March 31 is Transgender Day of Visibility, and we’re asking you to bring visibility to trans issues by writing letters to healthcare decision makers.
Your letter could be your opinions, or your own personal experience with gender affirming healthcare – whether your experiences were positive or negative. Personal experiences touch hearts, so speaking about the impact which healthcare struggles or joys had on you and your emotions can be a strategic decision.
A flood of letters from trans people can make a huge difference, going far, far beyond raising visibility.
Context
The government is planning to replace the District Health Board (DHB) system through the Pae Ora healthcare reforms, so now is a great time to raise the profile of trans healthcare. In our Pae Ora Legislation submission, Gender Minorities Aotearoa focused on the current failure of the healthcare system to meet gender affirming healthcare needs.
You have a legal human right to receive appropriate healthcare, and you have a right to be heard when the government fails to provide it.
For the system to work, there need to be changes at every level: better funding leading to increased capacity to meet the demand without unreasonable surgical requirements, better administration creating better and consistent health pathways and better trained doctors who are not themselves an obstacle to transgender people getting the healthcare we need.
For these sweeping changes to happen, we need Health NZ, and the Ministry of Health, to show strong leadership by first acknowledging the problem and then taking effective action to fix it.
What we want
We call on the government to establish a healthcare system which meets the needs of all trans people. This means a system which acknowledges our rights under the Code of Health and Disability Consumer Rights to access necessary healthcare via informed consent/assumed competence. This also means a system which sustainably provides:
Voice therapy/training
Permanent hair removal by electrolysis, laser or IPL
Chest binding prosthetics (binders)
Chest reconstruction (double mastectomy and contouring)
Breast augmentation
Fertility preservation of both eggs and sperm
GnRH puberty suppressants (puberty blockers)
Quick and accessible readiness assessments to establish capacity for informed consent (only in situations when they are really needed)
A diverse range of hormone therapy options to suit the diverse needs that exist
Hysterectomies and oopherectomies
Orchiectomies/orchidectomies
Clearing the backlog for genital surgery, and a sustainable funding plan
Improved access to psychologists and counselors when needed
National, standardised pathways that relocate more responsibilities into primary care (GPs)
Where to send your letter
Your letter could be directed to the healthcare officials within the Ministry of Health, or the acting officials of the future Health NZ. It could also be directed to MPs who have more influence over how funding is allocated at the highest level, MPs who are already committed to championing rainbow rights, or MPs who hold a responsibility to speak out on healthcare issues.
Government healthcare officials
Health and Disability Review Transition Unit Department of the Prime Minister and Cabinet Parliament Buildings Wellington 6160
Dr Ashley Bloomfield (Ashley.Bloomfield@health.govt.nz) Ministry of Health 133 Molesworth Street Thorndon Wellington 6011
Martin Hefford, acting chief executive of the interim Health NZ – Martin.Hefford@health.govt.nz Ministry of Health 133 Molesworth Street Thorndon Wellington 6011
Members of Parliament
This includes MPs who have influence over the yearly budget, MPs whose portfolios cover healthcare, and MPs who are already supporters and who will be likely to amplify our concerns
Hon Grant Robertson MP (Grant.Robertson@parliament.govt.nz) Minister of Finance PO Box 18 888 Parliament Building Wellington 6160
Hon Ayesha Verrall MP Associate Minister of Health responsible for Rainbow Health PO Box 18 888 Parliament Building Wellington 6160
Hon Andrew Little MP Minister of Health PO Box 18 888 Parliament Building Wellington 6160
Dr Elizabeth Kerekere MP Green Party spokesperson for Health and Rainbow Communities PO Box 18 888 Parliament Building Wellington 6160
Chris Bishop MP National Party representative for the cross parliamentary rainbow network PO Box 18 888 Parliament Building Wellington 6160
Dr Shane Reti MP National Party spokesperson for Health PO Box 18 888 Parliament Building Wellington 6160
Submission on the Inquiry into Supplementary Order Paper 59 on the Births Deaths Marriage Relationships Registration Bill
We support the intent of this Bill, as amended by Supplementary Order Paper 59. This SOP reflects the preferred option outlined in the Regulatory Impact Statement and its assessment of mana motuhake / Self- determination of sex.
