Today is June 28th, which means that the world celebrates Pride Day one more time with people commemorating diversity and human rights nearly everywhere. In Spain, the festivities almost fall on the same date of the first anniversary of the approval of the so-called “Trans Law” project. The project for a decree, passed on June 29th last year, aims at improving LGBT+ people’s experience in society, especially trans people. Here, we will discuss its local and global relevance with a focus on health.
As mentioned, the Law of Identity and Expression of Gender and Social Equality and Non-Discrimination is directed to solve issues that concern the whole LGBT+ community, even though it has transgender people’s rights at its core. The main changes it proposes to implement affect the way someone can change their name and sex in their ID: medical reports or proof of years of hormonal treatment wouldn’t be needed anymore, and adolescents from 12 years old could ask for these changes, altough only with authorization from a judge. Teenagers from 14 years old could do so with parental consent and those 16 or older would not need any of those documents. However, the project also puts forward broader measures such as the prohibition of conversion therapies, positive reinforcement to improve LGBT+ people’s access to employment, and including anyone capable of gestating as potential receivers of assisted reproduction services.
Even if some local governments of Spain passed a decree approving these measures within their region, the law is being discussed and defined for country-wide approval. From the first months of 2021 and until today, there is some reluctance. For example, the General Council of the judiciary stated its disagreement with the prohibition of conversion therapies that count with the consent of the individual. They also asked the minimum age to change the sex in the national registry to be raised to 18. Some aspects of the initially proposed text have been already changed or eliminated, being a consequence that refugees and migrants will not take advantage of its benefits. Even the far right party made an statement in its website, warning about the devastating consequences of this “wretched project”.
Despite the polemic around it, the new measures have improved the rights of LGBT+ people in general and trans people in particular in the region where it has been implemented. This law has the potential of bettering the life of those whose situation is particularly tough, especially regarding health. Queer people are more likely to experience health inequalities in a heteronormalized society in which they experience minority stress and stigma. For instance, a survey in the US found that gay and bisexual men reported higher odds of frequent mental distress and depression, compared with heterosexual men. Lesbian and bisexual women also had higher odds of frequent mental distress compared to heterosexual women, and sexual minorities in general faced higher odds of poor physical health, activity limitations, chronic conditions, obesity, smoking, and binge drinking. Also in the US, transgender individuals have a high prevalence of HIV/STIs, victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual or other LGBT+ individuals.
Although the problems are many and complex, laws like this one pave the way forward to overcome them. If it ends up passing, the Spanish public health system will have the duty to promote the training of health workers on gender identity and make sure specific health assistance to trans people is included in the National Health System, assuring non-pathologization, autonomy and non-discrimination. Some of the services that would become available free of charge are: hormonal treatment, including both hormonal blockade and cross-hormonal treatment; genital surgical process, body feminization and chest masculinization; prosthetic material; glottoplasty; and freezing of gonadal tissue and reproductive cells.
Violations of human rights not only contribute to and exacerbate poor health, but for many, including trans people, the health care setting presents a risk of heightened exposure to human rights abuses. That is the reason why, even if having to fight for social acceptance, these laws are a step forward in the right direction. Hopefully, the rest of the world will follow the lead and, eventually, we will all live in a place where our identity does not handicap our ability to enjoy a full, healthy, happy life.