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Association Between Gender Affirmation and Adoption Interest Among a Large Sample of Transgender, Nonbinary, and
Adedotun Ogunbajo1, Teresa DeAtley1, Aaron Breslow1
1Adedotun Ogunbajo is with the RAND Corporation, Santa Monica, CA. Teresa DeAtley is with the University of Utah School of Medicine, Salt Lake City. Aaron Breslow was with the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, at the time of the study. Kristi Gamarel is with the Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor. Don Operario is with the Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA. Trace Kershaw is with the Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT. Rebecca L. Emery Tavernier is with the Weitzman Institute, Moses/Weitzman Healthcare System, Middletown, CT. Arjee Javellana Restar was with the Departments of Epidemiology and Health Systems and Population Health, University of Washington School of Public Health, Seattle, at the time of the study.
Abstract:
Objectives. To investigate the association between gender affirmation and interest in adoption among transgender, nonbinary, and gender-diverse adults. Methods. We analyzed data from the Washington Priority Assessment in Trans Health Project, which was conducted in Washington State in 2023. We controlled for sociodemographic characteristics and health care indicators using multinomial logistic regression. Results. Of the 788 participants, 56% expressed interest in adoption, 24% were undecided or maybe interested, and 20% reported no interest. Participants who expressed interest in adoption were more likely to have updated their legal name documentation (adjusted odds ratio [AOR] = 4.7; 95% confidence interval [CI] = 2.73, 8.08), were more likely to have private insurance (AOR = 11.01; 95% CI = 2.89, 42.02), and were less likely to have food insecurity (AOR = 0.46; 95% CI = 0.20, 0.82). Participants who were undecided about adoption reported higher rates of legal gender affirmation (AOR = 1.59; 95% CI = 1.04, 2.42), educational attainment (AOR = 3.77; 95% CI = 1.19, 11.91), and internalized transphobia (AOR = 1.53; 95% CI = 1.01, 2.34). Conclusions. Legal gender affirmation and health care access were associated with adoption interest and were significantly influenced by economic stability and psychological factors. Comprehensive initiatives are needed to develop more trans-inclusive family-planning services. (Am J Public Health. 2026;116(2):229-239. https://doi.org/10.2105/AJPH.2025.308312).
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