non-binary

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CPATH: diversity, inclusion and decolonisation in trans health

I’m currently attending the CPATH (Canadian Professional Association for Transgender Health) conference in Vancouver. It’s a fascinating event which I’m hoping to write about more in the coming days. I’ll also be livetweeting whenever possible.

The first two days of the event are a “pre-conference” training session aimed largely at healthcare professionals, followed by a more standard three-day conference over the weekend. I’m fortunate enough to be attending the whole thing, funded through the ESRC-sponsored Trans Pregnancy project. I’m here to learn about how gender-affirming care is being practiced in North America, and to connect with people working in reproductive health and in supporting transition.

What’s really struck me so far is how much more intersectional and inclusive of actual trans people this event is when compared to professional events in Western Europe, particularly last year’s WPATH conference.

I was struck at the how the first pre-conference session I attended – billed as an introduction to gender-affirming care – had questions of diversity, power, and consent absolutely embedded into the presentations. Attendees were encouraged to reflect critically on their own privilege and social position, and that of key writers and trend-setters in the field. We discussed how social determinants of health (such as wealth, education, citizenship etc) play a huge role in determining inequalities within trans populations as well as between trans people and the cis majority.

These are pretty standard topics within sociology, but even so I felt the session was very well-presented and I learned a lot from the informative but open and deeply self-aware approach taken by the two presenters, Gwen Haworth and Jenn Matsui De Roo. It was immensely refreshing to see this kind of conversation take place in an event attended largely by healthcare providers. Too often, I feel clinical providers and researchers in the UK find themselves at loggerheads with trans patients. Often this may be because they haven’t thought to take a step back and consider the cultural context of their patient’s life and the systemic issues that this person might have encountered, let alone the deeply unequal power dynamic of the clinical encounter.

It was also really important for me as a non-clinician to take the time to listen to the stories and experiences of healthcare professionals, and learn more about the energy and care they put into the vital work that they do. I fear too many sociologists looking into issues around healthcare don’t actually attend medical conferences, and as such miss out from directly hearing about professional views and experiences.

I was also delighted to see that the space is pretty trans-friendly. People are generally sensitive around language, there are gender-neutral toilet blocks, pronoun stickers, and there’s also a “safer space” quiet room. At the WPATH conference last year, a number of trans attendees were attempting to make all of these things happen through forms of quiet guerilla disruption, for instance through putting holographic stickers on the toilets that switched between “male” and “female” images. At CPATH, trans language, trans culture and trans needs feel like part of the fabric of the event.

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My CPATH 2017 Conference name badge.
Under my name is a sticker reading “preferred pronoun: she/her”.

Finally, it’s good to see that there’s a serious decolonial agenda at CPATH. The conference booklet acknowledges that Vancouver is built on unceded lands; there are numerous sessions led by indigenous practitioners, researchers and activists; indigenous perspectives and issues are regularly discussed by non-indigenous attendees; and the introductory plenary for the conference proper on Friday will feature an opening speech and talks from indigenous activists and healthcare providers.

Of course, while all of this looks good for CPATH, the progressive appearance of the conference can hide the struggles that make real inclusion and recognition possible. I’ve heard that the opening plenary was the outcome of a struggle over indigenous representation after a number of papers were rejected. So, however good CPATH looks to me as a (white, British) outsider, it’s important to acknowledge the ongoing, silent (silenced) work that so often takes place behind the scenes to make this happen.

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Some reflections on Trans Health Matters 2017

Last week I joined over a hundred other attendees at the Trans Health Matters conference in London. The event (which takes place on a mostly annual basis) was organised by cliniQ, the city’s holistic trans sexual health clinic.

For impressions of the day, you can visit the Twitter hashtag for the event here.

When I attended the first cliniQ Trans Health Matters conference in 2013, I found it to be immensely valuable and informative, but left with a feeling of deep-seated distress that persisted pretty much ever since. For at that event, I gained a better understanding of the scale of the problems that plague trans healthcare provision.

These include widespread ignorance and often also active discrimination from practitioners, plus enormous (and growing) waiting lists for gender clinics. All things I already knew about, but swapping notes with other researchers and activists helped me realise just how common and severe the issues were. My impressions from the conference were also reflected in the initial findings from my PhD fieldwork, which I was undertaking at the time.

