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Transgender Health Care – A Real Problem for Real People December 13, 2009

Posted by Geekgirl in Gender Identity, Health, Intersex, Legal and Policies, LGBT, medical, transgender.
Tags: , , , ,

Do you know about The Trans PULSE Project? The Trans PULSE Project is a survey whose purpose is to learn more about how discrimination and erasure affect health care services of transgender individuals living in Ontario, Canada.  The Project continues to need volunteers for the survey.  Unfortunately, you have to live in Ontario to participate.

Part of what I find exciting about this project is that it isn’t run solely by researchers. The Trans PULSE Project has a Community Engagement Team (CET) is a dynamic team of trans volunteers from across Ontario who are helping to guide the Trans PULSE Project through the next phase. With members in Peterborough, Ottawa, North Bay, Sudbury, Hamilton, and Toronto, this team has the challenge of reflecting the vast diversity of Ontario’s trans communities. A central role of CET members is to engage trans people in their communities and involve them in completing the upcoming survey.

The good news is, the project continues to publish their findings. I can’t print the entire publication here as that would be a copyright violation, however you can request a free electronic copy from The Trans PULSE Project. I am including some quotes that seem especially informative.

Trans people represent one of the most marginalized groups in our society. Numerous needs assessments and research studies published to date have consistently indicated the numerous and interlocking challenges that trans people experience in their dayto-day lives (Kenagy, 2005; Namaste, 2000; Sperber,Landers, & Lawrence, 2005; Taylor, 2006). Despite consistency of results, little attention has been focused on understanding how and why trans people come to experience marginalization in such pervasive ways.

Trans people frequently encounter barriers to maintaining a stable income and quality housing(Gapka & Raj, 2003; Namaste, 2000; Xavier et al.,2007). It has also been shown that they experience disproportionately high rates of violence, harassment,and discrimination in workplaces, schools, and child welfare systems (Lombardi, Wilchins, Priesing, &Malouf, 2001; Sperber et al., 2005). Moreover, there are few jurisdictions where basic human rights protections for trans people exist and even fewer where they are enforced (Currah & Minter, 2000;Minter & Daley, 2003)

Given the discrimination and marginalization that transgender people face, it is likely that the number of individuals that identify as trans are much higher than those reported in the scientific literature. Take a look at this surprising statistic. Using the often cited statistics, there are more trans clients in Toronto than should exist in the entire province of Ontario.

Given oft-cited estimates from theNetherlands of 1 in 30,400 born females and 1 in11,900 born males being transsexual (Bakker, VanKesteren, Gooren, & Bezemer, 1993), there would be approximately 615 such people in Ontario, including children and infants. Although actual numbers are unknown, one publically funded community health centre in Toronto, which is mandated to provide primary health care services to LGBT communities, currently has more trans clients than should exist in the entire province, given these estimates.

So how does this impact trans people?

The perception that trans people are rare reinforces an erasure of trans communities and the continuing treatment of trans people as isolated cases. Erasure of trans communities extends from the cumulative invisibility of trans people through the processes discussed earlier as well as through other mechanisms such as infrequent or pathologizing media portrayals(Serano, 2007). There is also a tendency to see transpeople from a clinical rather than community perspective, and this bias results in an inability to recognize someone as trans if they do not fit a particular stereotype. As a result, the cumulative invisibilityof trans people has meant that the overall prevalence of trans people has continued to be grossly underestimated. These widely cited population estimates come from assessments of surgery-seeking transsexual people, who represent only a portion of the broader trans community.

A participant elaborated as follows:

Health care professionals need to have a sensitivity, that there are so many different kinds of trans people, and to have an assumption about a person because they identify as trans when they come through your door, you can’t have any assumption, because there is such a huge range about what it means to be trans.

A recent report published on Xtra, a Canadian website Where Queers Conspire, had this to say about the findings.

With preliminary results now being analyzed in the province-wide Trans Pulse Project (TPP) researchers say they’re finally getting statistics to back up what activists have been saying for years.

