Healthcare without the Gender Binary - Web Event #2

The embedded video (shows up at the end of the post) is an interview with Eden Atwood, conducted by Dr. Lindsay Doe, who was born intersex, meaning that she does not biologically fit into the gender and sex binary. She shares the story (starting at 4:57) of how she found out she is intersex and how she was treated as a child.

I watched this interview with Eden Atwood a few months ago, and her story shocked me. Her doctors and her parents lied to her and performed unnecessary surgery on her just because of her intersex condition. I also remembered that historically, there were people and organizations that tried to “cure” homosexuality, using physically abusive methods. I decided to look into how healthcare and health insurance in America support the socially constructed gender binary and heteronormative lifestyle by refusing some people care and forcing it upon others.

When a baby is born, the doctors assign a sex, and then the baby is expected to grow up identifying as cisgender and heterosexual. Many gender identities and sexualities that people discover as they get older fail to fulfill this outdated ideal, but healthcare has not adapted. Women are not treated equally by insurance companies, and homosexuality conversion therapy has only recently started to be banned. Transgender people are denied insurance and healthcare even when it does not relate to being transgender, and the existence of intersex individuals is essentially denied. Healthcare and health insurance should no longer be formed around the gender binary; instead medical help should be available to those who need it.

Although the American Psychiatric Association removed homosexuality from their definitive list of mental disorders in 1973, the idea of conversion therapy took years to fade. In fact, the initial removal did not last long: a new definition of homosexuality as a disorder was created in 1980 and then removed in 1986 (Herek). The attempts to cure homosexuality in the 1960s and 1970s “included aversion therapy, such as shocking patients or giving them nausea-inducing drugs while showing them same-sex erotica,” and inducing seizures. Homosexuality is no longer seen as a mental disorder, but only four states so far have banned conversion therapy (Pappas). In addition, Exodus International, a leader of the ex-gay movement believing that gay men and lesbians could change their sexual orientation “through prayer and psychotherapy” disbanded this year after thirty-seven years (Lovett). The narrative of pathological homosexuality might be being repeated.  Now, people who are transgender are told they have or are labeled as having “gender dysphoria” or “gender identity disorder,” making another identity into a mental disorder. Nobody should undergo therapy for their gender or sexuality.

Women’s health care issues are far from being over, and abortion and contraception are the current hot topics. There has been a lot of improvement, however, since the first half of the twentieth century, when unsafe douches were falsely advertised as effective birth control for women. The most popular brand was Lysol, which “was aggressively marketed to women as safe and gentle,” but in reality could cause “inflammation, burning, and even death.” And of course, as it was not an actual form of birth control, half of the women who used it got pregnant (Pasulka). Birth control is now legal and regulated, but there are still problems with access. Health insurance is “gender rated,” which means that insurance premiums for women cost more, even though maternity costs are not included (Slaughter). Women are being charged more for their health insurance but not receiving any special or extra coverage for that money. On top of that, in 23 states, there is a ban on healthcare covering abortion costs (Rovner). Health insurance for women should cover maternity costs and abortion costs. Or, at least in terms of abortion, each insurance company should have the option of including it, rather than the state banning coverage altogether.

Health insurance is a much greater problem for transgendered individuals. Sometimes individuals are denied coverage simply because they are transgender. If they do get insurance, the terms will almost never cover any costs related to being transgender, like hormones, stating that “all procedures related to being transgender are not covered” (Marksamer). Sadly, Medicaid does not fund sex reassignment surgery in forty states (Khan 25). An individual may be required to “present themselves as diseased or disordered” in order to get health benefits (Khan 13). Health insurance policies are generally separated by sex, so a person must choose “F” or “M” on the insurance forms, and then only receive coverage for that sex. For example, if a FTM transgender man selects “M”, then “he cannot get coverage for any gynecological care” (Marksamer). Insurance companies should not be able to deny coverage based on gender identity. The health insurance policies need to provide coverage for any medical problems in a person’s body, regardless of what their gender identity is.

