Briefing for parliamentary debate on the recommendations of the House of Commons Women and Equalities Committee Transgender Inquiry: The danger of unintended consequences

Summary

  • The report of the House of Commons Women and Equalities Committee Transgender inquiry contains a number of welcome recommendations to improve the lives of transgender people in the UK.
  • Transgender people should have the same rights as anyone else to be free from discrimination, to access the services that they need and to be treated with dignity and respect.
  • However there are a series of recommendations in the report which, which, taken together, risk unintended consequences for the safety and wellbeing of women and girls.
  • Adopting these recommendations would mean that violent male offenders could demand access to women only spaces and services such as refuges, rape crisis centres and prisons simply by claiming to identify as a woman, whether or not this was the case.
  • There is already evidence that this is happening in the prison service in the UK.
  • There is evidence from both the UK and internationally of people who were born male entering women only spaces dressed as women and going on to assault women.
  • Whether or not these offenders are transgender is irrelevant since the recommendations in the report would facilitate this type of offending by making access to women only spaces dependent on an individual’s declaration that they identify as a woman with no need for any process of social or medical transition.
  • The report also makes recommendations to reduce the assessment time before puberty blockers and cross sex hormones can be prescribed to children.
  • Around 80% of children who present with Gender Identity Disorder (GID) go on to identify as their birth sex as adults. This would suggest the need for caution rather than encouraging early transition, particularly in view of the long term health risks of cross sex hormones.
  • Trans people have the right to access the services that they need and there are real concerns about the safety of transwomen in particular if they are housed in the mainstream prison population in line with their biological sex. However the Committee’s recommendations in these areas are not the best way to address these issues and threaten the safety and wellbeing of women and girls.

Recommendations of the Transgender Equality Inquiry

The House of Commons Women and Equalities Committee published the report of its Transgender Equality Inquiry in December 2015[i]. The report contains much to welcome. It highlights the discrimination, harassment and violence experienced by too many transgender people and exposes the need to improve transgender people’s confidence in the criminal justice system. It makes important recommendations to ensure that transgender people receive the healthcare that they need and are treated with dignity and respect throughout the health service. It identifies the failure to implement the 2011 Advancing Transgender Equality Plan and recommends a new strategy. All these represent important steps in improving the lives of transgender people in the UK.

However the report also contains a series of recommendations which taken together would have unintended consequences for the safety and wellbeing of women and girls. These are:

  • To ‘bring forward proposals to update the Gender Recognition Act, in line with the principles of gender self-declaration that have been developed in other jurisdictions’
  • ‘that the Equality Act be amended so that the occupational requirements provision and / or the single-sex / separate services provision shall not apply in relation to discrimination against a person whose acquired gender has been recognised under the Gender Recognition Act 2004’[ii]
  • That ‘the protected characteristic in respect of trans people under the Equality Act should be amended to that of “gender identity’

 

Amending the requirements of the Gender Recognition Act

At present the Gender Recognition Act allows for a transgender person to be granted a Gender Recognition Certificate (GRC) if they are: over 18, diagnosed with gender dysphoria, have lived as their new gender for 2 years and intend to continue to do so and apply successfully to the Gender Recognition Panel. There is no need for the transgender person to have had surgery or other medical treatment. Once a person has a gender recognition certificate they legally become their ‘acquired gender’.

The Committee recommends that the Gender Recognition Act be changed in line ‘with the principles of self-declaration that have developed in other jurisdictions’ to become an ‘administrative process centred on the wishes of the individual applicant[iii].

It is not clear exactly what this ‘administrative process’ would involve but it is likely to be based on models developed in other countries where all that is required is a signed statement of intent to live permanently as their acquired gender witnessed by a solicitor or commissioner for oaths[iv].

This would means that it would be possible for someone who was born male and had gone through no process of social or medial transition to legally declare themselves to be a woman. There are people who were born male and identify as female but have no wish to transition through surgery, hormones or other medical intervention. Some of these people may choose to present as male, while identifying as female[v]. There are others who identify as both male and female, sometimes presenting as male and sometimes as female.

Since there is no way to tell if someone genuinely identifies as a woman this would include people who were born male, actually identified as a man, but claimed to identify as a woman. Both the British Psychological Society and the British Association of Gender Identity Specialists raised concerns that this was already happening in prison in their evidence to the Transgender Equality Inquiry (see section on prisons below).

The proposals to amend the Gender Recognition Act are particularly concerning when combined with the proposals to amend the exemptions in the Equality Act for single sex services.