However, as it stands, we believe the SOP does not fully meet its intended aims in making accurate birth certificates accessible for transgender and intersex populations. We recommend the following six amendments.
Permanent residents who were born overseas
Clause 27A of the current Act specifies that anyone who is entitled to be in New Zealand indefinitely under the Immigration Act (2009) is eligible to use the Family Court process to gain legal recognition of their sex.
However removal of the Family Court process, while overall positive, will remove this sole option for permanent residents.
Permanent residents born overseas will no longer be able to go the Family Court to get a Declaration as to Sex, which has their correct sex recorded, based on their gender. This removes two existing rights:
– Permanent residents who were born in other countries that have a gender recognition law (e.g. the UK), used that Declaration as to Sex from the NZ Family Court as evidence to change their birth certificate overseas. They will no longer be able to do that.
– Permanent residents could use this Declaration as to Sex in NZ as proof of their correct sex / gender. This is especially important for people whose overseas passport has their old name and/or sex marker.
This is a backward step for permanent residents, including quota refugees (who arrive here as permanent residents).
Recommendation 01.
That the NZ government ensures permanent residents retain their right to legal gender recognition, through an administrative process based on self-determination (self-identification) so that it is consistent with the changes the Bill is making for other trans and intersex people in Aotearoa.
Transgender people on a temporary visa
(A) The Bill provides no options for asylum seekers and Convention refugees on temporary visas.
The current legal situation:
– Asylum seekers and Convention refugees on temporary visas cannot change their name in NZ or go to the Family Court to get a Declaration as to Sex.
– Once an asylum seeker is accepted as a Convention refugee, they have the right to live in Aotearoa indefinitely and cannot be deported. New Zealand is their home, and yet they cannot obtain an official document with their correct name and gender.
– The Bill / SOP explicitly excludes them because they were born overseas.
(B) The Bill provides no options for other migrants in NZ on temporary visas.
The current legal situation:
– The existing Family Court process and the Bill both exclude migrants living in New Zealand who are on temporary visas. Some may have lived in New Zealand for a long time.
– Trans people born overseas, particularly trans people of colour, are regularly asked to show their passport to prove their immigration status, including their ability to work or study here. They face significant challenges when they have no New Zealand documentation with a name and sex marker that matches their affirmed gender.
Recommendation 02.
That the NZ government issues transgender and intersex asylum seekers and Convention refugees with an official identity document which shows their correct name and sex marker through a self-declaration process. For example, this could be through a certificate of identity issued by the Department of Internal Affairs and/or the Immigration New Zealand.
That the NZ government explores options for migrants on temporary visas to be able to obtain an official document with their correct name and sex marker through a simple, administrative, self-declaration process.
Multiple amendments to sex marker
Clause 22B in the Bill that was referred back from Select Committee included significant restrictions on people’s ability to amend the sex recorded on their birth certificate more than once. The SOP significantly improves the Bill by allowing for multiple changes of a sex marker over time. However new clause 22B(1)(d) signals that additional requirements may be imposed in regulations. It says:
(1) An application by an eligible person for registration of the person’s nominatedsex must— . . . . (d) if the Registrar-General has previously registered a nominated sex forthe person under section 22D, meet any additional requirements set outin regulations;
The Select Committee’s website notes that “The SOP aims to provide better support for the needs of transgender, non-binary, and intersex communities”. It is important that our communities are not only consulted but also resourced to participate fully in discussions about what, if any, additional requirements might be needed in regulations.
