminist care ethics focuses on relational, community-based care, advocating for affirming, inclusive practices that meet TGD individuals' unique needs. Using a community-centred approach to institutional ethnography, this research examines the policies, texts, and processes that shape and limit gender-affirming care. Interviews with care providers and TGD individuals reveal two main influences: institutional policies and community support. Providers often feel restricted by strict protocols and lack of training, leading to inconsistent care. Meanwhile, TGD individuals rely heavily on community-led mutual aid networks, especially after the closure of Clinic 554, a critical gender-affirming care provider. These grassroots networks embody transfeminist care ethics by providing adaptive, relationship-based support, emphasizing mutual aid, resource-sharing, and advocacy—elements often missing in institutional care settings. Mutual aid efforts, such as those by the Trans Mutual Aid Group NB, illustrate transfeminist care ethics in practice by coordinating hormone sharing and offering a buddy system for medical appointments. Health abolition, discussed in the study, involves rejecting harmful institutional structures that fail TGD individuals. Health abolition aligns with transfeminist care ethics by focusing on dismantling oppressive systems and envisioning alternative community support. Aftercare plays a key role by providing ongoing support after institutional care failures, highlighting community-based support for TGD individuals facing systemic neglect. Through transfeminist care ethics, this study reframes care as a relational practice centring TGD voices and community strengths. Findings suggest that care providers need continuous education to recognize and overcome biases, fostering an approach that values community-based, collective care. The research envisions a more inclusive model that meets TGD individuals' diverse needs by combining institutional reform with community-led solutions. Institutional policies must adapt to support TGD-inclusive care, while community networks continue to provide crucial aftercare and mutual aid, ensuring affirming and accessible care.

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Available for download on Sunday, February 28, 2027

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