HEALTH, DISABILITY & OUR SEX-BASED RIGHTS

“I feel that the present government is not acting in accordance with the first principles of Liberalism, by refusing the right of representation to women taxpayers." - Rosa May Billinghurst


Section One

What does self ID mean for women with additional support needs or women who need to access health care services?

In law, women and girls are currently entitled to the following to ensure our privacy, dignity and safety when accessing healthcare: 


  • Our right to ask for female personal care givers.

  • Our right to ask for a female nurse or doctor to carry out intimate procedures, including but not limited to; smears, sexual health exams, rape suite staff, mammograms, midwives, gynaecologists.

  • The right to expect single sex psychiatric wards. 

  • Our right to ask for or expect single sex hospital wards where women are often in partial undress, vulnerable or sleeping.


But many women are comfortable with males doing their personal care, intimate examinations and sharing their sleeping spaces. If they are fine, then what is the problem?..


In short, it’s not fine for everyone.

Studies show that 50% of women prefer female doctors, nurses and caregivers. Fact check

But further than this, if we lose our legal right to sex exemptions as described, who is this an amplified problem for?


  • Women and girls who have experienced rape, sexual abuse and sexual exploitation. (31% of women have experienced sexual abuse in their child hood, 20% have experienced sexual abuse in adulthood). Fact check.

  • Women and girls who have experienced physical and emotional abuse.

  • Women and girls with body confidence issues.

  • Women and girls with learning disabilities.

  • Women and girls for reasons of faith or culture. Fact check.

  • Women and girls who access personal care, especially those who have PA’s in their homes.

  • Women who are particularly vulnerable to sexual exploitation and assault. Of all the demographics of women, women with disabilities are twice as likely to be victims of domestic abuse and sexual assault. Fact check.

  • Women and girls who are detained under section who cannot actively consent to who is in their accommodation. Women from BME communities are proportionately over represented in this group. Fact check.

  • Women and girls accessing abortion services.

Research by the Women’s Resource Centre found that the majority of women valued women-only services. These include medical services, mental health services, and sex exemptions used to employ female therapists, doctors, nurses and caregivers etc. 

In a survey of 1000 women: 

  • 97% said that women should have a choice of women only support services if they had been a victim of sexual assault.

  • 90% believed that women should have the right to report sexual or domestic violence to a woman. 

  • 87% thought it was important to be able to see a female health professional about sexual or reproductive health matters

  • 78% thought it was important to have the choice of a woman professional for counselling and personal support needs

  • A study of women only services commissioned by the Equality and Human Rights Commission found that for the majority of service users the women only aspect of the service was important in their decision to attend. Reasons for this included safety and security, building trust and confidence, peer support and the ability to talk freely about the issues facing them. These were particularly important for ethnic minority service users.


So what does the NHS and Government guidelines say on this?


Single-sex wards

The NHS in England and Wales is committed to the elimination of mixed sex wards:

“1.1 Overview Every patient has the right to receive high quality care that is safe and effective and respects their privacy and dignity. This is one of the guiding principles of the NHS Constitution and is at the core of local NHS visions. This Delivering Same-Sex Accommodation guidance updates and replaces previous guidance (PL/CNO/2009/2 and PL/CNO/2010/3) on requirements around recognising, reporting and eliminating breaches. 

1.2 Guidance statement Providers of NHS-funded care are expected to have a zero-tolerance approach to mixed-sex accommodation, except where it is in the overall best interest of all patients affected.” - NHS Delivering same sex accomodation Sep 2019


However, this is directly undermined by the NHS already adopting the concept of sex self ID:

“• Trans people should be accommodated according to their presentation: the way they dress, and the name and pronouns they currently use. • This may not always accord with the physical sex appearance of the chest or genitalia.

• It does not depend on their having a gender recognition certificate (GRC) or legal name change” - NHS Delivering same sex accomodation Annex B Sep 2019

In short, the NHS misrepresents equality law.

Although Annex B correctly states that Gender Reassignment is a protected characteristic (Eq 2010), it is not the law that this legislation entitles that group to be treated as the opposite sex in all circumstances.

Sex exemptions allows for a single sex service (the exclusion of transwomen) if it is ‘proportionate to reaching a legitimate aim’. (See our legal page, currently being built). Moreover the technical guidance for the Public Sector Equality Duty states: 

‘These legal obligation means that the impact on women must always be considered and cannot be ignored or trumped by the rights of transgender people’. 

So as we can see, equality legislation is being misrepresented. Public bodies are embedding policies that go against the wishes and needs of women, and are in contravention of both the letter and the spirit of the law.

As the evidence WE have collated shows, services that do not reflect the wishes and needs of women impacts negatively on women and girls. Women self-exclude and unisex spaces are more stressful and dangerous for women and girls. The incidence of sexual assaults on mixed-sex wards is well documented here and here.


Our NHS has a duty to centre the safety and health of women, not endanger it via poor policy.

Sex self ID and our right to request female healthcare workers

WE believe that the legal right for women and girls to request a female healthcare provider must be upheld. Although there are reasonable clinical exceptions to this, women and girls must be able to trust that this request will be honoured. WE cannot accept a system where women self-exclude from essential healthcare services.

NHS Boards in Scotland confirmed that the NHS could not guarantee that a woman’s request for a female healthcare provider would be honoured, due to the fact that the provisions of the Gender Recognition Act 2004 prevented the disclosure of someone’s transgender status. Here. This concern is real amongst women. Here.

