A couple of days ago I joined Katy Montgomerie’s livestream to work through the current NHS England consultation on child and adolescent gender services. We discussed the background to the consultation, what the questions mean, and what some of the major issues are.
You can take part in the consultation here. It is open until 4th December 2022. Filling it in is a bit of an intense experience, but if you fancy some friendly company and catty cameos, I hope our video will help.
Three weeks ago, I wrote to the NHS England Gender Programme Board (of which I am a former “patient public voice” member) to raise urgent concerns about their consultation on a new interim service specification for children and adolescents.
The proposed service specification is deeply transphobic on numerous levels – from the dearth of relevant treatment pathways, to the assertion that being trans is likely a “phase”.
It is also probable that if implemented, this service specification will impact other young people more widely – especially girls and LGBTIQ+ youth – by undermining principles of autonomy and respect.
The consultation is open to anyone. If you have the time and energy, there is a guide to participating in the consultation here, prepared jointly by Gendered Intelligence, Stonewall, Mermaids, and the Trans Learning Partnership. If you are a community member, a healthcare practitioner, a researcher, or work with a relevant charity, it would be particularly useful for NHS England to hear from you.
Other things you could do to oppose the proposals include: organising a demonstration, raising awareness of this issue on social media, and/or writing to your MP or trade union and asking them to place pressure on NHS England to reconsider.
To date, I have not received a reply from NHS England. Given the danger the proposed service specification poses to the safety of young people, I have now decided to make my letter to them public.
I am emailing to share my great alarm at the proposed service specifications for child and adolescent gender dysphoria services. It is my expert opinion that, if implemented, these proposals will cause great harm to young people. Moreover, in opening such poorly designed and unevidenced specifications to consultation and media commentary, NHS England has already caused harm.
The fact that this consultation is happening at all represents an enormous failure on the part of every professional involved.
I stepped down from the Gender Programme Board earlier this month due to clashes with my teaching schedule. However, given the severity of this situation, I would be remiss in my ethical duties if I did not also email you directly to share my concerns.
My three main areas of concern are:
Social transition should not be subject to medical oversight. This would represent a gross abuse of power on the part of commissioners and practitioners. Choosing to wear different clothes, and possibly use a different name and/or pronouns – is a personal, non-medical decision related to a person exploring their identity and/or coming out. Preventing a young person from choosing a social transition amounts to an attempted conversion practice.
Punishing young people and their families by subjecting them to investigation if they access private services will not help them access healthcare. Young trans people who access private healthcare in the UK or abroad generally due so due to the severity of NHS failures. It will increase the likelihood of young people hiding the fact they are accessing external treatment from NHS clinicians, and of people turning to black-market hormone providers rather than private doctors. I am not sure that members of the Gender Programme Board are fully aware of how prevalent and dangerous the home-made substances already in circulation can be.
Requiring that young people become research subjects as a condition of accessing treatment is completely unethical. This is a well-established principle in the trans health literature. There is no way in which you can truly obtain informed consent for research participation from individuals who will be denied healthcare if they refuse to participate. I fully support the expansion of NHS-funded research into trans healthcare, but participants must not be recruited through coercion.
I will end by inviting all recipients of this email to reflect on what they do not experience, and what they do not know.
Most members of the Gender Programme Board have not experienced gender incongruence or gender dysphoria.
Most members of the Gender Programme Board are not members of a trans community. It is likely therefore that you – even if you are a clinician – have never found yourself in a position where you are confronted with the true impact of NHS failings on young trans people who rely on community support. You do not know what it is like to be trying to look after many extremely damaged members of your community dealing with complex trauma and self-harm from people who have been repeatedly abused by NHS clinicians and processes. We, in the community, are the ones left picking up the pieces of your failings, finding ourselves on constant suicide watch and scrabbling to keep people alive. Invitations onto bodies such as the Gender Programme Board, where we are expected to be polite while fighting for scraps – only to be ignored – do not right these overwhelming wrongs.
My book Understanding Trans Health is cited prominently in the new Philosophy Tube video on complaint, systematic inflexibility, and England’s NHS trans health crisis.
It’s a great video, which manages to capture the sheer horror of NHS failings while still delivering silly jokes, ridiculous costumes, and a strong analysis. In addition to drawing on my work, Philosophy Tube’s Abigail Thorne consulted me on the script for this episode, and I appreciated the opportunity to use my research in this way.
