Earlier this month, the National Center for Transgender Equality and the National Gay and Lesbian Task Force released the National Transgender Discrimination Survey Report on Health and Health Care (pdf). Reliable statistics on trans* people are notoriously difficult to come by, and among those that exist, many are outdated and/or derived from very small sample sizes. This U.S. survey included over 6,400 trans women, trans men, and people imperfectly grouped together as “gender non-conforming,” from all 50 states, plus the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. That makes it really big news, and a really important resource for information.
Sadly but far from surprisingly, there’s a lot of bad news. From the key findings of the report:
- Survey participants reported very high levels of postponing medical care when sick or injured due to discrimination (28%) or inability to afford it (48%);
- Respondents faced significant hurdles to accessing health care, including:
- Refusal of care: 19% of our sample reported being refused care due to their transgender or gender non-conforming status, with even higher numbers among people of color in the survey;
- Harassment and violence in medical settings: 28% of respondents were subjected to harassment in medical settings and 2% were victims of violence in doctor’s offices;
- Lack of provider knowledge: 50% of the sample reported having to teach their medical providers about transgender care;
- Despite the barriers, the majority of survey participants have accessed some form of transition-related medical care; the majority reported wanting to have surgery but have not had any surgeries yet;
- If medical providers were aware of the patient’s transgender status, the likelihood of that person experiencing discrimination increased;
- Respondents reported over four times the national average of HIV infection, 2.64% in our sample compared to .6% in the general population, with rates for transgender women at 3.76%, and with those who are unemployed (4.67%) or who have engaged in sex work (15.32%) even higher;
- Over a quarter of the respondents misused drugs or alcohol specifically to cope with the discrimination they faced due to their gender identity or expression;
- A staggering 41% of respondents reported attempting suicide compared to 1.6% of the general population, with unemployment, low income, and sexual and physical assault raising the risk factors significantly.
All of these points are really important, but I think the final bullet bears special mention, in light of the recent media attention on the high suicide rate for gay, lesbian, and bisexual youth that has almost entirely ignored the suicide epidemic among trans* youth. An attempted suicide rate over 25 times higher than the general population is profoundly distressing, and points rather strongly to systemic discrimination harassment, and huge gaps in health care, including mental health care. Indeed, the report notes in part:
Those who were bullied, harassed, assaulted, or expelled because they were transgender or gender non-conforming in school also reported significantly elevated levels of suicide attempts (51% compared with 41% of our sample as a whole). Most notably, suicide attempt rates rise dramatically when teachers were the reported perpetrators: 59% for those harassed or bullied by teachers, 76% among those who were physically assaulted by teachers and 69% among those who were sexually assaulted by teachers. These numbers speak to the urgency of ending violence and harassment of transgender students by both their peers and their teachers.
Those who had survived violence perpetrated against them because they were transgender or gender non-conforming were at very high risk; 61% of physical assault survivors reported a suicide attempt, while sexual assault survivors reported an attempt rate of 65%.
The rates of harassment, refusal of care, and even violence in medical settings are also worth expanding upon.
We also asked whether respondents had been denied service altogether by doctors and other providers. Nineteen percent (19%) had been refused treatment by a doctor or other provider because of their transgender or gender non-conforming status.
Doctors’ offices, hospitals, and other sources of care were often unsafe spaces for study participants. Over one-quarter of respondents (28%) reported verbal harassment in a doctor’s office, emergency room, or other medical setting and 2% of the respondents reported being physically attacked in a doctor’s office.
Those particularly vulnerable to physical attack in doctors’ offices and hospitals include those who have lost their jobs (6%); African-Americans (6%); those that engaged in sex work, drug sales or other underground economies (6%); those who transitioned before they were 18 (5%); and those who are undocumented non-citizens (4%). In emergency rooms, those more vulnerable to attack include those who are undocumented (6%); those who have engaged in sex work, drug sales, or other underground economies for income (5%); those who lost their jobs (4%); and Asians (4%). Obviously, harassment and physical attacks have a deterrent effect on patients seeking additional care and impact the wider community as information about such abuses circulates.
Any violence and harassment in medical settings, while not an uncommon experience for members of marginalized groups, is terrifying and inexcusable. But for these who were unaware of them, these particularly high numbers should make one’s blood run cold.
It’s also necessary to highlight, as Helen G did in her post on the report at Bird of Paradox, that as bad as these numbers are on their face, a significant majority of respondents were white, and the data show sharp increases in discrimination levels for respondents of color in almost all areas that the survey covers, from HIV rates, to levels of violence and harassment, to suicide attempts.
These results show that trans* people are, through many various means, undeniably being systemically denied meaningful access to health care. This is just one more site of discrimination and violence among many faced by trans* people every single day in a transphobic society run by cis people who see their own gender identities as more real, more legitimate, and entitling them to more humane treatment. It’s harming and killing people all the time, and it should be considered an outrage and getting a whole lot more attention.
Check out the full report here (pdf format). As far as these types of reports go, this one is relatively short, very easily readable, and filled with informative graphics. And it includes much more important, detailed information beyond what I’ve included here.
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