Queering SRHR: De-pathologizing Trans-people
Editor’s note: to mark pride month, Inspire has launched a series of articles called “Queering SRHR” with the goal to dive a little deeper in the various specific ways that SRHR relates to LGBTIQ people.
On the occasion of the upcoming Pride Month, the Inspire Team has launched a three-week series called “Queering SRHR” in the hope of raising awareness on current sexual and reproductive health and rights’ struggles, goals and achievements related to intersex, queer, gay, lesbian, bi and trans people. With this series, the goal is also to challenge the binary and heteronormative narratives around sexual and reproductive health and rights, and to encourage colleagues, partners and others to make SRHR discussions all-inclusive.
This is the third article of the “Queering SRHR” series. Here, you can read our other articles:
“Queering SRHR: LGBTIQ Families” Click Here
“Queering SRHR: Homo-Bi-Trans-Phobia No More” Click here
"Queering SRHR: The need for a trans-specific focus within SRHR" Click Here
De-pathologizing Trans-people: WHO removes transgender as mental disorder from the International Classification of Diseases.
In 1980, the third Diagnostic and Statistical Manual of Mental Disorders (DSM-III) introduced the disparity between anatomical sex and gender identity as a psychopathological condition of gender identity disorder. Ever since, this psycho-medical classification of trans people’s identities as pathological has justified violations of human rights at every turn.
Over the years, this institutionalised transphobia has impacted trans-people’s access to safe and adequate health care; reinforced stigma and discrimination, and has accounted for an indefinite amount of violence, harassment and abuse.
But this week, something has changed.
The ICD-11: The World Health Organization (WHO) finally de-pathologizes trans identities
During the 72nd World Health Assembly (WHA), taking place from 20 – 28 May, the World Health Organization (WHO) officially adopted the 11th Revision of the International Classification of Diseases (ICD-11). Up until now, the International Classification of Disease, a standard diagnostic tool published by WHO, listed what it defined as “transsexualism” and other “gender identity disorders” in the chapter of mental and behavioural disorders.
This week finally, all trans-related categories were deleted from the ICD Chapter on Mental and Behavioural Disorders. Instead, it has introduced new trans-related categories in another section of the ICD, namely, Chapter 17 on Conditions Related to Sexual Health, introducing “gender Incongruence of Adolescence and Adulthood” and “Gender Incongruence of Childhood”. This means, that from this week on, the WHO no longer categorizes trans or gender diverse persons as individuals with a mental disorder.
The recent victory that came with the de-pathologisation of trans identities in the ICD-11 was not an easy battle to win.Until the 1950s, homosexuality and gender identity disorder and associated conditions were not singularly taken into consideration but mixed together and all regarded as forms of sexual perversion. After the 1950s, sexologists and doctors started to refer to the disparity between anatomical sex and gender identity as the psychopathological condition of gender identity disorder. Since then, diagnostic tools such as the DSM and the ICD started to used the diagnostic name of “gender identity disorder” in their manual.
The term was first officially introduced in the DSM-III in 1980 and later adopted by the ICD-10 in 1990. Since the ICD is only periodically updated, for over 29 years, trans activists have been campaigning to make sure that trans identities would be effectively be de-pathologised when the latest version of the ICD, the ICD-11 would be published.
Although this is a landmark achievement for trans activists, there are many social and legal barriers to break in order to achieve full de-pathologisation and inclusivity of trans and gender diverse people.
Over the many years of campaigning, trans activists have emphasised the necessity to remove trans-related categories from the list of mental disorders. Failing to do so meant condoning human rights violations perpetrated against trans persons.
Joining the activists’ cause, the UN and trans activists have for long denounced violations against trans people such as forced sterilisation, non consensual genital surgery, lack of legal gender recognition, harassment, violence and discrimination in the areas of education, employment and of access to healthcare and justice.
A Human Rights Issue
Trans activists have pointed out that trans rights have somewhat been too scarcely discussed in the context of international human rights law. According to them, international human rights law should universally ensure that trans rights are upheld at State level.
The 2006 Yogyakarta Principles for example, have set the perfect example in showing why trans rights are fundamental and undeniable human rights that every individual should enjoy.
