Access and perspectives of gender affirming voice care in Aotearoa New Zealand

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Background Trans and gender diverse individuals often describe incongruence between their gender identity and voice. In Aotearoa/New Zealand, few individuals receive gender affirming voice care. This paper explored access and perspectives of gender affirming voice care in Aotearoa.Methods This study consisted of two data sources: (1) semi-structured interviews with 10 individuals who had previously received voice therapy, 7 speech therapists, 1 voice coach and 1 psychologist, all of whom had provided voice therapy and (2) a document analysis of online resources currently available in Aotearoa regarding gender affirming voice care. Interviews were analyzed using thematic analysis. Internet searches were conducted and evaluated for accessibility, credibility, readability, content and relevance.Results Five themes described experiences: societal visibility, occupational barriers, cultural intersectionality, therapeutic competence and education, and barriers to best care. There were mixed experiences of access, cost, success and satisfaction. Service users regularly paid for therapy and sought multiple therapists. Professionals were frustrated by service inequity as well as the lack of training. 52 resources were retrieved. Most online resources were not developed in Aotearoa (92%). Discussion forums were prevalent (23%) as well as international professional generated education materials (50%) and service user generated advice videos (17%).Conclusions Services for people seeking gender affirming voice care in Aotearoa are disjointed. Further work is required to solve systemic organizational barriers of inequity and to support access to evidence-based, culturally relevant, best practice. Development of national-level competency frameworks for speech-language therapists and local-level resources for those seeking care are needed.

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