By contrast, I left this year’s event with a greater sense of optimism and hope.

That’s not to say that trans health isn’t still a disaster area. It really is. However, I feel that since 2013, there has been a real growth in community health initiatives, and also in cis practitioners’ active engagement in the issues. This was actively reflected in the conference programme, which focused largely on what is being done and what we can do to make things better.


What is “trans health”?

Interestingly, another positive aspect of the conference for me was that gender clinics and transition processes were barely discussed at Trans Health Matters 2017.

That isn’t to say that these aren’t important things to talk about – they absolutely are – but one of my observations over the last few years has been that discussions of “trans health” focus so overwhelmingly on gender identity services that an outside observer would be forgiven for thinking that transition is the only healthcare issue that really exists for trans people.

Which, of course, would be completely wrong. Trans people face extremely high rates of discrimination, harassment, internalised stigma, poverty, physical violence and domestic abuse. These challenges can be be linked to endemic mental health problems, suicidality, substance abuse, “risky” sexual practices and disability within trans populations. Moreover, there is the matter of everyday transphobia and cisgenderism in everyday encounters with healthcare practitioners.

So it was genuinely refreshing to attend a trans health conference that focused largely on sexual health (particularly HIV prevention, reflecting cliniQ’s role as a sexual health clinic), with some additional discussion of matters such as therapy, sex work, data collection, and intersectionality. These are all deeply important issues that really deserve the attention they received on the day.

Of course, the absence of discussion on gender identity services would be a real issue if these conversations weren’t already happening elsewhere. But they are. This year alone, I’ve attended two UK trans health conferences which centred issues of transition, and I know there have been plenty of other such events that I haven’t been able to go to. This is another cause for optimism: a great increase in activist, academic and professional events looking at trans health from a range of angles, reflecting the rapid growth and increasing visibility of our communities.


Towards inclusive care

While there are a growing number of trans-specific sexual health services available in UK cities, it was really good to see a lot of discussion around how trans people can be included in services (and the promotion of these services) more generally. A great example of this was a short film that’s been made about PrEP, from which extracts were shown at the conference.

I was also really heartened to see that Trans Health Matters was a somewhat more intersectional affair this year. Two of the four speakers on the keynote panel were trans women of colour. We got to hear a particularly inspiring speech from Mexican/US activist Alexandra Rodríguez, who explained how she created a pioneering HIV prevention service for trans Latinas in California after realising there were no existing services, and reflected on the importance of providing care and support for trans migrants.

I also attended an afternoon session on barriers to access and strategies for inclusion for some of the most vulnerable trans populations in the UK: black and minority ethnic trans people, non-British trans people, and economically marginalised trans people (these are, of course, groups that frequently intersect!)

Barriers to healthcare access for BAME and/or non-British trans people.
Photos taken with permission during breakout session.

One of the most important lessons from this session was the importance of reaching out for service providers, rather than expecting that the most marginalised people will feel that a service is necessarily for them. This is particularly the case if a service is normally primarily attended by and promoted to a relatively privileged demographic.

The work of reaching out may involve an element of discomfort for white and/or middle class providers; it can involve sensitively negotiating access to new spaces (e.g. club nights and community groups run by and for people of colour and/or working class people), learning from mistakes and being open to listen and learn with humility. But it is vital to ensure that community services are truly inclusive.


Reproductive health survey

The importance of the work of inclusion really came to the fore in a plenary session where we were shown initial findings from a trans reproductive health survey undertaken by Public Health England.

The survey is still open: you can take it here.

This is the first major stastical study looking at trans people’s reproductive health and experience of services in the UK. As the survey hasn’t yet closed and the data still requires some additional processing, we were asked not to report on specific figures. However, what I can say is that (unsurprisingly) there were generally high levels of dissatisfaction with existing service providers and sexual health education, reflecting an urgent need for improvement and trans inclusion.

The aspect of the survey that inspired the most discussion and debate amongst conference attendees, however, was the lack of diversity among existing survey respondents. A majority of respondents had received a university education, and an overwhelming number were white. This reflects a wider trend in trans community responses to online surveys: it is the most privileged individuals who are more likely have access to these.

