March 5, 2026

Human Rights in Contemporary Societies

Cecilia MacDowell Santos e Rita Alcaire

In 2018, the Portuguese Parliament approved Law no. 38/2018, commonly referred to as the Gender Self-Determination Law. This legal reform allowed individuals to change their legal gender and first name in official documents without undergoing a psychiatric evaluation, a clinical diagnosis, or mandatory bodily modifications. While this represented an essential step toward the legal recognition of gender diversity and the depathologization of trans identities, it did not dismantle the structural and symbolic barriers that continue to affect transgender people's access to reproductive health. Despite this legislative change, many trans people in Portugal still face what can be described as reproductive oppression, expressed in the form of symbolic sterilization, exclusion from reproductive care services, and a lack of recognition of their reproductive health needs. In this context, legal recognition does not guarantee reproductive autonomy or access to affirming, competent, and inclusive healthcare. Building on this critical understanding, this thesis asks: What institutional, professional, and personal narratives emerge regarding trans people's reproductive health needs and rights in Portugal following the implementation of the Gender Self-Determination Law? Anchored in a transfeminist constructionist research philosophy and grounded in the political frameworks of Reproductive Justice and Transfeminism, through an intersectional analysis, this research examines how access to reproductive healthcare is shaped by the existing discourses on transgender people's reproductive health in the country since the Gender Self-Determination Law. The study seeks to understand the lived and symbolic dimensions of reproductive health access and autonomy, as well as the norms and institutional practices that continue to govern reproductive healthcare services for trans individuals in Portugal. I argue that a medico-legal paradigm persists in shaping trans people's access to reproductive health, reinforcing cisnormative and gender binary frameworks that often render trans reproductive healthcare needs unintelligible or invalid. This thesis employs a qualitative and multi-method research design composed of three interrelated components. First, I undertook an analysis of the regulatory framework for healthcare legislation, medical guidelines, and public policy documents related to gender identity and reproduction. This analysis covers the period between 2018 and early 2024, marking the end of field research, but also includes key historical legislations and policy developments prior to 2018 that remain foundational for understanding the regulatory landscape of reproductive health in Portugal. Second, I conducted semi-structured interviews with healthcare professionals who interacted with trans patients. These interviews offer insight into the practices that shape institutional responses to transgender reproductive health. Third, and most importantly, through Photovoice, an arts-based participatory method, transgender participants narrated their experiences with reproductive health and decision-making and through visual and narrative testimonies, in response to the research questions. This method centers the knowledge of trans individuals as legitimate and critical, challenging the historical marginalization of their voices, and complements the regulatory and institutional analysis. Together, these elements enable a nuanced examination of the interplay between lived experience, professional practice, and institutional discourse. This thesis demonstrates that despite Portugal's legal recognition of gender diversity, a persistent medico-legal paradigm continues to frame reproductive health services through cisnormative and binary assumptions. Drawing on institutional, professional, and lived narratives, the study reveals how these assumptions marginalise trans people's reproductive needs and explores how principles of Reproductive Justice can inform more inclusive, diverse, and affirming approaches to reproductive health policy and practice.

Keywords: access to reproductive health; gender self-determination; reproductive choices; trans reproductive justice