Access to treatment is very hard to come by, because not only are transgender people denied health insurance for the treatment, the treatment is not seen as “medical necessary” (Mock). Chelsea Manning, a transgender woman in prison, is not being provided with hormone treatment. But, inside or outside prison, transgender healthcare is “life-changing and life-saving” and should be provided for just like any other healthcare (Mock). Surgery is very expensive, and it is denied because it is seen as cosmetic and unnecessary (Khan 21). Because “non-transgender patients regularly seek these same interventions for…aesthetic purposes,” the insurance policies see the surgery as aesthetic in all situations. In reality, the surgeries are vital to transgender people who want that transition, and may even be necessary to attain a legal gender change (Khan 23-24).

Accessible healthcare is very important for transgender people so that they can carry out whatever procedures are necessary for them, from hormones to surgery. The healthcare for “gender identity disorder” is going to be different on an individual basis, which is difficult when people are faced with “all or nothing” medical options for treatment. However, for children who identify as transgender, puberty blockers should definitely be available. Puberty blockers are reversible, will spare the child the distress of going through the puberty of the wrong gender, and will give them time to make decisions about other treatments (Forcier). Unfortunately, when people who are transgender visit doctors, they face discrimination and transphobia. For instance, a FTM patient died of ovarian cancer because he was denied treatment; the doctor refused to treat a transgender patient. Doctors may be disrespectful toward the patient’s body, or might refuse to see a transgender patient altogether (Marksamer). Doctors need to be taught how to respect transgender patients, and those patients must never be denied treatment solely based on their gender identities.

Far from the problem of denied surgeries faced by people who are transgender, people with intersex conditions are given unnecessary surgeries when they are babies. When an intersex baby is born, the doctor will assign a sex and will most likely perform surgery on the baby’s genitals to match the assigned sex. But, this surgery is completely medically unnecessary and comes with “substantial risks to life, fertility, continence, and sensation” (Dreger). Intersex conditions are hidden from the parents and the child because they are very taboo. In the interview video, Eden Atwood shares that she was not told the truth about her surgery and her intersex condition, and she found out by accident in the form of an insult. Talking about being transgender or homosexual used to be concealed and taboo as well, but those identities are much more accepted publicly now than intersex conditions.

Intersex babies will form a gender identity when they grow up, but there is no way to predict what that identity will be. For instance, parents of an intersex child are suing the hospital that performed surgery on their child M.C. who “chooses to identify as a boy, despite doctors deciding that M.C. should be a girl at 16 months old” (Nelson). Surgery can be performed later in a child’s life if and when the child decides they want it, but “surgically constructed genitals are extremely difficult if not impossible to undo,” so surgery on infants does not make sense. Often, there is no true consent given to the surgery, and “parents are often not told the failure rate, lack of evidentiary support for, and alternatives to surgery” (Dreger). “Normalizing” surgeries on infants need to end, because they are unnecessary and cause distress and complications for the child when they grow up.

Unlike the active changes that need to occur in order to provide important and non-discriminatory healthcare to people who are transgender, the solution for intersex people, especially when they are born, is to stop the unnecessary measures taken to conceal their intersex existence and to be open with information. When a baby is identified as being intersex, the parents should be notified and the condition should be fully explained. A preliminary sex should be assigned, because there are currently no alternatives (although Germany has recently added a third option on forms for intersex babies). The parents should allow the child to determine their own gender identity, as any other child should be able to (Dreger). The child should be informed of their condition, rather than the current system of concealment and lying. Intersex exists, and people need to be aware of it, rather than taking extreme steps like unconsented surgery to hide it.

The Affordable Care Act (ACA) that will go into effect in 2014 offers some hope for the insurance-related issues that women and transgender people face. However, the ACA is not a quick fix for these problems, as it will only help with providing insurance fairly to all people. The ACA “forbids sex discrimination in health insurance,” so gender rating making women’s insurance cost more will no longer be legal (Grady). In addition, preventative services for women “from mammograms to pap smears” will be covered in health insurance (Slaughter). But, as stated earlier, 23 states do not allow healthcare to cover abortion costs, so there are issues for women that the ACA will not solve.