I am personally more optimistic than Abigail about the opportunities offered by the four NHS England ‘pilot’ clinics. These are beginning to slash waiting times, and several are now effectively run by trans people, for trans people. However, I do think it’s important to still critique the very logic that underpins many trans healthcare systems, especially the highly questionable ways in which the medical diagnosis of ‘gender dysphoria’ is constructed, and used to try and control us.
You can buy Understanding Trans Health directly from Policy Press here. It’s also available from all major booksellers, plus many independent queer book stores (e.g. Leeds’ brilliant The Bookish Type). I have also written to my publisher for permission to put a chapter of the book online for free – watch this space! In the meantime, free links to much of my other academic writing can be found here.
I was dismayed to read that the UK Government are amending the Gender Recognition Act. Specifically, they are removing the offence under section 22(1) of the Gender Recognition Act 2004 for the disclosure of protected information, to enable this disclosure where it is “necessary for the purposes of facilitating, assisting or undertaking relevant research”.
This amendment enables NHS England to obtain trans people’s confidential information about their medical treatment for the purpose of research into child and adolescent gender services by the Cass Review. Specifically, it enables the acquisition of information (a) that could contain personal identifying details, (b) without that person’s consent, and (c) for individuals who obtained specific legal protections with the reasonable belief that these would remain in place. There has been no community consultation ahead of this move.
As a social researcher and expert in ethical methodologies, I believe that any research undertaken under these circumstances would represent an enormous breach of the basic principles of research ethics. Moreover, it will could significantly undermine the already extremely low existing low level of trust between trans community members, researchers, and medical practitioners.
Finally, the amendment also represents a significant weakening of the Gender Recognition Act’s legal protections for trans people (although for a full and measured analysis, see this post by What The Trans).
I have therefore written to the NHS England’s Gender Identity Programme Board to express my concerns about this development. I also hope that any university or NHS ethical panel overseeing the approval of such research will prevent it from taking place.
There have been some really exciting developments in England over the last couple of months for trans birth parents (that is: men and non-binary people who conceive, carry, and give birth to their own children).
In April, a groundbreaking report on Trans and Non-Binary Experiences of Maternity Services was published by the LGBT Foundation. I am really proud to have co-authored parts of this report with colleagues in NHS England and the LGBT Foundation, and to have supported the research which informs it.
The report, which was funded by NHS England, offers a sobering account of healthcare inequalities for trans birth parents. However, it also includes important examples of good practice and recommendations for professionals.
Trans people’s experiences of perinatal care are consistently worse across the board compared with cis women.
30% of trans birth parents didn’t access perinatal healthcare at all during pregnancy – this compares to less than 2.1% of the general population.
Transphobia and racism in perinatal care intersect to produce particularly poor outcomes for trans parents of colour.
Recommendations include: supporting the delivery of personalised and trauma-informed perinatal care; proactively adopting inclusive language and targeting outreach to trans birth parents; and implementing IT and demographic monitoring systems to enable the sensitive collection of data about gender identity and trans status in perinatal services.
Excitingly, it appears that work is already underway on many of these points. For example, last year a fabulous series of resources for practitioners were published by Brighton and Sussex Gender Inclusion Midwives, and I have heard good things about progress on trans-inclusive data collection.
Best of all, NHS England now provide a range of tailored, accessible advice to trans parents as part of their new guide to having a baby if you’re LGBT+. This includes ways to become a parent, advice on testosterone and pregnancy, and chestfeeding/breastfeeding for men and transmasculine non-binary people.
These resources should really be seen as a starting point (for example, there is no advice for trans women who breastfeed). But equally, it is brilliant to see progress being made on the provision of practical advice that will help prospective and new parents. I am especially grateful to an NHS whistleblower who ensured their dissemination through revealing to The i that their publication had been blocked by some senior figures at NHS England for nearly a year.
This all serves as an important reminder that NHS England is not a monolith, and that concerted pressure from community groups and allies can have real long-term benefits.
It’s very easy to be cynical about our NHS given the poor overall state of trans healthcare, as well as opposition to equitable provision by some within the health service. However, all the positive moves I have reported in this post are also the result of hard work by numerous NHS midwives and members of the NHS digital team. Alongside community members who generously offered their time and knowledge, they have collectively fought to ensure that trans birth parents and the practitioners who work with them have access to resources and information.
All of this makes me feel hugely optimistic. These are difficult times, in which prejudice and disinformation are rife. Yet ordinary people are still fighting – successfully! – for positive change. This new research and guidance should be of great help to new parents and their children, and for that we can be grateful.
