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.”
While transgender people make up about 1% of the general population, they make up at least 10% of the autistic population. Some studies suggest 23% or higher.
Studies also suggest that while autistic people make up around 5% of the general population, they make up 13% of the transgender population.
Autism diagnosis by gender
A 2018 study (linked below) shows autistic people’s responses across a range of issues, alongside responses from non-autistic people who have an autistic relative, and the responses of those who are neither autistic nor have autistic relatives (usually professionals who work with autistic people). It is not a representative study, but it is an enormous study by any research standards with over 11,000 respondents from across many different autism forums in several different countries.
1. Autistic respondents preferred the term “autistic person” (52%) rather than “person with autism” (12%). “Both” was selected by 28%, and “neither” was selected by 9%. In contrast, non-autistic respondents strongly preferred “person with autism”.
2. When asked if they identified as LGBT+, 7% of non-autistic respondents answered yes, while 38% of autistic respondents answered yes. 20% of respondents who said they might be autistic answered yes.
3. When asked if they were cisgender (not transgender), 17% of non autistic respondents replied no, while 23% of autistic respondents replied no.
4. There was a major correlation between being non-binary and being autistic.
5. Autistic respondents were more likely than non-autistic respondents to disagree with the statement “I have a religious faith”, and this was especially so for non-binary autistic respondents.
6. When asked if they agreed with the statement “I identify as liberal rather than conservative”, over 42% of autistic respondents strongly agreed, and over 20% agreed..
“Many autistic advocates prefer “identity-first” language (“autistic person” instead of [“person-first” language] “person with autism”). Our disability is part of us, and we don’t want to dance around it. And please — don’t call us “high functioning” or “low functioning.” If you don’t respect our language, you don’t respect us.” – AAPD
Studies have shown that autistic people are less likely to make decisions based on “what everyone else does” and are more likely to make decisions based on pragmatism. They often have a strong sense of fairness and social justice. This may partly explain the liberal (rather than conservative) tendency, and openness to exploring their gender and attractions in non-heteronormative ways.
Autistic young people
7. 84% of autistic respondents disagreed (74% strongly disagreed) with the statement “I am concerned about a link between vaccines and autism” while 62% of non-autistic respondents disagreed (47% strongly).
8. Most autistic respondents said their school didn’t know how to provide for them.
9. Almost half of the autistic respondents who struggled in school did not have an academic learning difficulty.
10. Most autistic respondents were strongly against ABA (Applied Behavioral Analysis therapy) for children.
11. Autistic respondents strongly believed that autism awareness focused too much on children.
While we don’t have data on autistic trans students in Aotearoa, we know that 23% of trans students experience weekly (or more frequent) bullying in schools, while this is experienced by just 5% of their cisgender counterparts. We also know that this bullying is often not addressed appropriately, and not dealt with effectively. There are schools which make it difficult for trans students to attend; including not providing bathrooms, insisting on inappropriate clothing (eg. wrong gender uniforms), and not making school content relevant for them (eg. sex education teaching only about cisgender boys and girls). We also know anecdotally that bullying and accessibility issues are common for autistic young people. We believe there is crossover here.
Applied Behavioral Analysis therapy on children is considered by many to be analogous with conversion therapy. It focuses on teaching autistic people to “not act autistic” through rewards and punishment. It has been alarmingly popular with non-autistic people for a long time, but autistic adults are now speaking out against it.
“The stated end goal of ABA is an autistic child who is ‘indistinguishable from their peers’—an autistic child who can pass as neurotypical. We don’t think that’s an acceptable goal. The end goal of all services, supports, interventions, and therapies an autistic child receives should be to support them in growing up into an autistic adult who is happy, healthy, and living a self-determined life.” – Autistic Self Advocacy Network.
12. 72% of autistic respondents would not take a “cure for autism” if one existed, and 14% said they would. Of non-verbal and selective mute autistic respondents, 75% said they would not take a “cure”, and 12% said they would. 69% of autistic respondents with learning difficulties said they would not take the “cure”, and 16% said they would.
13. 34% of non-autistic respondents said they would not give a “cure” to an autistic relative, and 41% said they would.
14. Respondents who had a positive association with autism – as represented by those who selected “awesomeness” as a characteristic of autism – were much more likely to be anti-cure, to say “autistic person”, and to be autistic (especially if they also had an autistic relative).
15. Almost three quarters of autistic respondents struggled with employment.
16. 75% of autistic respondents felt socially isolated.
Many non-autistic people believe that it would be better if autism didn’t exist. Autistic people disagree. Autistic lives are worth living, just like trans lives are worth living. Stereotypes, prejudices, and discrimination are common, but it is these things – not autism – that autistic people would rather live without.
17. 60% of autistic respondents had an anxiety disorder, 42% had a Sensory Processing Disorder, 40% had depression, and 35% had ADHD, followed by digestive issues at 20%.