I asked the speaker if there had been a paper version of the survey produced: these can help obtain a greater number of responses from individuals less likely to access an Internet survey, including trans people of colour, working class trans people, and older trans people. He noted that unfortunately the research team (which I believe consists just of himself and a single support worker) are underfunded and are trying to do their best with the resources they have. However, other audience members noted that there were still things that could have been done to increase the response rate from underrepresented groups. For instance, the research team could have reached out to UK Black Pride and asked for help with dissemination.

To me, this conversation really brings home the importance of active inclusion, which was the main thing I have been thinking about since attending Trans Health Matters. We can’t just assume that all members of our communities will be able to access services and research: rather, we need to make the effort to ensure that they are accessible. This can involve additional work, but the real challenge is overcoming the ignorance that can arise from our own privilege, even if we are ourselves marginalised in different ways.

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Concerts in Coventry: 24th June, 29th July

I’m involved in organising two exciting events at Coventry’s Tin Music and Arts over the coming month.

This coming Saturday sees the return of feminist club night Revolt, complete with bands, DJs, spoken word, zines and our Feminist Library. I’ll be opening the night with my band Dispute Settlement Mechanism.

For tickets and more info, click here.

Revolt #10
On Saturday 29th July we’ll be treated to a performance by CN Lester, who will be performing songs from their new album Come Home and reading from their great new book Trans Like Me.

For tickets and more info, click here.

CN Lester.png
Entry will also be available on the door on a donations basis (suggested donation £5, but no-one will be turned away for lack of funds).

 

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Forthcoming books!

I’m delighted to announce that I have recently signed not one, but two book contracts. Both books are scheduled for publication in 2018.

My first monograph, provisionally entitled Understanding Trans Health, will be published with Policy Press. This book will draw upon extensive qualitative fieldwork in the UK to examine how trans identities, experiences and healthcare needs are differently understood within community, activist and professional contexts. It shall explore how these different understandings can lead to conflict and mistrust within medical settings, and propose means by which more collaborative relationships might be fostered in the future.

An edited collection, provisionally entitled The Emergence of Trans: Essays on Healthcare, Culture and the Politics of Everyday Life will be published with Routledge. Assembled in collaboration with Dr Iggi Moon and the late Professor Deborah Lynn Steinberg, this book builds on the success of our 2012-2014 seminar series Retheorising Gender and Sexuality: The Emergence of Trans. It will feature international contributions from a range of authors based in different academic disciplines.

Academic books are often unaffordable to lay readers, and unavailable outside of academic libraries. I was therefore really keen that both books would be available in paperback and ebook format as well as the traditional hardback. I’m really pleased to say that both publishers have agreed to print paperback editions in the first run, in recognition of how the book topics are relevant to ordinary people within trans communities.

I’ll be sharing more details on these books as the publication dates approach.

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WPATH 2016 poster: “A time of anticipation”

Here’s the poster I presented at this year’s WPATH Symposium:

Anticipation poster.png

You can also download a PDF version here.

The magnet is a metaphor for anticipation, which is both a product of and shapes feelings, emotions and experiences of time. This process is mediated by both trans community discourses and medical systems.

It’s very important to note that the majority of research participants had good things to say about the health professionals who helped with their transition. However, there is also a high prevelance of transphobia and cisgenderism within medical systems and clinical pathways. Anxiety and mistrust of practitioners within the trans patient population is endemic, and this is compounded by long waiting times.

My wider research looks critically at how discourses of trans health are differently understood within and between community/support spaces, activist groups and the professional sphere; however, the purpose of this particular poster was communicate some of the difficult experiences that current patients have with waiting. It sparked some productive conversations and I hope that further work will follow from this.

Sources:

Transitional Demands (Jess Bradley and Francis Myerscough)

Experiences of people from , and working with, transgender communities within the NHS – summary of findings, 2013/14 (NHS England)

Current Waiting Times & Patient Population for Gender Identity Services in the UK (UK Trans Info)

 

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Gender recognition: where next?

I recently co-wrote a short report for UK Trans Info with CN Lester. Entitled ‘Gender recognition: where next?’, it reports upon the findings of a short survey about possible replacements for the Gender Recognition Act. The survey was created in response to calls for reform of the Gender Recognition Act 2004, in the wake of a Transgender Equality Inquiry conducted by the UK Parliament’s Women and Equalities Committee.