To celebrate this year’s umpteenth hit-piece on trans equality, I thought I might tell a little story about toilets.
On Friday, The Times reported that the University of Warwick has been “criticised for its ‘capture’ by Stonewall”, as evidenced by guidance asking people to challenge their biases, plus a proliferation of gender-neutral pronouns and toilets.
This coverage struck me as both unsurprising and bizarre. Unsurprising, as Stonewall have recently been subject to a barrage of homophobic and transphobic coverage from the likes of The Times, the BBC, The Guardian, the Telegraph, the Daily Mail etc etc. But also bizarre, as this is simply not news – all of the initiatives described have been underway for many years now, and they were hardly introduced by Stonewall.
As such, this feels like a good opportunity to explore the forgotten history of one of these initiatives: the introduction of all-gender toilets at Warwick, and in UK universities more widely.
I first became involved in campaigning for all-gender toilets in 2007. Using public toilets was a huge fear for me when I first transitioned. Fortunately, it turned out I was able to use women’s toilets without any trouble, but many of my queer siblings were not so lucky. I met and read about many trans people and other gender-nonconforming individuals, especially butch lesbians, who faced abuse and harassment in toilets due to their appearance. All-gender toilets offer a level of safety and access for people who don’t necessarily tick binary gendered boxes.
I was inspired therefore to learn about campaigns for all-gender bathrooms in US universities, through blogs, forums, and the 2004-05 TV documentary TransGeneration. I teamed up with some friends to write a motion for the 2007 National Union of Students (NUS) LGBT conference, calling on the NUS LGBT to campaign for equal toilet access. The motion passed with a near-unanimous vote, and you can see the text of the resulting policy below:
Of course, we were hardly the first people to undertake such campaigns in the UK. In 2002, Benjamin Cohen wrote an (unsuccessful) motion in favour of gender-neutral toilets for the King’s College London Student Representative Council. In 2005, an NUS LGBT briefing stated that ‘ideally a unisex toilet would […] be provided for those who feel uncomfortable defining into male or female’. Plus, throughout the 2000s “unisex” toilets were introduced in many UK nightclubs, although their owners were generally not so interested in the welfare of clubbers.
Buoyed by the success of our NUS LGBT motion, I took a similar proposal to the Students’ Union (SU) Council at the University of Warwick later in 2007. The motion was passed, albeit with an amendment to say that we would “investigate the possibility” of providing accessible toilet facilities for trans people, instead of committing to actually providing them. I invited Riley Coles, a student campaigner from the University of Bradford, down to Coventry to speak in support of the motion as they had recently introduced all-gender toilets at Bradford SU (you can hear Riley’s side of the story here). In turn, I was invited to speak in support of all-gender toilet policies at various Student Unions, including at Manchester and Sheffield as well as Bradford.
What we rapidly realised was that having a policy isn’t the same as achieving an outcome. NUS LGBT introduced numerous policies at its conference every year, and student officers simply didn’t have time to campaign on all of them. Moreover, at the time the campaign was dominated primarily by cis gay men and lesbians. Consequently, all-gender toilets were not to become an NUS LGBT campaign priority until the 2010s.
Similarly, having a policy at Warwick SU did not translate into the immediate introduction of all-gender toilets in the SU building, let alone across the university campus. It took a concerted campaign across many years to make that happen, involving innumerable staff and students. All-gender toilets were first introduced in odd corners of the SU building, then occasionally elsewhere on campus, and then gradually in new buildings before being more widely rolled out. This process took well over a decade.
In opening up new conversations about toilets, we rapidly realised that all-gender toilets were not just beneficial to trans and gender non-conforming people. For example, single parents benefited from being able to accompany young children of a different gender into facilities, and carers could do the same with people they cared for.
Equally, we knew that all-gender toilets were not appropriate for all people. Some women and men do not share gendered spaces for religious reasons. Women and girls who have experienced male harassment and violence may also not wish to share spaces with men. We therefore campaigned for an “additive” approach, with all-gender toilets available alongside women’s and men’s facilities: the approach eventually adopted by the University of Warwick.
Additionally, some service providers sought to introduce all-gender toilets at the expense of disabled people, much to our frustration. If single-cubicle “accessible” toilets are the only all-gender toilets available, it can increase the number of people using these facilities, to the detriment of disabled people who require them. We therefore urged university bodies that this was not an adequate solution.
These issues were explored in detail in a briefing published by West Midlands Area NUS (WMANUS) in 2007. This document also included a series of sample arguments in favour of all-gender toilets, case study examples of their implementation, and model motions for Students’ Unions. I also included a section on toilets in the Under Construction: Trans Studentsguide I wrote for the NUS in 2008.