18. These conditions were consistently more common for non-binary autistic respondents (anxiety disorder 78%, depression 75%, ADHD 46%, digestive issues 40%). Non-binary autistic respondents had higher rates of Sensory Processing Disorders (56%) and Post Traumatic Stress Disorder (56%).
It is worth noting that male and female respondents were not separated by being transgender or cisgender, so it is possible that all transgender respondents had elevated rates of these conditions.
19. The most common effects of autism for non-binary autistic respondents were sensory issues (91%), anxiety (90%) and enthusiasm for special interests (90%).
Making environments accessible for autistic trans people means not only eliminating transphobia and providing appropriate bathrooms; but considering sensory needs, social stressors, and managing trauma triggers and responses.
20. Respondents were asked about empathy, and options included intense empathy, lack of empathy, both, and neither. Excluding the ‘both’ responses, 58% of autistic respondents ticked ‘intense empathy’, while only 11% ticked ‘lack of empathy’.
Including those who selected ‘both’, 67% had selected intense empathy. Responses were similar across non-verbal autistic respondents and autistic respondents with learning difficulties. Of the non-autistic respondents with an autistic relative, only 22% ticked intense empathy, while 27% ticked lack of empathy, and 47% selected ‘neither’.
Autistic respondents who are both non-verbal and have learning difficulties selected 60% intense empathy, 15% lack of empathy, 14% both, and 11% neither (a total of 74% intense empathy), while respondents who were non-autistic relatives of a non-verbal autistic person with a learning difficulty selected 51% neither, 32% lack of empathy, 13% intense empathy, and 3% both.
Autistic people are vastly more likely to feel intense empathy than a lack of empathy. But non-autistic relatives are likely to believe that they don’t feel intense empathy, and almost a third believe they lack empathy.
What it means
Autistic transgender people face unique challenges, and high levels of stigma and discrimination. Families, communities, and healthcare providers must be culturally competent and work to unlearn bias against autistic people, and recognise where this bias may affect the ways they interact with the autistic trans people they come into contact with.
GMA has a number of autistic transgender staff, and hears from many dozens of autistic trans people every year, who are struggling to access gender affirming healthcare at a disproportionate rate, and who are struggling with a lack of accessibility and safety in their schools, workplaces, and home environments.
It is common for autistic people to be denied gender affirming healthcare as their gender expression may not be binary, or because they may struggle to express or parents/clinicians may struggle to understand the autistic person’s complex ideas and understandings of gender. They may believe the autistic person is unable to fully understand the consequences of transition – most often due to difficulty with communication, rather than understanding. It is essential that a transgender diagnosis should not be withheld on the basis of a patient being autistic.
Further research is needed on autistic transgender experiences. GMA advocates for more research into autistic adults’ experiences, and for this to be developed by or in collaboration with autistic researchers and autistic populations, including those who are rainbow and transgender.
Any one of these parts on their own can be transphobia.
Stereotypes are widely held ideas about a certain group of people, which are oversimplified generalisations.
Prejudices are unjustified preconceived opinions, attitudes, thoughts, and feelings about a person, which often come from believing in stereotypes about the group they belong to.
Prejudice function in 3 main ways:
– Maintaining an exploitation/domination relationship (keeping people down). – Enforcing social norms (keeping people in). – ‘Disease avoidance’ (keeping people away).
Discrimination is the actions (including failure to act) based on prejudice.
This can include interpersonal discrimination in one’s private life, e.g. social exclusion, bullying and harassment, physical and sexual violence.
It can also include discrimination in public areas of life, e.g. exclusion from human rights protections, exclusion from other legal rights, exclusion from or discrimination in housing, healthcare, the justice system, accessing goods and services, recreation and sport, education, employment, etc.
Examples include: requiring medical interventions in order to gain an accurate birth certificate, landlords refusing to rent to trans tenants, inadequate access to appropriate healthcare services, schools or employers not taking action to keep students or employees safe.
67% of trans people report experiencing high levels of discrimination in NZ, 44% experienced this in the past 12 months (vs 17% of the general population).
Cognitive; thoughts about people.
Overgeneralised beliefs about people may lead to prejudice.
”Being trans is a sexual fetish”, ”They are dangerous”.
Affective; feelings about people, both positive and negative.
Feelings may influence treatment of others, leading to discrimination.
”I am genuinely afraid of sexual violence from trans women”.
Behavior; positive or negative treatment of others.
Holding stereotypes and harboring prejudice may lead to excluding, avoiding, and biased treatment of group members.
”I want to stop trans women from using women’s bathrooms” ”Trans people should be sterilized to change their birth certificate”.
It is very common for trans people to be stereotyped in a variety of ways, and to experience stigma and discrimination across all areas of life. The impact of widespread transphobia is the key factor in the disparities faced by transgender people.