The Regulatory Impact Statement and Cabinet Paper suggest that the chief concern for the government as to why people should be restricted from changing their sex marker more than once was to prevent the likelihood of identity fraud. However, the Cabinet Paper makes it clear that a record of sex marker changes will be kept by DIA. Therefore, steps have been taken to mitigate the risk of identity fraud.
The SOP also clarifies in new clause 22B(2) this this requirement “does not apply if the nominated sex is the same as the information relating to sex registered in the person’s original birth record”.
This provision is useful for the small number of people who affirm a transgender identity, and later decide to affirm a cisgender identity again (sometimes called “retransition”). If there are no additional requirements for this group of people, then It is hard to see what rationale there is for developing regulations that require extra steps for other people making their second or subsequent application to amend their sex marker.
A study of 28,000 people showed that 8% of respondents experienced retransition. Of those who did, 62% said that they only did so temporarily, and the most common reason for retransition was pressure from a parent. There were also instances of being pressured to “go back into the closet” by parents, schools, therapists, or faith community leaders. [1]
There are many reasons why someone may wish to amend their sex marker. For some people this includes not feeling it is safe enough to maintain a transgender identity. Regulations should not creates unnecessary barriers for them to re-affirm their transgender identity when it is safe for them to do so.
Others may have wanted a non-binary option on their birth certificate, but the current law has not given them that choice. This means there are likely to be people who chose the second-best option of changing their sex marker from female to male or vice versa, who will now want to amend it to non-binary. They should not be required to meet any additional regulatory requirements simply because the law has finally provided a way for them to accurately self-identify their sex. [2]
Recommendation 03.
Ensure that trans, non-binary and intersex people are not required to meet unnecessary additional requirements when making subsequent changes to their sex marker by:
– removing new clause 22B(1)(d) unless there is a strong evidence-based rationale for making this distinction based on a person’s gender identity, or
– consulting trans and intersex led organisations and individuals on any regulations developed in relation to this SOP, including by resourcing them to participate fully in those processes.
Youth access to correct identity documents
Youth aged 16 or 17
The introductory letter to Cabinet of the proposed changes, from the Office of the Minister of Internal Affairs, specified on page 9 that people aged 16 and 17 should be able to make their own application to amend their sex marker, with either the support of their guardian or a qualified third party.
This was also reflected in the Regulatory Impact Statement, which made the same recommendations. This is now reflected in new clause 22B(1)(c) and is a significant improvement on the Bill’s previous requirement which required support from both a legal guardian and a qualified health professional.
This proposed amendment is particularly important for trans people who are rejected by and estranged from their family and recognises the diversity of qualified people that may be providing them with support.
However, as 16 is the age of consent, both for sexual intercourse and for consenting or refusing consent for particular medical procedures, it is difficult to understand why a 16 or 17 year old would need additional consent from either party for a simple administrative update.
Youth aged 15 or younger
Under the proposed SOP transgender children aged 15 or younger would be required to have an application filed on their behalf, with the support of both a legal guardian and a health professional.
It is very common for transgender children and youth to be in the care of guardians who are unsupportive. [3]
The child’s right to an accurate birth certificate must be inclusive of children who are in the care of an unsupportive or discriminatory guardian.
Recommendation 04.
– Remove 22B(1)(c), allowing a 16 or 17 year old to make this decision.
– Amend new Clause 22C (1) (d), so that either a legal guardian or a health professional may make the application on behalf of a child aged 15 or under.
Sex categories
The cabinet papers recommended that a range of non-binary sex categories should be available, and that these categories should not be fixed in legislation. They also recommended a consultation process to determine what these categories should be.
The Supplementary Order Paper says:
New clause 22B(1)(a) and new clause 22C(1)(a) enable a person to specify male, female, or any other sex or gender specified in regulations as the person’s nominated sex.
Recommendation 05.
Consult with transgender, non-binary, and intersex people and organisations on any regulations developed in relation to further sex or gender options for birth certificates, including by resourcing them to participate fully in those processes.