By 2009 I started my postgraduate studies and took a step back from toilet campaigns. However, there was no shortage of new activists to step into the breach. There are too many to name them all, but one of the key figures has been Sam Parr, who continues to push for more accessible toilets for all on the University of Warwick campus through endless meetings and consultation exercises.
By the mid-2010s, all-gender toilets could be found on many university campuses and other public buildings, including at Warwick. In 2017, when I organised a conference about the gender equality scheme Athena SWAN, I was delighted hear a conversation among a group of cis equality and diversity workers about how best to make the case for all-gender toilet provision at their institution.
Meanwhile, when I spoke to a new generation of student activists, I began to hear complaints around how some campaigners focused too much on toilets as an “easy” campaign priority, rather than tackling issues such as trans healthcare, employment, and housing. Certainly, an all-gender toilet will not put food on your plate or a roof above your head. They must be part of a wider struggle for liberation.
Still, that struggle continues. So I was delighted to hear from colleagues this week that sanitary bins will soon be available in all toilets across campus at the University of Warwick, especially for the benefit of trans and/or disabled men who might require them in men’s facilities. You can see a reference to this idea in our original 2007 policy, albeit with some pretty awkward phrasing!
Trans histories tend to be forgotten. They are frequently not written down, and are often lost due to a lack of intergenerational contact. The only way we can change that is through sharing our stories and building back our history. I hope this post can help with that a little.
I have not named numerous individuals involved in the campaigns I describe in this post as I am aware that doing so could result in harassment. However, if you see yourself in this story and would like to be named, please let me know and I will gladly edit this post to credit your work!
About a month ago I participated in the TPATH conference. This groundbreaking online event centred trans healthcare practice, research, and activism by and for trans people.
I was very impressed with the measures taken by TPATH organisers to ensure the conference was accessible to as many people as possible from around the world. They organised live translation to and from English, French, and Spanish, provided live captioning, encouraged presenters to speak slowly and clearly to enable lipreading, and ensured that generous scholarships were available for those who would not otherwise afford to attend. Most of the event was recorded, and videos are gradually being uploaded to the TPATH Youtube channel.
At the conference I joined Tash Oakes-Monger from NHS England to present initial findings from the ITEMS project (Improving Trans Experiences of Maternity Services). The ITEMS team, led by Michael Petch from the LGBT Foundation, ran a survey in early 2021 to explore the experiences of trans people (including non-binary people) who give birth in England. I supported the design and dissemination of the survey through my former role with the Trans Learning Partnership.
There is some really exciting information emerging from the ITEMS data. For example, it appears that more trans people are giving birth than ever before (see above). However, it was also apparent that trans people face substantial inequalities.
Many of the questions in the ITEMS survey used comparable wording to the CQC Maternity Survey – from this we can see that trans people appear more likely to have negative experiences in NHS maternity services than cis women across the board. Even more disturbing is that 30% of trans respondents gave birth without the support of an NHS or private midwife (rising to 46% among trans people of colour). This indicates a lack of trust in midwifery services among prospective trans birth parents, with potentially lethal consequences for both parent and baby.
For the past couple of years, I have been working quietly on a new edited collection with my colleagues Sonja Erikainen and Ben Vincent. It is titled TERF Wars: Feminism and the fight for transgender futures.
TERF Wars is being published as part of the Sociological Review monograph series. This means it is available digitally as a special issue of the century-old journal The Sociological Review, and will also be available to buy as a reasonably-priced paperback book.
Our aim has been to provide a critical, scholarly response to the growing circulation of both “pro-trans” and “anti-trans” ideas within feminism, especially in the academic context in which we work. As the “trans debate” has grown ever more extensive and complex, newcomers often express confusion around why this has happened, what the fiercely contested language actually means, and how it has all become so polarising.
The collection therefore addresses a range of issues, including (but not limited to) definitions of sex and gender, trans/feminist histories, racism, autogynepilia, “rapid-onset” gender dysphoria, detransition, access to public toilets, and contestation over the “TERF” acronym (“Trans Exclusionary Radical Feminism”) itself. We have been privileged to work with a range of amazing authors, including Jay Bernard, Lua da Mota Stabile, Jen Slater, Charlotte Jones, B Camminga, Rowan Hildebrand-Chupp, Florence Ashley, Julia Serano, María Victoria Carrera-Fernández, Renée DePalma, Emi Koyama, Cristan Williams, and Sally Hines.