Removing the exemption for single sex services and employment in the Equality Act

The Equality Act allows for single sex services in certain limited circumstances if they are ‘a proportionate means of meeting a legitimate aim’. It allows for discrimination on grounds of gender reassignment in provision of single sex services if this is a ‘proportionate means of meeting a legitimate aim’. The Guidance on the Act gives an example specifically relating to women only services:

A group counselling session is provided for female victims of sexual assault. The organisers do not allow transsexual people to attend as they judge that the clients who attend the group session are unlikely to do so if a male-to-female transsexual person was also there. This would be lawful.[vi]

 The Equality Act also allows for certain jobs to only be open to members of one sex if there is a ‘genuine occupational requirement’. This can include specifying a women only job is not open to transwomen as one of the examples in the Guidance for the Act makes clear:

A counsellor working with victims of rape might have to be a woman and not a transsexual person, even if she has a Gender Recognition Certificate, in order to avoid causing them further distress.[vii]

It should not be hard to understand why a woman who has been a victim of sexual violence might not want to take part in a group therapy session with or receive counselling from someone who they consider to be male, regardless of whether that person identifies as a woman[viii].

The Committee recommends ‘that the Equality Act be amended so that the occupational requirements provision and / or the single-sex / separate services provision shall not apply in relation to discrimination against a person whose acquired gender has been recognised under the Gender Recognition Act 2004’. In support of this recommendation it cites a legal opinion provided by Claire McCann who was an advisor to the committee that excluding someone with a GRC would not be proportionate. However the committee has also recommended amending the Gender Recognition Act to make application for a GRC a process of self -certification. This would mean that there would be no requirement for a person to suffer from gender dysphoria, or a requirement to have lived in their acquired gender for two years and no panel process to test whether the application was genuine. A person could be born male, identify, live and present as a man and still be entitled to a GRC so long as they declared that they identified as a woman, even if this was not the case. In such circumstances it is hard to see how a decision to exclude such a person could never be considered proportionate.

This proposal would prevent women only services from excluding transwomen who had a GRC even if that meant that other women would not access the service, or if this risked women’s safety. It is clear from the EHRC advice in this area that the current exemption in the Equality Act does not permit a blanket ban on transgender people accessing single sex services. The exemption applies in situations like group counselling where other women might not access services if there was a transwoman present. There are rape crisis centres which provide help line support and one to one counselling to transwomen but do not invite them to take part in group therapy because this would prevent other women from taking part in the group. This might be a particular problem if the transwoman concerned continues to present as male. This policy balances the rights of transwomen who have experienced sexual violence to get support they need with the rights of other women to get the support they need. This policy would be illegal under the committee’s proposals.

Any policy has to be proportionate and relate to specific circumstances such as where the inclusion of transgender people might prevent others from accessing the service.

Taken together with the proposals to change the Gender Recognition Act this would mean that women only services would be obliged to offer services to people who were born male and presented as male, so long as they certified that they identified as women, regardless of the impact that this would have on other women accessing their services.

Extending the coverage of the Equality Act

The Women and Equalities Committee has recommended that: ‘the protected characteristic in respect of trans people under the Equality Act should be amended to that of “gender identity”.

The Equality Act does not provide protection to transgender or gender variant people who are not proposing to undergo, under-going or have undergone the process of gender reassignment (the definition of gender reassignment in the Act). Furthermore that the Act does not cover people ‘who do not identify exclusively as male or female’ or people who do not live permanently within their preferred presenting gender role or intersex people. There are people who were born male and identify as female but have no wish to transition through surgery, hormones or other medical intervention. Some of these people may choose to present as male, while identifying as female.[ix] There are others who identify as both male and female, sometimes presenting as male and sometimes as female. A major study of transgender people in the US found that 18% said that ‘they did not want to live full time in a gender other than that assigned at birth’ and concluded that

For many gender non-conforming people, transition as a framework has no meaning in expressing their gender — there may be no transition process at all, but rather a recognition of a gender identity that defies convention or conventional categories. For yet other gender non-conforming people, transition is a meaningful concept that applies to their journey from birth sex to their current identity, which may not be male or female.[x]

The Gender Identity Research and Information Service states that 650,000 people (1% of the population) are ‘gender incongruent to some degree’ [xi] and that of these a fifth might be expected to seek medical treatment for gender dysphoria, based on Dutch research that showed that 19% of men who cross dressed wanted ‘a complete role adaptation’[xii]. This would suggest that the majority of people categorised as ‘trans’ do not wish to permanently transition to live as the opposite gender to their biological sex.

There are two issues here. The first is the right of people who do not exclusively identify or live as male or female to be free from discrimination simply because of their transgender status. For example if a job was open to both women and men it would be wrong for a person who did not identify exclusively as either to be unfairly discriminated against in the recruitment process. Similarly it would be wrong for most goods and services that are open to the general community to be denied to a person simply because they did not identify as male or female or identified as both. However in the vast majority of cases people are not discriminated against because of how they identify, but because of how they present. Employers or service providers may discriminate against somebody they believe to be male who is dressing in clothes that they associate with women for example. This is a form of sex discrimination, based on the assumption that certain clothes and hairstyles or the wearing of make-up are only appropriate for women. Protection against this sort of discrimination should exist regardless of whether or not the person concerns identifies as a woman.

