May 17: Call to Action on Trans* Rights to Equality in Health Care

Posted by Wayves by Wayves volunteer Hugo Dann 17/05/2013

Protesters and puppies at the NSRAP rally for International Day Against Homophobia & Transphoba in Grand Parade listen to Halifax's Raging Grannies sing in support of trans* and queer rights

By Kate Shewan

Six months ago, the trans* community along with most Nova Scotians applauded when the Government changed the human rights act to include gender identity and gender expression as protected categories, and in a rare show of unity there was unanimous support within the legislature.  And we have already seen examples of these protections having an impact on decisions when trans* people have faced discrimination or a lack of acceptance.

This was an important change in Nova Scotia and similar legislation at the federal level is currently in the Senate.  It is fantastic that we are witnessing this progress with specific recognition of the rights of trans-people. 

However legal recognition is only one step.  There was an expectation, or at least a hope,  within the trans* community that following the specific recognition of rights there would be policy changes brought in to address some of the challenges and discrimination faced by the trans* community.

Sadly we have seen very little follow up since the human rights changes, despite the overwhelming support for the changes.  The government needs to take the lead by addressing the instutitionalized and often hidden transphobia that is built into the system. The government needs to immediately address the policies within various departments that discriminate against trans* people.

An area that I want to specifically address today is the discrimination against trans* people that is built in, and in fact regulated into, the health care system.  There are a number of barriers to access of appropriate health care for trans* people, but the issue that I want to focus on today is access to surgeries.

As Trans* people, we are dealing with a situation where our gender identity, our deeply felt internal experience of our own gender, does not match the sex assigned at birth.  This often causes significant distress or discomfort and can impact all areas of life.  In some cases, it can lead to depression or other mental health concerns.  It can sometimes lead to feelings of shame or embarassment or difficulties in our personal lives and family relationships. 

Many trans* people will address this situation through a gender transition so that we can live our lives in the correct gender. Transition usually includes both a social component and a physical component, including medical intervention, to address the incongruity between our physical body and our gender.  Transition of this kind has been shown to greatly improve wellbeing for trans* people.  For many trans* people surgery of some kind is a hugely important piece of  the overall transition process and can play a major role in a successful transition. 

For example, a recent study of female-to-male transsexuals found significantly improved quality of life following hormone therapy.  Moreover, those who had also undergone chest reconstruction had significantly higher scores for general health, social functioning, as well as mental health.

In Nova Scotia, there is no public funding under the medical services insurance plan for surgery related to transition.  In fact, there is a clause in the MSI regulations that specifically excludes coverage through public health care for any transition related surgeries or as they are referred to:  “Gender reversal or trans-sexual surgeries.”

This has been used to deny coverage for all types of transition related surgeries for both trans-men and trans-women.  As we heard here last year, it has even been used to deny coverage for a hysterectomy that was required for reasons unrelated to transition, solely because the person requiring it was transgender.

It is accepted in the professional medical community that for many trans* people, transition related surgeries are medically necessary.  Gender identity disorder (or gender dysphoria as it will soon be known) is a recognized medical condition.  There is a detailed and thorough disgnostic process to identify the condition, and detailed protocols in place for determining the appropriate treatments, which may include surgeries.  This is not brand new territory, there are now decades worth of research and a strong body of evidence showing the positive outcomes to the well being of trans* people from these treatments.

WPATH, the World Professional Association for Transgender Health and the Canadian equivalent CPATH have a strong position that under certain conditions surgeries are medically necessary for trans* people.

WPATH stated, "The medical procedures attendant to sex reassignment are not "cosmetic" or "elective" or for the mere convenience of the patient. These reconstructive procedures are not optional in any meaningful sense, but are understood to be medically necessary for the treatment of the diagnosed condition."

Locally, Doctors Nova Scotia has written letters in support of NSRAP’s request to end the exclusion of coverage of surgeries in the treatment of trans* people.

The transgender community has for a long time been a marginalized community.  Rather than reaching out to help us, we are being singled out and specifically denied services that would benefit us.  The ban on funding makes surgery an impossible dream for many trans* people, leading to despair and a sense of hopelessness for many in the community and perpetuating the issues suffered within our community.  I also know of young, well-educated trans* people with bright futures, who  have been forced to leave Nova Scotia and move to provinces that offer this coverage rather than remain here. 

Those trans* people who are well off and can afford to pay out of pocket are able to access these services, while those less well off Nova Scotians are left with no access to these medically necessary procedures.  Surely this is not the healthcare vision of this Government.

Despite the fact that this government changed the Human Rights Act to make it illegal to discriminate based on gender identity or gender expression, they have not addressed the fact that they are specifically excluding medically necessary transition related surgeries from coverage under the public health care system.  These are procedures that meet all of the criteria under MSI but do not get covered because the regulations specifically exclude transition related surgeries.

Let me repeat that:

This Government, that has passed legislation to protect transgender people from discrimination, is itself continuing with the discriminatory practice of denying access to medically necessary procedures specifically because they relate to the person’s gender transition.

It is time for trans* people to receive equal access to medically necessary surgeries without discrimination.  We need to end the exclusion on funding for surgeries related to gender transition.  It is just the right thing to do. 

So today, on the International Day against Homophobia and Transphobia, I call on the Nova Scotia Government to do the right thing and immediately address the transphobia and discrimintation built into their own policies and regulations, starting with eliminating the discriminatory treatment of trans* people in the health care system.

Over the coming weeks and months, NSRAP will be pushing for these changes, I would ask all of you here to get behind this push for action.  Talk about the issues with your friends, sign the petition, write your MLA and let the Government know that it is time to make these changes. 

Editor's Note: The above photo shows Kate Shewan addressing the crowd at the May 16 rally. Originally from New Zealand, Kate Shewan spent five years living in England, before moving to Canada nineteen years ago, and has lived in Nova Scotia for the last five years.  She is a parent of three teenagers, an accountant by profession and is an active member of the transgender community in Halifax.  Kate has been the treasurer of NSRAP for the past year, having initially decided to become involved in advocacy and activism for trans* rights after facing discrimination at the hands of an insurance company, where she was denied coverage specifically as a result of her gender transition. Wayves is proud to publish her call to action for members of the community who couldn not attend the rally in Halifax on May 16.

The photo above is of Kate Shewan addressing the crowd on May 16. Photos by Kirk Furlotte. Wayves would to thank the Nova Scotia Rainbow Action Project for making both Ms. Shewan's speech and their photos available for publication.



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