Navigating Reproductive Health Across Diverse Gender Identities: Structural and Emotional Challenges Explored through Participatory Action Approach

Introduction: Reproductive health needs and parenthood aspirations remain insufficiently explored among individuals facing fertility-impacting conditions such as trans* populations. Traditional standardized measures often fail to capture the emotional, structural, and socio-legal barriers experienced by marginalized groups. Participatory Action Research (PAR) provides a community-based approach that emphasizes collaboration and empowerment, ensuring that participants’ voices directly inform scientific inquiry, clinical practice, and policy. Purpose: This study aims to investigate reproductive health experiences across diverse gender identities and fertility-impacting conditions in Italy, with a focus on trans* participants. Objectives include identifying barriers and unmet needs, co-constructing new narratives on parenthood, and producing participant-driven recommendations to improve reproductive healthcare and policy. Method: A PAR methodology was implemented in collaboration with an Advisory Committee (ACM) composed of LGBTQ+ community leaders, health professionals, and organization workers. Participants aged 18–49 were recruited via social media, reproductive clinics, university networks, and LGBTQ+ associations. Data collection involved focus groups guided by semi-structured questions and collaborative activities. Sessions included three phases: (1) open-ended reflection on reproductive experiences, (2) co-construction of group concept maps to visualize decision-making factors, and (3) consensus-building to generate community-informed materials, including recommendations for healthcare professionals, educational resources, and advocacy tools. Data (transcripts, concept maps, artifacts, and researcher/ACM notes) was analyzed through inductive Thematic Analysis using NVivo. Results: Findings provided in-depth qualitative insights capturing individual complexity of navigating parenthood desire across diverse gender identities and fertility-impacting conditions. Moreover, structural and emotional barriers specific to trans* participants have been identified—such as medical gatekeeping, misgendering by providers, and lack of tailored reproductive information. Conclusions: PAR methodology fostered empowerment, enhancing participants’ agency in reproductive decision-making and strengthening community connections. Results inform inclusive reproductive health services, psychological practices, and policies, promoting equitable access to parenthood for marginalized populations.