The second, more complex issue, relates to employment, goods or services that are only open to one sex. The law protects the rights of someone with gender dysphoria who wishes to transition to live permanently as a woman to be treated as a woman in most circumstances, and to be legally recognised as a woman through applying for a Gender Recognition Certificate. However should someone who was born male, sometimes or mostly presents as male but identifies as female automatically be entitled to access services aimed at or reserved for women? Should an organisation that provides services to women victims and survivors of violence be obliged to provide services to a person who sometimes identifies as male because they also sometimes identify as female? If the organisation does provide such a service would they be obliged to provide it at times when the person was presenting as male? How would that impact on the willingness of the other women who need those services to access them? This question becomes particularly problematic when combined with the proposal to remove the exemption in the Equality Act for single sex services.

Prisons

The report states that ‘there is a clear risk of harm, (including violence, sexual assault, self-harming and suicide) where Trans prisoners are not located in a prison or other setting appropriate to their acquired/affirmed gender’. This implies that Trans prisoners should be housed in line with their stated gender identity rather than their biological sex, regardless of whether they have a gender recognition certificate.

One of the cases cited in support of this conclusion is that of Joanne Latham who committed suicide in November 2015. However it is not at all clear whether Latham’s suicide was the result of being held in a man’s prison – Latham had only recently changed to a female name, had not requested a transfer to a women’s prison and had a history of mental illness. Latham was an extremely violent offender serving a series of life sentences, including for two attack on fellow inmates and was judged so dangerous that he had to be handcuffed to two nurses when seeing a lawyer. He had not had any hormonal treatment or surgery. The inclusion of Latham’s case suggests that the committee is suggesting that an extremely violent offender, who has undergone no process of transition, should be moved to a women’s prison immediately on announcing that they wish to be known as a woman. There is no discussion in the report of the possible dangers this might pose to women prisoners, nor how these should be addressed.

Two bodies representing gender identity specialists who take referrals from prisoners gave written evidence to the committee raising concerns about a number of sex offenders who the organisations believed were claiming to be Trans when they did not in fact identify as women. According to the British Psychological Society the reasons for this were:

  • As a means of demonstrating reduced risk and so gaining parole;
  • As a means of explaining their sex offending aside from sexual gratification (e.g. wanting to ‘examine’ young females);
  • As a means of separating their sex offending self (male) from their future self (female);
  • In rare cases it has been thought that the person is seeking better access to females and young children through presenting in an apparently female way.

The British Association of Gender Identity Specialists warned of:

‘The ever-increasing tide of referrals of patients in prison serving long or indeterminate sentences for serious sexual offences. These vastly outnumber the number of prisoners incarcerated for more ordinary, non-sexual, offences. It has been rather naïvely suggested that nobody would seek to pretend transsexual status in prison if this were not actually the case. There are, to those of us who actually interview the prisoners, in fact very many reasons why people might pretend this. These vary from the opportunity to have trips out of prison through to a desire for a transfer to the female estate (to the same prison as a co-defendant) through to the idea that a parole board will perceive somebody who is female as being less dangerous through to a [false] belief that hormone treatment will actually render one less dangerous through to wanting a special or protected status within the prison system and even (in one very well evidenced case that a highly concerned Prison Governor brought particularly to my attention) a plethora of prison intelligence information suggesting that the driving force was a desire to make subsequent sexual offending very much easier, females being generally perceived as low risk in this regard’.

The evidence from BAGIS is briefly referred to in passing in the report; ‘the press have reported cis-gendered males claiming to be trans in order to obtain privileges and Dr Barrett of BAGIS suggested that their might also be other more varied and sometimes sinister motives’. It goes on to dismiss these concerns, citing the Prison reform trust who ‘felt that the number of prisoners in this situation and the challenges they posed, might have been exaggerated’. However the Prison Reform Trust’s comments specifically related to press reports of prisoners who wished to ‘live in role’; living as a woman in a men’s prison. Their submission did not address the particular concerns raised by the BAGIS of prisoners who were claiming to be Trans in order to transfer to a women’s prison. Aside from this very brief mention there is no discussion of the concerns raised by either of the two organisations, nor of the implications that the committee’s proposals might have on the safety of women prisoners.

Treatment of children

On the treatment of children the report concludes that ‘there is a clear and strong case that delaying treatment risks more harm that providing it. The treatment involved is primarily reversible, and the serious dangerous consequences of not giving this treatment, including self harm and suicide are well attested. Accordingly, we recommend that, in the current review of the service specification and protocol for the Gender Identity Development Service, consideration be given to reducing the amount of time for the assessment that service users must undergo before puberty blockers and cross sex hormones can be prescribed.’