The headlines are as follows:

  • There is strong support for some form of legal gender recognition grounded in self-declaration – comparable perhaps to creating a statutory declaration or deed poll – as opposed to the current system of applying to a ‘Gender Recognition Panel’ with huge amounts of evidence and hoping for the best.
  • We asked what respondents were not prepared to compromise on in any change of law; a considerable majority stated that they regarded non-binary recognition as a red line in any negotiation. This will no doubt be very difficult to achieve due to the lack of any precedent in law for the recognition of non-binary gender identities, but it’s vital that trans advocates make the effort to push for this over coming months, for the sake of solidarity and inclusion.

You can read the report here.

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Imagining a trans-inclusive Stonewall

“The meeting actually went pretty well, didn’t it?”

I heard a number of variations upon this statement echo around the pub we gathered in yesterday evening, as some 40-odd trans activists digested the day’s work. There was an undertone of incredulity: most of us had managed our expectations carefully in advance of the day. This was due in part to the fractious nature of trans communities, but also stemmed from our difficult history with Stonewall.

Back in 2008, many of us had been present at a loud, colourful demonstration outside the Victoria and Albert Museum as it hosted the annual Stonewall awards. We were there to express our displeasure at an organisation that didn’t simply exclude trans people, but seemed to keep making mistakes that caused harm to us.

A lot can happen in six years. Change has come from two directions: from continued external pressure from trans people, but also from a genuine willingness to reconsider matters from Stonewall following a shift in management in February.

In this post, I outline the themes and outcomes of a meeting held on Saturday to discuss potential options for trans inclusion in Stonewall. I will repeat some of the points made by CN Lester and Zoe O’Connell in their accounts of the day, but recommend you also have a look at what they have to say. For an idea of what is at stake, I recommend posts by Natacha Kennedy and Kat Gupta, as well as my previous writing on the topic.


A meeting with trans activists

The meeting – held in central London – was attended by a large number of trans activists who had been directly invited to the event, as well as three cis attendees: new Stonewall CEO Ruth Hunt, Jan Gooding who is Chair of trustees for the group, and a facilitator (who, incidentally, did a very good job).

A number of us felt that a more open meeting or more transparent means of securing invitation would have been beneficial. I’ve made my own views about this clear (particularly on social media) but in this post I will focus upon what we actually achieved, and what will happen next.

The event was in some ways quite diverse, and in others ways very limited in terms of representation. There were a wide variety of experiences represented, and views from across the political spectrum. There were a great range of gender identities represented, although a particularly large part of the group were trans women. There were attendees from across England and Wales, with James Morton from the Scottish Transgender Alliance present to talk about the situation in Scotland (where Stonewall is an LGBT organisation). The group was overwhelmingly white. There were a number of disabled people present, but not many with experiences of physical impairment.

Several commentators have stated that Stonewall were responsible for the make-up of the meeting, and therefore could have made more effort in terms of inviting a diverse range of participants. This is true, but I feel that trans activists also need to step up and take some responsibility here. Most of our loudest voices are white trans women like myself. We need to keep our own house in order: by reaching out to communities of trans people from under-represented groups, by “boosting the signal” and talking about the work of trans people from under-represented groups, and by ensuring that it’s not just us with places at the table.

It’s worth noting that this event was framed by Ruth as one part of a far wider consultation on Stonewall’s future engagement with trans issues. If you’re trans please ensure that your voice is heard in this. You can do so by writing to Stonewall here, or by emailing: trans@stonewall.org.uk. There will be more about the next steps of consultation later in this post.

The meeting ultimately had two purposes: to move on from the problems of the past, and examine potential options for future collaboration between Stonewall and trans communities.


An apology from Ruth Hunt

The day began with a refreshingly honest admission of fault on the part of Stonewall from Ruth. She offered a point-by-point account of how Stonewall has let trans people down over the past few years, and offered both apology and explanation for these incidents, as well as an account of how these are now being addressed.

This was not the main focus of the day, instead clearing the air from the start to enable a productive discussion. However, I feel it is important to provide a public record of this session: if we are to collectively move on from the past, then we need to remember that Stonewall has demonstrated a commitment to change.