These disparities include: being bullied in school (21% vs 5% general population), being forced to have sex against their will (32%, vs 11% of women in the general population*), poverty (trans people’s median income is half the median income of the general population), going without fresh fruit and vegetables (51%) and putting up with feeling cold (64%) – 3 times the rate of the general population, being asked invasive questions during a medical visit (13% in the last year), reparative [conversion] therapy (17%), avoiding healthcare visits to avoid being disrespected (36%), high levels of psychological distress (71%, vs 8% general population), suicidal ideation (56% in the last year), suicide attempts (37%).
Gender Minorities Aotearoa undertook research in the Wellington region in late 2019, in order to gain understandings of the circumstances surrounding homelessness for transgender people; their experiences of it, the support services required to address it, and the housing aspirations of those experiencing it. This report details the findings of the research in which 43 participants contributed.
These participants are mostly European/Pākehā young adults and gender diverse. A large proportion of them have had relatively stable home environments as children, yet many of them have experienced situations of homelessness from an early age. All of the participants disclose that they have at least one health condition, with the three most prevalent conditions being: mental health condition, neuro-diversity, and disability. For most, employment opportunities and incomes are limited.
The participants tend to move housing within the same region; moving across regions seems to be less frequent. However, most of the participants change sleeping arrangements frequently, from every few weeks to every few months. This is due to a number of concurrent and compounding factors such as poor quality housing, temporary availability, unaffordability, and eviction. All of the participants have been able to sleep in safe and relatively long-term housing at some point over the past five years, however, about two-thirds of them have also experienced unsafe, temporary, or exposed forms of housing.
When describing safe, stable and long-term housing, the participants mention affordability and good quality housing as key criteria, as well as positive relationships with flatmates; in particular, flatmates who are not transphobic or sex worker phobic. The characteristics of the neighborhood are also important to consider (e.g. close to public transport and services). Finding appropriate housing is impacted by experiences of stigma and interpersonal prejudice, structural and systemic discrimination, potential changes to whānau composition, and limited financial capacity; necessitating moving frequently to try to improve one’s situation. To help in their search for suitable housing, the participants rely on their close networks such as friends and family, and the use of technology including social media and apps. Many also contact professional organisations or support services. A range of other strategies are used, including the provision of semi-commercial sexual services.
A number of recommendations are provided to help address some of the disparities highlighted in this research. They include an emphasis on prevention and better access to the welfare system, as well as the delivery of timely and integrated support services when people experience homelessness. Safety is a critical factor and needs to be reflected in the provision of temporary/emergency housing, as well as long-term housing (e.g. council and public housing aimed at trans and non-binary people). These need to be complemented by other actions to address disparities and assist people to sustain their housing. For example: reducing discrimination across education and employment in order to be able to afford rent; better access to appropriate healthcare services to enable trans people retain employment; and education campaigns to reduce stigma and discrimination.
Counting Ourselves, a national report on transgender health, has just been released.
The survey had 1,178 participants, from all regions of Aotearoa, ranging from 14 to 83 years old.
The research, funded by the Health Research Council and with support from University of Waikato and Rule Foundation, found that trans people experience discrimination at more than double the rate of the general population, almost half of trans people had someone attempt to have sex with them against their will since age 13, and almost a third reported someone did have sex with them against their will since age 13. Participants reported high or very high levels of psychological distress at a rate nine times that of the general population. In the last 12 months, more than half had seriously considered suicide, and 12% had attempted suicide.
In the last 12 months, 13% of participants were asked unnecessary or invasive questions during a health visit
17% reported they had experienced reparative therapy (a professional had tried to stop them from being trans)[note: sometimes called “conversion therapy”]
36% avoided seeing a doctor to avoid being disrespected
Stigma, Discrimination, and Violence
67% had experienced discrimination at some point
44% had experienced discrimination in the last 12 months – this was more than double the rate for the general population (17%)
21% were bullied at school at least once a week, much higher than the general population (5%)
83% did not have the correct gender marker on their New Zealand birth certificate
32% reported someone had had sex with them against their will since they were 13
47% reported someone had attempted to have sex with them against their will since they were 13
Compared to the general population, participants were almost three times more likely to have put up with feeling cold (64%) and gone without fresh fruit or vegetables (51%) in order to reduce costs.
Distress and Suicide
71% reported high or very high psychological distress, compared with only 8% of the general population in Aotearoa New Zealand
56% had seriously thought about attempting suicide in the last 12 months
37% had attempted suicide at some point
12% had made a suicide attempt in the last 12 months
Participants who reported that someone had had sex with them against their will were twice as likely to have attempted suicide in the past year (18%) than participants who did not report this (9%)
Participants who had experienced discrimination for being trans or non-binary were twice as likely to have attempted suicide in the past year (16%) than participants who did not report this discrimination (8%)
Participants’ rate of cannabis use in the last year (38%) was more than three times higher than the general population (12%)
57% reported that most or all of their family supported them. Respondents supported by at least half of their family were almost half as likely to attempt suicide (9%).
62% were proud to be trans, 58% provided support to other trans people, and 56% felt connected with trans community.