However the written evidence from the Tavistock clinic recognises that ‘Although pubertal suppression, cross-sex hormones and gender reassignment are generally considered safe in the short term, the long-term effects regarding bone health and cardiovascular risks are still unknown’. In an interview with the Guardian Dr Polly Carmichael, the consultant clinical psychologist who leads the Tavistock’s Gender Identity Development Service, argued that: “The blocker is said to be completely reversible, which is disingenuous because nothing’s completely reversible. It might be that the introduction of natal hormones [those you are born with] at puberty has an impact on the trajectory of gender dysphoria.” Her colleague Dr Bernadette Wren argued that “We have shifted to make the treatment available earlier and earlier. But the earlier you do it, the more you run the risk that it’s an intervention people would say yes to at a young age, but perhaps would not be so happy with when they move into their later adulthood.”

This suggests that puberty blocking treatment, far from being reversible and guaranteeing positive outcomes, may in fact lead to further problems later in life as young adults regret the decisions they made as children. Both puberty supressing treatment and cross sex hormone carry long term health risks. Some of the known risks of cross sex hormones include mood swings, increased risk of heart disease, diabetes, cancer and loss of fertility. It is widely recognised that there is insufficient evidence to show what the long term consequences of a life time on hormones might be. There is no evidence in the report that these risks were considered before the committee made its recommendations.

At the same time it is not clear that these treatments will improve outcomes for children presenting with gender identity disorders. The report accepts uncritically the argument from the organisation Mermaids that high levels of mental distress, self-harm and suicide among transgender young people will be alleviated by medical treatment in the form of puberty blockers and cross sex hormones. However there is little evidence that this is the case. The report refers to a Dutch study of 55 young people, cited by the Tavistock clinic in its submission, which appeared to show the benefits of early intervention. However the Tavistock submission makes clear that these findings ‘those young people who achieve good outcomes are more likely to be those who have experienced life-long gender non conformity and who start off with significant social advantages: chiefly, the absence of any serious psychological difficulties and the presence of strong family support’ and that ‘this is not the profile of a high proportion of GIDS clients’. The written evidence from the Tavistock clinic concludes that ‘the research evidence for the effectiveness of any particular treatment offered is still limited’.

Conclusions

There is a real need to ensure that Trans people have access to the services that they need, including services that are currently provided on a single sex basis. There are justifiable concerns about the safety of Trans people if they are housed in the main prison population based on their biological sex. These needs and concerns must be properly and sensitively addressed. However, the recommendations of the Women and Equalities Committee fail to recognise the very real risk of unintended consequences for women and girls as a result of their recommendations. There appears to have been no assessment of the impact of these recommendations on women and girls as required by the Public Sector Equality Duty.

We ask that Parliament request that the Committee revisits these recommendations, consults properly with women’s organisations and develops a new set of proposals that do not have these unintended consequences.

 

 

[i] House of Commons, Women and Equalities Committee, Transgender Equality, First Report of Session 2015-16 http://www.publications.parliament.uk/pa/cm201516/cmselect/cmwomeq/390/390.pdf

[ii] http://www.publications.parliament.uk/pa/cm201516/cmselect/cmwomeq/390/390.pdf

[iii] http://www.publications.parliament.uk/pa/cm201516/cmselect/cmwomeq/390/390.pdf

[iv] See for example the application process used in the Republic of Ireland

[v] See for example Danielle Muscato who presents as male but identifies as a woman https://www.facebook.com/daniellemuscato.page/?fref=nf or VarmitCayote https://www.youtube.com/watch?feature=youtu.be&v=MORAczk_m9w&app=desktop

[vi] http://www.legislation.gov.uk/ukpga/2010/15/pdfs/ukpgaen_20100015_en.pdf

[vii] http://www.legislation.gov.uk/ukpga/2010/15/pdfs/ukpgaen_20100015_en.pdf at 789

[viii] http://www.newstatesman.com/politics/2015/02/when-i-was-raped-it-was-female-only-spaces-helped-me-recover

[ix] See for example https://www.youtube.com/watch?feature=youtu.be&v=MORAczk_m9w&app=desktop

[x] Grant, J, Mottet, L, Tanis, J, Min, D, Harrison, J, Herman, J and Keisling, M, Injustice at Every Turn: Report of the National Transgender Discrimination Survey, The National Center for Transgender Equality and National Gay and Lesbian Taskforce. Available on line at: http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf

[xi] http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/women-and-equalities-committee/transgender-equality/written/19292.pdf

[xii] http://www.gires.org.uk/assets/Medpro-Assets/GenderVarianceUK-report.pdf