Some of the issues discussed by Ruth included:

  • Nominating transphobic individuals for awards. This was acknowledged as a mistake, and we were assured that nominees are now scrutinised more carefully (not just for transphobia).
  • Insensitive use of language in Fit, Stonewall’s video resource for schools. Ruth explained that the inappropriate section has been removed from the DVD.
  • Stonewall’s campaign with Paddy Power, who were severely rebuked by Advertising Standards Authority for a transphobic advert in 2012. Ruth noted that Stonewall is now using its relationship with Paddy Power feed back on advertising they consider to be offensive (interventions which are not just limited to addressing homophobia) which has resulted in a number of changes being made.
  • Stonewall representatives speaking out inappropriately and/or not speaking out on trans issues whilst lobbying Government and MPs. There’s a long and complex history here that I’m not going into in this post: suffice to say that one aim of Saturday’s meeting was to ensure that this is done better in the future.

There was also significant evidence that Stonewall is undergoing major institutional change in regards to trans issues. I was pleasantly surprised to hear that Ruth had emphasised seeking a solution to the organisation’s difficult relationship with trans people when applying for the position of CEO, and that this was viewed favourably by trustees who considered her job application. Trans employees of Stonewall are reportedly more likely to be “out” and feel comfortable speaking about trans issues and concerns.


What’s on the table?

We then moved onto the main point of the event: to discuss proposals for a new relationship between Stonewall and trans people. There were four options for us to consider in group conversations, with attendees also encouraged to suggest any additional solutions that might not have been considered.

The options were:

  1. A fully inclusive LGBT Stonewall, which considers campaigning on trans issues to be a full part of its remit.
  2. Stonewall becomes nominally LGBT, but also funds and provides resources and guidance for the creation of a new, effectively autonomous trans organisation to work on trans campaigns. This organisation will eventually become independent, but can work closely with Stonewall.
  3. Stonewall remains LGB, and provides grants for a number of trans organisations so they can do their own campaigning work.
  4. Stonewall remains LGB, and works to be better ally.

Ruth explained that option (4) was not really favoured by Stonewall, particularly given the appetite for a closer relationship amongst many trans activists. The general feeling of the room reflected this, and we focussed our discussion upon the first three options.

Option (3) was largely rejected also. Criticisms raised included concerns about who would get the money, the impact of competition between smaller trans organisations, about what the conditions might be for such grants, and the amount of money and energy that would be spent by both Stonewall and trans groups on managing the system and applying for grants – money and energy that could be better spent on actual campaigning. Ruth further pointed out that Stonewall doesn’t actually have a lot of money to spare, outlining how money is currently spent on Stonewall’s employees and existing campaigns.  If the grant scheme was to go ahead, then there would likely be a knock-on effect on (for instance) campaigning in schools, and Stonewall might need to apply for extra money from funding pots that are already used by trans groups.

Options (1) and (2) both had great deal of support from within the room. Several groups suggested variations upon an “option 1.5” that sat between the two – proposals included the creation of a “trans department” within Stonewall, and semi-autonomous “sibling” organisation linked permanently to Stonewall.


Outcomes

There was a pretty clear consensus on the following points at the end of the day:

  • Barring the unexpected (e.g. widespread opposition from trans people contributing to the public consultation) Stonewall will become an LGBT organisation, in one form or another.
  • Any eventual solution should provide for joint ‘LGBT’ campaigning on shared issues, such as homophobia and transphobia in schools.
  • Any eventual solution should provide for campaigning on trans-specific issues, such as on relevant legislation (e.g. the Gender Recognition Act and amendments to the recent Marriage Act) and on addressing issues with health care.
  • Future campaigning work must be intersectional, recognising the diversity of trans experience in areas such as gender identity, race, disability and age.

 

What happens next?