Worryingly, earlier this year, an official NHS training document cited an example of a letter where a breast cancer patient and child sexual abuse survivor was asking for a female nurse and doctor to do her mammogram as an example of ‘transphobia’. Here and here

The patient in question has an MBE for services to the LGBT community. Here.

It is a shameful that a woman, clarifying and exercising her legal rights has been framed in such a way by our NHS.


Although the NHS trust in question did retract this training document (here), WE are not reassured. This only came to light via a whistleblowing process. It is deeply concerning that those producing, signing off, and delivering the training felt this was appropriate.


In addition, the policy of allowing staff to sex self ID at this NHS trust remains in place, undermining our legal right to request female practitioners. Although they apologised for their training document, their staff policies indicate they have not taken on board the needs of women and especially survivors.


It also, sadly demonstrates how the needs of women and girls are being ignored and misrepresented in a top-down push for sex self ID in frontline services.

WE believe in women's full bodily autonomy. This means that every woman and girl has a right to consent to who sees and touches their body.

WE must clarify policy and bring it back in line with legislation. WE must embed respect for women and girls needs into all areas of health policy.

 

SECTION 2
WEP Health Policy & will self-ID impact it?

 

Section Two

WEP Health Policy- what does it say and will sex self ID affect it?

The opening section of WEP’s health policy area begins highlighting the health inequalities (sex health gap) faced by women and girls:

“The physical and mental health of women in the UK is compromised every day by a healthcare system that discriminates against them twice over. Diagnosis and treatment is based on male-centred research that ignores females’ different biology; and gender stereotypes and biased medical textbooks lead to women’s ill health being disbelieved and taken less seriously than men's.” - WEP health policy document


It goes on to say:


Women are disbelieved and dismissed by the health system - females are rarely used in biomedical research and trials because of "hormonal interference", therefore we don’t understand the effect of drugs on women, who are 60% more likely to react* to prescription drugs than men. Public health programmes and diagnostic criteria for heart disease and attacks emphasise symptoms experienced by men, despite this being one of the leading causes of death of women in Britain.”

(*correction, WE think WEP means we are adversely affected).


WE are deeply concerned that when the sex health gap is still so prevalent, that any policy that makes access to health care more problematic, that impacts on the quality of sex based medical data will only deliver progressively worse health outcomes for women.


Taking what we know about the sex health gap between women and men, and the obvious physiological differences between the sexes it is clear that the sex markers on health records and ID should remain accurate to sex. But what if a person does not wish this? If having their sex marker on their medical records causes them distress?


Medical ethics are generally informed by four underlying principles; respect for autonomy, nonmaleficence, beneficence and justice. Respect for autonomy is one aspect of good practice. However, respect for autonomy is more complex than it initially seems. It relies on an individual having a full understanding of a decisions consequences, and for their decision to also be free from ‘controlling influences’. To what extent does gender dysphoria still allow for full autonomy?


Moreover, nonmaleficence puts an ethical onus on a doctor to record sex accurately because of the obvious impact this has on diagnosis, treatment and dosage. WE refer you to this article in ‘The New Bioethics Journal’ on the need for sex recorded accurately on medical records.


So what does the General Medical Council (GMC) suggest?


“Respect a patient’s request to change the sex indicated on their medical records; you don’t have to wait for a Gender Recognition Certificate or an updated birth certificate.

Don’t disclose a patient’s gender history unless it is directly relevant to the condition or its likely treatment. It’s unlawful to disclose a patient’s gender history without their consent.” - GMC Trans Confidentiality Guidelines 2016


The current General Medical Council’s Trans Healthcare Ethical Advice is also at odds with standard ethical considerations.

WE believe that these GMC guidelines are problematic, and if they become standard practice would place the health of trans identifying patients at great risk, and go directly against the principles of nonmaleficence. 

In addition, obscuring a persons sex, and placing them in single sex wards of the opposite sex this is contrary to the principle of beneficience as explored in section one.


In conclusion, this  looks distinctly like sex self ID is largely already GMC and NHS policy. This is concerning as this has been arrived at with no due process (user consultation, Equality Impact Assessments and risk assessments) or acknowledgement of the impact of these policies on women. 



Returning to WEP health policy, their following policy recommendations will also become problematic to deliver:


“WE will establish a health research institute for women and girls to invest in careful research and medical testing on females, and spearhead research on reproductive health throughout women’s lives. The institute will investigate any conditions or symptoms disproportionately experienced by women. 

WE will update regulations and standards for the approval of clinical and pre-clinical trials to require them to systematically account for sex differences. 

WE will require labelling to make it clear if testing and analysis has taken account of sex differences. 

WE will review and reform medical curricula so that medical students learn to identify and treat diseases and conditions as they present in women. 

WE will introduce quotas for commissioners of research such as NICE, universities and government representatives until they have 50 percent women on their decision-making boards.” - WEP Health Policy Document


Self ID obscures sex. How do we ensure and measure female representation on decision making boards when we can no longer measure sex?


WE believe sex self ID as policy is hugely problematic and raises complex questions and creates complex situations. WE foresee that this will impact greatly on the quality of health care delivered to women and girls.


WE urge members of WEP to demand better for women.

"I hope we don't have to keep going back over the same territory and winning the same rights over and over again. The battle for birth control, the battle for abortion. The parity of women's health. It’s very depressing to think we win these rights, but then you have to win them again, and again, and again, and fight the same battles over and over” - Erica Jong

 

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