As expected healthcare and social service access in general remains very challenging for trans Ontarians and the implications are distressing,” says Jake Pyne, TPP’s community development coordinator. “Trans people report unmet healthcare needs, avoiding emergency rooms because they are trans, as well as avoiding or being denied access to services such as shelters and sexual assault centres.

“Most disturbing is the extremely high numbers who are reporting having seriously considered suicide in their lives.”

The initial results are based on the more than 200 responses that have been filled out since the survey into trans health was launched last February.

“When I said, ‘I knew there were problems,’ I had no idea,” says TPP coinvestigator Michelle Boyce, who adds that the study looks at health in a broad sense. “We look at shelter, income, employment and housing…. We look at the whole picture that makes a person healthy or unhealthy.”

“What is emerging is an extremely clear picture of the impact of social exclusion and discrimination on the lives of trans people in Ontario,” says Pyne. “Despite being well-educated trans people report very low incomes, many at or near the poverty line; worries about losing their housing; and anxiety about having enough to eat and enough money to pay the bills. Trans people are reporting that they have been turned down for jobs or fired for being trans. They are moving to other cities for safety reasons and to access trans-sensitive services.”

So what does Canada hope to accomplish through this research project? The paper has a list of recommendations and some comments.

Recommendations for Inclusion of Trans People in Institutional Contexts:

  • Removal of sex designations from identifying documentation unless necessary
  • Development of intake forms that allow for trans patients or clients to self-identify
  • Assumption by providers that any patient may be trans
  • Assurance that all providers and staff use pronouns and names appropriate for a patient’s gender identity, asking the patient if in doubt
  • Indication of trans-friendly environments through posters or other visible signals
  • Development of protocols for testing or treatment that are not sex-specific or that do not assume all members of a sex are cissexual
  • Assurance that there is a comfortable place for trans patients within sex-segregated systems such as hospital wards or elimination of sex segregation where possible
  • Development of resources for referral to trans-friendly providers, where needed
  • Assurance that billing systems are set up to accommodate scheduling and billing ‘‘women’s’’ services to men, and ‘‘men’s’’ services to women

This work further developed the concept of erasure within trans communities by identifying specific contexts in which erasure occurred and delineating ways in which this process functions. Specific recommendations have been provided to begin to remedy erasure. Whereas this article has focused on issues in health care, the processes of erasure outlined herein have application to other areas in which trans individuals interface with institutions or systems  around issues such as housing, employment, and social services. Although this work sought to expand the theoretical basis for social exclusion of transpeople, the theoretical and practical are not discrete areas.

One participant phrased it well, as follows:

The barriers remain within the larger society and even within the larger LGBTTQ [lesbian,gay, bisexual, trans, two-spirit, and queer]community, acceptance of who we are as equal and deserving of the same resources, the same attention. And what’s the word? Erasure—which all of [us] are familiar with as a theoretical and practical term. I don’t think this is theoretical;this is our lives.

For the record, these definitions are presented in the publication.

Trans is an umbrella term that encompasses a diverse group of people whose gender identity or expression diverts from prevailing societal expectations. Trans includes transsexual, transitioned, transgender, genderqueer and two spirited people.

Table 1. Transgender Terminology

Transsexual ‘‘Those who live as members of the sex other than the one they were assigned to at birth.’’ (Serano, 2007, p. 25)

Transgender An umbrella term used since the 1990s ‘‘to describe those who defy societal expectations and assumptions regarding femaleness and maleness; this includes people who are transsexual, intersex (those who are born with a reproductive or sexual anatomy that does not fit the typical definitions of female or male), and genderqueer (those who identify outside of the male/female binary), as well as those whose gender expression differs from their anatomical or perceived sex..’’ (Serano, 2007, p. 25)

Cissexual ‘‘People who are not transsexual and who have only ever experienced their subconscious and physical sexes as being aligned.’’ (Serano, 2007, p. 12)

Cisgender ‘‘People who are not transgender.’’ (Serano, 2007, p. 33)



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