  • The public consultation will continue for several months. If you’re trans, please make sure your voice is heard!
  • There will be further meetings held with people from under-represented groups. This is a vital opportunity to address the problem of diversity at Saturday’s meeting. Stonewall are planning meetings with people from a number of groups, including intersex people as well as trans people of colour, disabled trans people and young trans people. If you want to attend one of these meetings, please contact Stonewall: trans@stonewall.org.uk
  • There will be a formal proposal for trans inclusion in Stonewall made in January 2015 in the shape of a report. This will then be consulted upon internally (i.e. within Stonewall) and externally (i.e. amongst trans people).
  • A final decision on the future of Stonewall should be made in April 2015. If this involves full trans inclusion and/or the creation of a new trans group, this will take several months to implement.

It’s important to note that this is not a process that can take place overnight! The process of consultation is lengthy in order to take on board the views of as many trans people as possible. We have such a range of perspectives that there is no chance that everyone will be happy, but the aim is for change to be trans-led, and to reflect the desires and interests of as many people as possible.

Once the consultation ends, its results cannot be implement immediately either. Stonewall may need to revise its priorities and work plans, and Ruth noted that a full-scale programme of training on trans issues and awareness will be necessary for the organisation’s staff.


Personal reflections

I feel positive about the future. There is so much unnecessary suffering amongst the trans population that allies are vital, and Stonewall could be a particularly large and powerful ally.

I believe in diversity of tactics to bring about change, and Stonewall takes a particularly centrist, “insider” approach to this. It is vitally important that Stonewall is never the only voice in LGBT activism, and that other groups continue to take more radical approaches to trans campaigning. It is also important that we remain capable of critiquing Stonewall, and holding it to account. Ultimately though, I’d rather be a critical friend than an entrenched foe.

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Gender recognition under threat in UK universities

I read a very disturbing internal email this afternoon. I’m not going to quote the majority of it in order to preserve anonymity, but the central content is of concern to any current or future trans student in Higher Education.

Earlier this year, HESA [Higher Education Statistics Agency] confirmed a series of changes that they would be making to the HESA Student Record for the 2012/13 academic year, which would have an impact on some of the questions that students are asked during the application and enrolment process. A number of these changes relate to equality issues and the 2010 Equality Act and I thought it would be prudent for us to consult […]

The key changes of relevance are as follows:

(1) There is an existing field Student.GENDER which will from 2012/13 be replaced with Student.SEX. The new Student.SEX field will reflect ‘legal’ biological sex at birth and we have been advised that there will be only two valid entries for this field, either Male or Female.

(2) To complement the new Student.SEX field there will also be an additional field, Student.GENDERID, which is intended to reflect the student’s gender identity based on their own self-assessment. A response to this question, should we choose to ask it, would be optional for students. The ‘suggested question’ from the Equality Challenge Unit for eliciting this information is “Is your gender identity the same as the gender you were originally assigned at birth?” and it would be possible for students to respond with ‘Yes’, ‘No’, or ‘Information Refused’.

At my university, the current student.GENDER field allows students to identify as “female”, “male”, “other” or “prefer not to say” following intervention from trans activists and past Students’ Union welfare officers. This system, and any similarly progressive approach from other institutions, will be overturned by the new HESA guidelines.

My concerns are as follows:

1) What is “legal” sex? Is it:
(a) my birth sex? (in which case I’m male)
(b) what’s on my passport? (in which case I’m female)
(c) whether or not I have a gender recognition certificate? (in
which case I’m male)

[edit: a skim of the HESA guidelines shows that (a) is not the case, with the university apparently using the phrase “sex at birth” in error]

2) If (a) or (c), then the University is going to revert my “sex” on its forms. This will disclose I am trans to anyone using their records.

3) If (b), then anyone wishing to update their gender will have to out themselves by walking into the university administrative building and presenting their passport. I had to do this in 2005 and it caused all kinds of weird issues with the Students’ Union and my records. We changed the system in two stages (the last one is referred to in the letter) in order to prevent this from happening to anyone else.

4) The new system erases intersex people.

5) The new system erases people with a non-binary identity.

6) This whole approach has an extremely flawed methodology that will only invalidate the desired data!

I suspect my university doesn’t have much of a choice about how this is carried about, and neither will others. We urgently need to lobby HESA to reverse their policy on this.

I’ll aim to write a more coherent analysis of the situation (inc. the complex role of the Gender Recognition Act) when I’m feeling more coherent.

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EDIT: HESA notes changes to the student.GENDER field here. Information on the new (binary) gender identity code can be found here.