The Yogyakarta Principles
Yogyakarta Principle 18, the principle of “Protection from Medical Abuses” and Yogyakarta Principle 31, “the Right to Legal Recognition”, are two examples of how international human rights law applies to trans-people.
YP 18 sets forth that:
“No person may be forced to undergo any form of medical or psychological treatment, procedure, testing, or be confined to a medical facility, based on sexual orientation or gender identity. Notwithstanding any classifications to the contrary, a person's sexual orientation and gender identity are not, in and of themselves, medical conditions and are not to be treated, cured or suppressed.”
Moreover, YP 31 marks that:
“Everyone has the right to legal recognition without reference to, or requiring assignment or disclosure of, sex, gender, sexual orientation, gender identity, gender expression or sex characteristics. Everyone has the right to obtain identity documents, including birth certificates, regardless of sexual orientation, gender identity, gender expression or sex characteristics. Everyone has the right to change gendered information in such documents while gendered information is included in them.”
But why are these principles important?
In November 2006, 29 distinguished human rights experts met in Yogyakarta, Indonesia, to draft, develop, and redefine what are now called the Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Sexual Identity.
The YPs were issued to reflect the existing international human rights laws in relation to issues of sexual orientation and gender identity considering the principles of universality and non-discrimination.
Reminding ourselves of the existence and importance of these principles is essential when looking at how these principles are implemented at a national level in both Europe and Central Asia.
The current situation of SRHR related Trans-Rights in Eurasia.
Transgender Europe (TGEU) publishes a yearly map on Trans Rights in Europe and Central Asia. As it can be seen analysing the 2019 map, 36 countries in Eurasia still require a mental health diagnosis before trans persons can have their identity documents adapted. Such a requirement violates the right of every person to self-determine their gender identity. A mandatory diagnosis further drives stigma, exclusion and discrimination as it relies on the false notion that being trans is a (mental) illness.
Unfortunately, this is not all. At the moment:
- 16 countries still require sterilisation of trans persons seeking recognition of their legal gender recognition;
- 4 countries (only) recognise the gender identity of a trans parent;
- 19 countries (only) offer express protection against discrimination in healthcare;
- 2 countries (only) prohibit conversion therapy on ground of gender identity.
Although the WHO’s de-pathologisation of trans identities should have a positive impact on future implementations of trans rights in national and international settings, the current-dire situation of trans rights in Europe and Central Asia, calls for a necessary collective action to ensure that Sexual and Reproductive Health and Rights are accessible to trans and gender diverse people across Eurasia.
The ICD-11’s removal of trans-identities as mental disorder should be the first of many steps taken in order to definitely remove cisnormative and harmful gender stereotypes. Ensuring that legal gender recognition is accessible without medical requirements, is one of those many steps.
In order to ensure that trans and gender-diverse people can fully enjoy their fundamental rights and gain full equality, we encourage partners and allies in the SRHR community to join forces with the LGBTIQ community in order to increase information exchange and build SRHR projects inclusive of trans and gender diverse people. We also encourage the SRHR community to develop language and approaches going beyond cisnormativity and binary understandings of gender.
Later this week, Inspire will be publishing its fourth article: “Queering SRHR: the need for a trans-specific focus within SRHR” where we will dig a little deeper in the SRHR-related topics that we should take into consideration to include trans and genderqueer people in the SRHR conversation.
Together let’s work on Queering SRHR!
- GATE. Press Release: ICD-11 depathologizes Trans & Gender Diverse identities. May 2019. Link.
- ILGA. Being trans is not a mental disorder anymore: ICD-11 is officially released. June 2018.Link.
- International Journal of Environmental Research. Gender Identity: The Human Right of Depathologization. March 2019. Link.
- Kara, Sheherezade. Gender is not an illness: How pathologizing trans people violates international human rights law. GATE. 2017. Link.
- Seishin Shinkeigaku Zasshi.The history of the concept of gender identity disorder. 2012.Link.
- The Yogyakarta Principles 2006. November 2006. Link.
- The Additional Yogyakarta Principles (YP+10). November 2017.Link.
- Transgender Europe. Trans Rights Europe and Central Asia Map and Index.Link.
- WHO. ICD Updating Process. 2019.Link.