CREVE COEUR, Mo. \u2014 Rene\u00e9 Luckfield tries not to knock like a cop.<\/p>\n
In fact, the 29-year-old spends a lot of time thinking about how to make strangers comfortable when she shows up at their door to talk about transgender healthcare. A syncopated \u201ctap \u2014 tap-tap-tap\u201d sounds friendly even when she knocks loudly. In each encounter, she masks her own unease.<\/p>\n
\u201cHonestly, it\u2019s not something that I\u2019m entirely comfortable with,\u201d Luckfield, a transgender woman, said while walking door to door in this affluent St. Louis suburb. \u201cAnd it\u2019s not fair that we have to do this work.\u201d<\/p>\n
Transgender issues have become a major theme<\/a> in this year\u2019s midterm elections, especially in Missouri, where voters are weighing a proposed constitutional amendment<\/a> to bar minors from gender-transition surgery, cross-sex hormone therapy, and puberty blockers. The potential ban is part of a proposed amendment to reinstate a near-total ban on abortion<\/a> in the state.<\/p>\n Voters in four other states<\/a> will also decide on transgender issues this year: a proposed ban on transgender health care for minors in Colorado, and proposed restrictions on transgender athletes in youth sports in Arizona, Colorado, Nebraska, and Washington.<\/p>\n Luckfield is part of an effort by the LGBTQ+ advocacy organization PROMO Missouri<\/a> to defeat the Missouri measure by knocking on 100,000 doors across five of the state\u2019s largest metro areas before the election \u2014 an ambitious target the group is trying to reach with a mixture of full-time canvassers like Luckfield, the St. Louis lead, and volunteers who show up on weekends. About one out of every 10 knocks turns into a conversation, and they\u2019re aiming to have 10,000 conversations before Election Day. The group celebrated reaching 6,000 in early October, but the process is slow going, intentionally, as canvassers aim for open-ended, \u201ctransformative\u201d conversations with potential voters.<\/p>\n The technique, \u201cdeep canvassing,\u201d has a history of changing people\u2019s perspectives on difficult political topics, including a 2012 campaign that overturned a gay marriage ban in Maine<\/a> and a 2021 campaign for police reform<\/a> in Minnesota that, while defeated, triggered new debate. Now organizers in Missouri hope it can help stave off the latest effort in the state to permanently ban gender-affirming care for minors.<\/p>\n In 2023, Missouri\u2019s Republican-dominated legislature permanently blocked minors\u2019 access<\/a> to gender-affirming surgeries and temporarily blocked their access to new prescriptions for puberty blockers and cross-sex hormones for four years. The state is one of 27<\/a> that enacted restrictions on gender-affirming care for minors in the past five years.<\/p>\n The deep canvass in Missouri began in 2024<\/a>, as transgender healthcare was becoming a focal point of state and national elections. President Donald Trump\u2019s campaign, and pro-Trump groups, spent millions of dollars<\/a> that year attacking Democratic presidential nominee Kamala Harris over transgender issues, such as one declaring<\/a>, \u201cKamala is for they\/them. President Trump is for you.\u201d<\/p>\n And in Missouri that year, an amendment to add abortion protections to the state\u2019s constitution passed by fewer than 100,000 votes. Opponents argued the measure would also enable the state\u2019s ban on gender-affirming care for minors to be overturned. \u201cNO TAX PAID CHILD SEX CHANGE SURGERY\u201d read a sign opposing the amendment.<\/p>\n This year\u2019s amendment to reinstate the state\u2019s abortion ban and codify the ban on trans healthcare for minors is polling neck and neck<\/a>, with 43% supportive of the bans, 44% opposed, and 13% undecided, against a margin of error of 4.09%. This most recent poll doesn\u2019t ask separately about abortion and gender-affirming care, but polling from February<\/a> showed stronger support for abortion access. The deep canvassers are trying to reach voters who are against banning abortion but are more ambivalent on trans issues. That means not spending too much time talking to people who are already very opposed or very supportive of the proposed bans.<\/p>\n Te\u2019 Hopkins introduces \u201cdeep canvassing\u201d while training volunteers to knock on doors in suburban St. Louis to discuss transgender healthcare. (Kyle Pyatt for KFF Health News)<\/p>\n To discern people\u2019s views, canvassers are trained to ask the person they\u2019re speaking with to place themselves on a scale from 0 to 10, with 0 being totally opposed to banning abortion and 10 being totally in favor of it. Then they ask the person to use the same scale to rate their feeling toward banning \u201cgender-transition procedures for trans minors\u201d \u2014 language similar to what voters will see on the ballot. After each of those questions, canvassers ask why the number the person chose is right for them.