Access to healthcare for transgender people

Transgender healthcare

By: Valiant Jacob, The City Law School, City, University of London

The transgender community have the attention of the public eye in recent times. Many are curious perhaps out of concern or ignorance as to the position of transgender people within public policy. One of the most prominent of these considerations is transgender peoples’ access to healthcare.

A 2014 survey found that 22% of transgender people in Europe felt discriminated against when seeking out access to healthcare in the last 12 months. This is concerning. Access to healthcare is an important consideration for transgender people as it is:

(a)  An important right

(b)   Necessary for transgender individuals seeking gender-affirming medical transition

Are protections in place for transgender people when accessing healthcare?  Are those protections codified in European Union healthcare law or policy?

A study published in the BMC Public Health analyzed healthcare access for minority groups based on gender identity, sexual orientation, race and ethnicity and religion or belief. They found that generally, EU legislation does provide protections on the above grounds. However, EU secondary law only provides specific protections based on sex and race/ethnicity. The other grounds are not explicitly addressed by EU secondary legislation.

The study also analyzed potential reasons for the absence of regulations regarding non-discrimination with regards to healthcare access. It outlines the division of competencies between the EU and the Member States. There is a reluctance on part of the Member States to adopt comprehensive anti-discrimination provisions at EU level especially with regards to codifying anti-discrimination for transgender people.

Therefore, due to the division of competencies, the European Union does struggle in codifying anti-discrimination policy. It is further complicated as Member States have such varying approaches when it comes to codifying access and care for transgender folks in their own nations.

The state of legal discrimination in the EU outlines inconsistencies in the treatment of transgender people amongst different Member States. Only 10 EU countries do not require a mental health evaluation in the provision of gender-affirming healthcare for transgender people. Furthermore, several Member States have the concerning growing trend of the requirement for sterilization for transgender people seeking gender-affirming healthcare.

There are also additional issues that transgender people have with access which is not just transphobic discrimination. There is also the issue of long waiting times to receive gender affirming care. It is an additional burden upon transgender peoples’ access to healthcare.

Additionally, there is the issue of arbitrary distinctions and limitations placed upon healthcare procedures (especially surgical treatments) for transgender people. These distinctions limit access to insurance funding for transgender folks by labelling procedures as medical vs. cosmetic. The result being inconsistent labelling of important gender-affirming treatments and arbitrarily limiting transgender people’s access to self-determination. These limits place  arbitrary hurdles before transgender people, imiting access and thus, preventing transgender people from receiving healthcare that they need.

There are, however,  positive movements within the EU for codifying and increasing access for transgender people within EU healthcare. The EPATH 2021 conference featured experts from several Member States: Sweden, Croatia, Denmark and Hungary, in which they discussed progress in transgender access to healthcare.

 Experts outlined inexperience on the part of healthcare professionals and within healthcare systems in managing transgender patients and the lack of specific protections. However, there is a heartening trend in which Member States are expanding standards of care and access for transgender people by increasing units in which gender-affirming services are provided and codifying standards of care for different age groups.

 Furthermore, there are trends within Member States prioritizing self-determination and de-psychiatrizing transgender healthcare. This is progress in light of some Member States requiring sterilization and refusal of access to transgender people on the basis of mental health concerns. These are positive steps taken on Member States’ initiative to tackle transphobic healthcare policies, which is a positive outlook for further developments of transgender peoples’ healthcare access. But, what of the European Union’s stance?

The EU Parliament had recently released a report which recognized transgender people’s need for comprehensive reproductive healthcare. It signals an important milestone as it heralds recognition by European Parliament of the needs and rights of transgender folks during rampant media-driven transphobic attacks. This recognition is also important as it understands that transgender people need comprehensive reproductive healthcare. The Parliament has taken a clear stance against sterilization and shows an understanding of the nuances of transgender healthcare needs.

Through European Parliament policy making, there is a clear call to action and recognition of transphobic violence that may exist in European Member States. There is a recognition that limiting access and placing burdensome requirements does amount to transphobic violence.  Through the report, Parliament calls upon the Member States to counter transphobic discrimination and protect transgender peoples’ rights to self-determination. Additionally, the European Parliament takes a firm stand against the sterilization requirements that some Member States require of trans people in their medical transition.

The European Union have made some progress in their provision of anti-discrimination policies and improving healthcare access for transgender people. It is especially heartening that there is a distinct call by the European Parliament to Member States about improving access to gender affirming healthcare for transgender people. Hopefully in the days to come, there will be greater access and development in transgender people’s healthcare policy.