I am proud of what we have achieved, and hope the collection will serve to move some of these debates forward. However, I also believe it is important to emphasise that trans people face far more significant issues than debates within feminism.
I have long felt that the “TERF wars” are a distraction from the endemic discrimination and gross inequalities faced by trans people in all areas of public and private life. There is a reason that my own research and activism has focused primarily on healthcare, both before and during the editing of this collection (which I have very much treated as a side project). Arguing with strangers about sex and gender on Twitter won’t reduce waiting lists or stop doctors from sexually assaulting patients. Equally, it becomes harder to concentrate on the task in hand when vicious anti-trans columns are constantly published in the mainstream media, and when your research plans are derailed by a malicious Freedom of Information requests from anti-trans campaigners hope to access your work emails.
There is no easy solution to this conundrum. However, I urge readers to consider how they, personally, might aim to move beyond the TERF wars. My main hope for this edited collection is that will be helpful for people to better understand this particular realm of transphobic discourse, and to counter harmful and inaccurate arguments. Having done so, I urge you to turn to the real tasks of trans liberation: fighting sexism, racism, and ableism, protecting personal autonomy, building collective solidarity and mutual aid networks, providing services to our communities, and imagining new worlds.
This is a deeply strange time to have a new peer-reviewed article out. I’ve been on strike for weeks, and otherwise on annual leave, planning a move south (for my new job) which may well be indefinitely postponed. It’s hard to comprehend the enormity of the COVID-19 crisis, nor the fact that the most helpful thing I can do right now is stay put.
The article was originally drafted in 2018, and based on experiences I had during fieldwork and while disseminating my research between 2013 and 2017. With the pandemic upon us, this previous decade feels like deep, distant history. Here in the UK, the true, awful toll of the illness is yet to become apparent; yet cities are beginning to turn silent as we self-isolate, political axioms are turned on their head, and all conversation turns eventually to the virus.
In this context, it’s easy to wonder if any of the work we did a month or more prior could possibly still be relevant. And yet.
My new piece is titled A Methodology for the Marginalised: Surviving Oppression and Traumatic Fieldwork in the Neoliberal Academy, and it is published in Sociology, the journal of the British Sociological Association. I use my experiences as a trans academic as a case study to talk about the huge inequalities endemic within universities, and how these disproportionately impact those who already experience forms of social marginalisation. My aim is not simply to chronicle the harms of marketisation, transphobia, sexism, and racism, but to also propose a way forward. We need to start thinking and acting more collectively; in addition to workplace organisation and union activity, this is relevant to how we design and implement our studies.
My proposed “methodology” involves bringing questions of solidarity and mutual support to the procedure of research design. Universities have long been bastions of privilege, with mechanisms of exclusion are unthinkingly built into every aspect of academic life. The only way we can possibly open up higher education is through creating systems of support which acknowledge and account for pre-existing inequalities, and these must be embedded within the process of knowledge creation itself.
My article uses the example of suicide within trans communities to illustrate this principle. Suicide ideation and suicide attempts are especially common among trans people. As such, it is highly likely that any given trans academic will either be suicidal, or will have friends who are. Consequently, if trans people are to stand a reasonable chance of surviving within the university, this is something that should be accounted for in research design and funding proposals as well as in wider institutional support structures.
It’s impossible right now to know when and if the world will return to “normal”. I have seen some contend that this cannot be possible given the devastating number of predicted deaths, the shock to our economic and political systems. Others observe that the prevailing social order has survived before, and argue that any emergency measures to support workers who have lost their livelihood and/or increase police powers will inevitably be reversed in the long term.
However, what we do know is that universities have historically been remarkably resiliant – as have the inequalities in our society. Whatever happens next, we must continue to fight for a better world, and that includes within academia.
We can already see this beginning to play out in the UK as universities scramble to shift their activities online. Managers are relying on staff to carry on teaching, conducting research, and undertaking assessment and monitoring activities such as the REF. Meanwhile, most of us struggle to balance working from home with looking after partners, housemates, and/or families, wrestling with IT systems that have been heavily undermined by cuts as shiny new buildings stand empty on our campuses. We cannot possibly expect to carry on as normal.
It is in this context that I invite you to read my new article, as and when you find the time and mental energy. It is one of the most difficult and vulnerable things I have ever written. I am really proud of it. It helped me think through some small ways in which I might change my work patterns and practice of solidarity, as part of a far larger push for change. I hope that in turn, it might help you also.