Birthing parents
Clause 11(2) and 11(3)(c), and 12 (3) refer to notice of birth. The language used presumes that a birthing parent is always a woman, when this is not the case.
Recommendation 06.
Amend Clause 11(2) and 11(3)(c), and 12 (3) references to ‘the mother’ and ‘the woman’. Instead use legally accurate language such as ‘the birthing parent’.
Citations:
[1] The Report of the 2015 U.S. Transgender Survey – James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). Washington, DC: National Center for Transgender Equality (2015).
[2] Counting Ourselves National Transgender Health Report Aotearoa NZ – Veale J, Byrne J, Tan K, Guy S, Yee A, Nopera T, & Bentham R (2019).
You can find more information about our free transgender IPL club, clinics in other areas, and WINZ funding to help with treatment in other regions below. If you can’t find what you’re looking for, get in touch.
Submission on the Conversion Practices Prohibition Legislation Bill
We support the intent of this Bill, however as it stands we believe it does not fulfill it’s intent to protect transgender populations from conversion practices. The following are our main (though not only) concerns.
Every year we hear the personal stories of a great number of transgender people who have experienced conversion practices in healthcare settings.
They are offered anti-depressants as an alternative to being trans, or told that are simply confused and need counseling, while being referred to a counselor who doesn’t “believe in” being transgender.
Conversion Practices Carried Out in a Healthcare Setting
The Bill states that:
The purpose of this Act is to—
1. prevent harm caused by conversion practices; and 2. promote respectful and open discussions regarding sexuality and gender.
However, in its current state it defines conversion practices as not including conversion practices which are carried out in a healthcare setting. This allows healthcare providers to continue to engage in conversion practices with vulnerable patients, and effectively excludes transgender and intersex people from protection in the setting where they are most likely to experience conversion practices.
In clause 5, the Bill states:
Meaning of conversion practice
(1) In this Act, conversion practice means any practice that—
a) is directed towards an individual because of the individual’s sexual orientation, gender identity, or gender expression; and b) is performed with the intention of changing or suppressing the individual’s sexual orientation, gender identity, or gender expression.
(2) However, conversion practice does not include—
a) a health service provided by a health practitioner in accordance with the practitioner’s scope of practice; or b) assisting an individual who is undergoing, or considering undergoing, a gender transition; or c) assisting an individual to express their gender identity; or d) providing acceptance, support, or understanding of an individual; or e) facilitating an individual’s coping skills, development, or identity exploration, or facilitating social support for the individual; or f) the expression only of a religious principle or belief made to an individual that is not intended to change or suppress the individual’s sexual orientation, gender identity, or gender expression.
The Bill compares this to similar legislation in Australia, however, all the similar exemptions in the Victoria Act are prefaced by the requirement that the practice “is supportive of or affirms a person’s gender identity or sexual orientation”.
This exemption for conversion practices in healthcare settings is not something that was suggested in the Regulatory Impact Assessment (RIA). The RIA only suggested that conversion practices are not common in healthcare settings. While this may be true for gay, lesbian, bisexual, and other sexuality minorities, it is complely contradictory to the available evidence on transgender and intersex populations, including the evidence cited by the RIA.
We need to ensure that this error is not carried through into the legislation and compounded.
Conversion Practices in Healthcare Settings Target Transgender People
The Counting Ourselves (2019) transgender research report found that more than one in six of all participants (17%) reported that a professional, “such as a psychiatrist, psychologist or counsellor”, had tried to stop them being trans or non-binary. A further 12% were not sure if this had happened to them. (p.38).
Researchers asked (p.37) “Have you had any of these things ever happen to you, as a trans or non-binary person, when you were trying to access healthcare? You were discouraged from exploring your gender…” This means that while trying to access healthcare, these transgender people were told that they should stop being transgender. This is conversion therapy, in a healthcare setting.
16% of trans people said yes, they had experienced this. 4% said they had experienced this in the last year. This means 16 out of every 100 transgender people face routine conversion therapy from doctors, therapists, and other professionals in a healthcare setting.