Additionally, the ACA should hopefully prevent insurance companies from denying health insurance to people who are transgender; pre-existing conditions will no longer be a valid reason to refuse coverage. However, this change may not help transgender people access the care they need relating to being transgender. There is no “federal legal requirement” for insurance to cover transition care (transequality.org). Bigger changes are needed in insurance, but also in the medical facilities that discriminate.

Misconceptions and misinformation, discrimination, and equality are major problems in healthcare and health insurance, affecting people whose identities defy the heteronormative gender binary. Major progress has been made for women, but abortions are still not readily available. Relevant and vital treatment needs to be available in an open, non-discriminatory environment for transgender people. Intersex babies need to be accepted rather than “normalized.” There are currently incorrect assumptions about what is medically necessary for people—surgery for intersex babies, but not for transgender people who want it—and medical professionals, as well as patients and sometimes their parents, deserve to be better educated. As for insurance, hopefully the Affordable Care Act will help next year, but more procedures and treatments need to be covered in health insurance.

video link: http://www.youtube.com/watch?v=GnO7ezXMrF8

Works Cited

Dreger, Alice, Ph.D. "Shifting the Paradigm of Intersex Treatment." Intersex Society of North America. ISNA. Web. 30 Oct. 2013.

Forcier, Michelle M., MD, MPH, and Emily Haddad, LCSW. "Health Care for Gender Variant or Gender Non-Conforming Children." Rhode Island Medical Journal 96.4 (2013): 17-21. Rhode Island Medical Society. 17 Apr. 2013. Web. 30 Oct. 2013.

Grady, Denise. "Overhaul Will Lower the Costs of Being a Woman." The New York Times. 29 Mar. 2010. Web. 2 Nov. 2013.

"Health Care Rights and Transgender People." National Center for Transgender Equality. Mar. 2012. Web. 1 Nov. 2013.

Herek, Gregory M., Ph.D. "Facts About Homosexuality and Mental Health." Psychology. UC Davis, 2012. Web. 01 Nov. 2013.

Khan, Liza. "Transgender Health at the Crossroads: Legal Norms, Insurance Markets, and the Threat of Healthcare Reform." Yale Journal of Health Policy, Law, and Ethics 11.2 (2013): 375-418. Yale Law School. Digital Commons, 3 Mar. 2013. Web. 1 Nov. 2013.

Lovett, Ian. "After 37 Years of Trying to Change People’s Sexual Orientation, Group Is to Disband." The New York Times. 20 June 2013. Web. 1 Nov. 2013.

Marksamer, Jody, and Dylan Vade. "Recommendations for Transgender Health Care." Transgender Law Center: For Transgender Health Care. Transgender Law Center, 2010. Web. 01 Nov. 2013.

Mock, Janet. "Chelsea Manning & the Battle for Trans Inclusive Healthcare Without Bias." Critical Writings by Janet Mock. Janet Mock, 22 Aug. 2013. Web. 30 Oct. 2013.

Nelson, Steven. "Parents of Intersex Child Sue Over 'Unnecessary' Surgery." US News. 14 May 2013. Web. 1 Nov. 2013.

Pappas, Stephanie, and Tia Ghose. "Gay Conversion Therapy: What You Should Know." Live Science. Tech Media Network, 19 Aug. 2013. Web. 01 Nov. 2013.

Pasulka, Nicole. "When Women Used Lysol as Birth Control." Mother Jones. Feb. 2012. Web. 01 Nov. 2013.

Rovner, Julie. "Which Plans Cover Abortion? No Answers On HealthCare.gov." NPR. 1 Nov. 2013. Web. 01 Nov. 2013.

Slaughter, Louise. "Don't Return to Discriminatory Health Care Against Women." The Huffington Post. 18 Jan. 2011. Web. 01 Nov. 2013.