UC Merced

Background: Research on transgender people's health, particularly in reproductive health, has expanded exponentially over the past decades. However, previous studies frequently highlight perceived inaccessibility and gender-exclusivity of reproductive and perinatal care for transgender people. Objective: This observational study used a cross-sectional content analysis to examine online obstetrics, labor and delivery, and pregnancy-related materials from a purposive sample of 178 online hospital resources across the United States to understand the extent to which they use gender-inclusive and gender-exclusive language, imagery, and other inclusive symbolism. Methods: Two hundred US hospitals were purposively selected from the most populous cities in each state; 22 (11%) lacking obstetrics pages were excluded, yielding 178 (89%) hospitals across all 50 states. Four coders assessed obstetrics websites (from October 2025 to December 2025) for transgender-specific resources, inclusive language, second-person language, exclusive language, inclusive imagery, and inclusive symbols or statements. Hospitals were categorized by US Census region, transgender-specific legal protections, and university or religious affiliation. Results: Across the United States, the presence of gender-inclusive elements was relatively rare, while most hospitals consistently used second-person or gender-exclusive elements. These patterns persisted across geographic regions, university affiliations, religious affiliations, and variation in state-level, transgender-specific legal protections, although hospitals in states with stronger protections and university-affiliated institutions showed somewhat higher rates of inclusive content. Importantly, even on websites that included gender-inclusive language, such content co-occurred with gender-exclusive terms, raising questions about how transgender and gender-diverse patients might interpret these mixed signals when deciding where to seek care. Conclusions: These findings underscore the need for hospitals to develop clear, service-specific standards for gender-inclusive obstetric communication and to ensure that online materials visibly and consistently signal their readiness to care for transgender and gender-diverse patients across the perinatal period.