While healthcare practitioners must be able to make medical decisions in the best interest of their patients, that is not what conversion practices are. This Bill should not include exceptions for carrying out conversion practices in healthcare settings.
If we acknowledge that conversion practices are harmful and we want to protect rainbow people from them, we should not exclude transgender people from these protections by allowing their abuse in healthcare settings.
Nothing raised in the Regulatory Impact Assessment suggests that including conversion practices done by healthcare practitioners in the definition of conversion practices would create any issues or further risks.
Conversion Practices in Healthcare Settings Target Diverse Sex Characteristics
The exclusion from the legislation of conversion practices that are directed/performed on the basis of sex characteristics is also unacceptable. While sexual orientation, gender identity, and gender expression are currently protected in the wording of the Bill, the Bill as it stands would allow conversion practices that target people on the basis of their variations of sex characteristics, or that aim to change their sex characteristics. This affects almost all transgender people – whose sex characteristics are not typically associated with people of their gender.
Historically, conversion practices have almost always been targeted at people based on perceived mismatches between their sex characteristics and other aspects of their sexuality and gender. Sex characteristics have often been a specific target of coercive control. It is important that the definition of conversion practices in this Bill encompasses all types of conversion therapy.
It is not necessary to use a narrow framework here: most strong definitions of conversion practices, and indeed most human rights frameworks that intend to protect rainbow communities, such as the Yogyarkata Principles plus 10, and the PRISM report by the Human Rights Commission, do not exclude sex characteristics. This is especially relevant because the Conversion Practices Prohibition Legislation Bill includes an amendment to the Human Rights Act, and therefore the definition of conversion practices in that Act will be based on the language in this Bill, should it become an Act.
If conversion practices on the basis of sex characteristics are not prohibited by this Bill, these harmful practices will continue in Aotearoa.
Nothing raised in the Regulatory Impact Assessment suggests that it would create any risks or issues to include conversion practices on the basis of sex characteristics, or aimed at changing sex characteristics, in the definition of conversion practices.
What Needs to Change
The RIA identified a risk that conversion practitioners may adapt their practice to get around the legislation, while still performing conversion practices. In our professional opinion, this risk applies in healthcare settings. Therefore, it is imperative that the definition of “conversion practices” is robust.
Conversion practices in healthcare settings must be included in this definition, along with the explicit addition of conversion practices on the basis of “sex characteristics” alongside “sexual orientation, gender identity, or gender expression.”
A super quick guide to writing a letter to the editor of a newspaper
A letter to the editor is a short opinion piece submitted to a newspaper. The opinion page is one of the most widely read pages in the newspaper. This means it’s a great way to get your message out to the public.
What you can write about
The first thing you need to know is that you can only write a letter to the editor in response to article which their outlet published. Alternatively, if you’ve read a letter to the editor in their paper, you can write in response to that.
Getting published
it’s usually best to send your letter to the editor by email, on the same day as the item you’re responding to. This means your letter can be published in the next day’s paper. Include the subject line ‘letter to the editor.’
Make your letter under 200 words long. Ideally use fewer than 25 words per sentence, one to three sentences per paragraph, and three to five paragraphs maximum. So stick to just a couple of points, and explain them succinctly.
Your letter needs to make sense on it’s own, because the original article will have been published on a different day. Be concise, educational, and compelling. Get straight to the point, and set your argument out logically. In other words, a well written letter is much more likely to get published. Use facts and statistics if you can.
If you want a particular MP to read your message, mention them. They care about how the public thinks about them, and whether their stance on an issue is appreciated or not.
Your letter is most likely to be published if it offers a different perspective, however, the message is more important than the messenger. Avoid saying things like “as a transgender person”.
Lastly, include a call to action. Let people know an action they can take or how they can contact you. You must write your name and full address, though your exact address/street will will not be published.
