We’re ‘so far behind’ on trans and gender-diverse health rights

So says the Human Rights Commission, launching its new report.

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Health professionals and organisations could do better when it comes to providing Australia’s transgender and gender diverse with equitable care, according to those at today’s launch of the latest Australian Human Rights Commission report.

Long wait times, under-resourcing of services, providers with limited training, misgendering, dead-naming and privacy breaches, as well as administrative difficulties in changing names on health records and identity documents, are just some of the issues faced routinely by trans and gender-diverse patients.

Report contributor Professor Sandy O’Sullivan, from the centre of Critical Indigenous Studies and the Centre for Global Indigenous Futures at Macquarie University, said:

“We’re so far behind … I’d be really happy with just not having a terrible time at the doctors.”

The report, Equal Identities: A human rights review of the experiences of trans and gender diverse people in Australia, was released today, the International Trans Day of Visibility. It drew on 97 submissions, in addition to Australian and international research, and made 19 recommendations.

“The one measure that we get all the time … is that Australia is really progressive on a lot of this, and what this report draws out is why and how we’re not and how that could change,” said Professor O’Sullivan.

The report was divided into three themes: being safe, being seen and heard (dignity) and being able to participate.

All of the themes cut across health policy and practice, but especially the second (dignity).

The report said there was a lack of consistent population data, limiting policy design, service delivery and accountability. It recommended that the ABS 2020 Standard, which provides best-practice questions (sex recorded at birth, current gender, sexual orientation and variations of sex characteristics), should be adopted for all governments and research.

Panellist and director of the Trans Justice Project Jackie Turner noted that there also needed to be clarity about why the questions were being asked, as in an environment where trans and gender diverse people were being targeted around the world, they worried the information might be used against them.

“The data we did have showed that trans and gender diverse people had poorer health outcomes due to stigma, discrimination and service inaccessibility,” the report said.

In addition to cost, long wait times and under-resourcing of services, they faced providers with limited training, misgendering, dead-naming and privacy breaches, as well as administrative difficulties in changing names on health records and identity documents.

Standards and reviews (and there needed to be more of those) showed that gender-affirming healthcare (which included hormone treatment and, for young people, puberty suppression under clinical governance) had positive outcomes, but there were many barriers to accessing it, including cost, geography, lack of professional training and false information, the report said.

“One of the big things that we’re seeing at the moment is the role of disinformation in the health side,” said Ms Turner.

“We know that there’s a number of actors that are working to try to undermine the science around gender affirming care. But what we know is that gender affirming care is important for so many trans people. It helps us lead good lives, it gives us the ability to thrive and feel at home in our bodies,” she said.

She said there was misunderstanding and ignorance about what gender affirming care was, and that was being exploited.

Ms Turner said more training of healthcare professionals, including GPs, was needed.

One of the report’s recommendations was that healthcare providers and training institutions “should ensure that all healthcare and healthcare-adjacent workers and students receive education and ongoing professional development on inclusive care for trans and gender diverse people. This includes awareness of how intersecting forms of discrimination can affect trans and gender diverse people’s health and access to healthcare services.”

She said expanding telehealth would be helpful, as well as Medicare item numbers to properly capture Trans and gender diverse healthcare, which currently had to be “cobbled together”.

Healthcare was not just about how trans and gender diverse people presented to the world, Ms Turner pointed out.

“It’s also in how we lead healthy lives. We know that trans people avoid seeking out healthcare of all kinds when they don’t feel safe in accessing their local GP or calling the nurses’ line these sorts of things,” she said.

The report recommended that:

• Federal, state and territory governments should reduce barriers that prevent trans and gender diverse people from accessing all forms of healthcare, including gender affirming healthcare
• Federal, state and territory governments should end pauses on puberty suppressants and other hormone therapies for children and young people and ensure that … Gillick competence and clinical standards of care are the framework guiding the provision of healthcare to trans and gender diverse children and young people; and,
• Federal, state and territory governments should introduce or amend legislation to ban conversion or suppression practices.

The recent decisions made in Queensland and the Northern Territory about gender affirming care had ignored families relying on that care and clinicians providing that care, said Ms Turner.

“There’s a big role in making sure that health professionals are actually standing up against this, because we know that the attacks on healthcare and bodily autonomy are a really worrying first sign of attacks on the rights and autonomy of all people,” she said.

“Once governments start making decisions about what healthcare we can access based on their own whims, that’s a really dangerous sign for so many communities.”

Professor O’Sullivan noted that older trans and gender diverse people also needed access to gender affirming care and were often excluded from trans and gender diverse services.

The report said that its recommendations focussed on actions that governments and service providers could take.

Trans and gender diverse people were already designated as a priority population, and organisations often had some LGBTQI+ representation, said report contributor and panel facilitator Budi Sudarto, but “progress has been painstakingly slow”.

As the report highlighted, organisations were responsible for making sure the needs of trans and gender diverse people were met, the panellists said.

There was a moral imperative, in particular, to keep public institutions and the frontline service sector accountable to the public for their role in ensuring trans and gender diverse people could access the services they needed, said panellist Elena Rosenman, CEO of Women’s Legal Centre ACT, and chair of Women’s Legal Services Australia – which included services designed for women.

The report recommended that “State and territory governments should review and amend their antidiscrimination legislation to ensure that trans and gender diverse people have equal access to publicly funded services, including those provided by religious bodies”.

It also recommended that the Department of Disability Health and Ageing “should require and report on LGBTIQA+ and trans and gender diverse representation in their workforce and on key advisory groups, committees and rapid reviews”, that it “establish a specific ongoing LGBTIQA+ Health Advisory Group” and that “The Australian Government Department of Education should require LGBTIQA+ and trans and gender diverse representation on key advisory groups, committees and rapid reviews [and] … establish an LGBTIQA+ Youth Advisory Group”.

Professor O’Sullivan said organisations had to move beyond just “finding a warm body” to fill representative roles and had to do better at evaluating their performance.

“Australia doesn’t do a very good job with evaluation. We know this. We know that evaluation is often a closed loop of reporting success on measures. We have to crack that open, and I believe this report allows us to do that,” said Professor O’Sullivan.   

Sex discrimination commissioner Dr Anna Cody, who wrote the forward to the report, said everyone had a role to play in ensuring the rights of trans and gender diverse people.

“Depending on where you’re coming from, what you want to get out of this report, I would say pick one of the recommendations, pick one issue and decide to take some action on it.

“So, if you’re in government, then think about how you can include trans voices meaningfully. Picking up Sandy’s point, not just a warm body, actually someone who can give you some meaningful input on how to improve your programs and policies. Is it an advisory group? How are you going to actually enact that?

“If you’re an academic, read through the report thoroughly. A lot of people won’t, but as an academic you probably will, and think about how to include those perspectives in your research.

“If you’re a community member, then think about one way that you can reach out, whether it be around access to healthcare or making it safe for people who you encounter in your daily life.

“Inform yourself, read poetry, read stories by trans and gender diverse people. We all need our minds to be opened. I love the idea of solidarity and also the potential of changing how we think because of our exposure to different ways of life and different ways of being. So that would be my idea of where to go from here, for each of us.”

Read the full report here.