A Narrative Policy Framework Case Study Analysis of Arkansas Policy Banning Gender-Affirming Care for Transgender and/or Gender-Expansive Youth

Background and purpose: In the past four years, there has been an alarming increase in state-level attempts to pass policies that would restrict access to gender-affirming care for transgender and/or gender-expansive (TGE) youth. Arkansas became the first state to successfully pass a ban on gender-affirming care for youth in 2021 (H.B. 1570) through a majority vote in the state Senate. Although this bill was ultimately blocked following a lawsuit from the American Civil Liberties Union in June 2023, there are several other states that have used the same narratives to pass similar policies. Therefore, it is important to understand the ways in which narratives are utilized by conservative policymakers to endorse and advocate for bans on gender-affirming care for youth.

Methods : We used a narrative process framework (NPF) to analyze the narrative constructed from the introduction of the bill into the Arkansas House of Representatives (February 2021) to the passage of the bill (April 2021). We discuss the setting, characters, plot, morals, and content used in the narrative to frame the availability of gender-affirming care for TGE youth as a problem that needs to be solved through policy.

Results: Results confirm the presence of a narrative in this policy process with several relevant narrative elements/components. The setting of the bill in a socially conservative state and following a conservative federal administration (President Trump’s first term) promoted support for the bill which likely aided its passage. Within the narrative used by the sponsors of the bill, characters included perceived victims (TGE children), heroes (policymakers), and villains (medical providers and opposers). The plot of the narrative centered around the idea of regret and a desire to de-transition, which they believed would cause irreparable harm to the TGE child. The moral of the narrative was to restrict gender-affirming care for TGE minors, as they are vulnerable and in need of protection. Throughout the narrative, supporters of H.B. 1570 primarily utilized the devil-angel shift as their narrative strategy, which is exemplified in the characterization of supportive doctors as “experimenters” and themselves as “protectors” of children. We identified two primary policy beliefs foundational to the narrative: systemic cisnormativity and the rights of parents to make decisions regarding their children’s healthcare.

Conclusions and Implications: This paper has important implications for developing a counternarrative that can be used by TGE advocates and policymakers to garner opposition against these harmful bills, which continue to be introduced at both the state- and federal-level. Based on the NPF analysis, counternarratives should consider using the devil-angel shift to frame conservative politicians as villains who bar youth from receiving lifesaving care. Additionally, counternarratives should amplify the voices of TGE children to challenge cisnormative policy beliefs and the framing of TGE children as victims. The results of this policy analysis highlight the success of using narratives as a technique to promote policy and provide targets to disrupt these harmful narratives in future policy debates.