<\/p>\n On an overcast Saturday morning in late September, with Missouri\u2019s summer heat seemingly broken at last, the sounds of lawnmowers and leaf blowers filled the air as Luckfield began knocking doors in a neighborhood 20 miles west of the Gateway Arch.<\/p>\n The first person who opened their door was a 10\/10 in canvasser shorthand \u2014 in favor of banning abortion because of her Christian faith and in favor of banning gender-transition procedures for minors because she doesn\u2019t think children are equipped to make those decisions and doesn\u2019t think parents should either.<\/p>\n \u201cI hear you,\u201d Luckfield replied. \u201cThat\u2019s everything I need from you today. Thank you very much for your time.\u201d<\/p>\n The exchange wasn\u2019t unusual, Luckfield said. Neither was a conversation she had later that morning with Carol Parsons, who said she was opposed to banning both abortion and gender-transition procedures for minors \u2014 a 0\/0. Luckfield acknowledged Parsons\u2019 support and asked if she had any questions about the process kids go through to get care.<\/p>\n \u201cI do feel that they need to be old enough to realize that that is life-changing,\u201d Parsons said. Surgery is the thing she\u2019s not sure about, she said.<\/p>\n \u201cIt is tricky, and it is scary to think of that happening for young kids,\u201d Luckfield acknowledged. \u201cThe phrase \u2018transgender procedures\u2019 \u2014 that\u2019s, I think, very deliberately chosen language to stoke that fear of surgeries in particular.\u201d<\/p>\n Gender-affirming surgeries for minors are rare. One study of 2019 insurance claims for nearly 23 million children<\/a> found surgeries were performed at a rate of 2.1 per 100,000 for those ages 15-17, 0.1 for those 13-14, and none for those 12 and younger. Prescription treatments are also uncommon, given to fewer than 1 in 1,000 adolescents who have commercial insurance, according to another study<\/a>.<\/p>\n Luckfield explained to Parsons that in addition to banning surgeries and hormone treatments, Missouri\u2019s proposed amendment would ban puberty blockers. She said that puberty blockers are reversible and can be prescribed at an appropriate age alongside counseling and social transitioning to give a child time to mature and make an informed decision about further transitions.<\/p>\n \u201cWell, I definitely agree with that,\u201d Parsons replied. \u201cI think that would be a good solution.\u201d<\/p>\n The final door Luckfield knocked on belonged to Louis Meyer, who had previously spoken to a different deep canvasser and expressed some ambivalence about transgender care for minors. This time, he told Luckfield he was fully against both bans \u2014 a 0\/0. Luckfield asked what had changed his mind.<\/p>\n \u201cThe original question was about where my morals sit and what I would do, which is a different statement than what I want the government to dictate,\u201d Meyer replied.<\/p>\n Rene\u00e9 Luckfield (right) speaks with Louis Meyer (center), as a journalist observes. Meyer is one of five people with whom Luckfield had an extended conversation while canvassing about transgender healthcare in Creve Coeur, Missouri, one day in late September. (Kyle Pyatt for KFF Health News)<\/p>\n Luckfield knocked on 12 doors in an hour and a half and had conversations with five people, four of whom opposed both bans. Those numbers weren\u2019t surprising, Luckfield said, in part because St. Louis County tends to be more liberal than Missouri overall. But she thinks it also reflects something larger.<\/p>\n She pointed to research from the Transgender Law Center<\/a> finding that when people are asked about their opinions on trans issues, they tend to answer favorably, but when they are asked how they think their neighbors feel, their answers are less certain.<\/p>\n \u201cPeople are more accepting than they think the people around them are,\u201d Luckfield said.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":" CREVE COEUR, Mo. \u2014 Rene\u00e9 Luckfield tries not to knock like a cop. In fact, the 29-year-old spends a lot of time thinking about how to make strangers comfortable when she shows up at their door to talk about transgender healthcare. A syncopated \u201ctap \u2014 tap-tap-tap\u201d sounds friendly even when she knocks loudly. 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