Lesbian, Bisexual and Trans Women’s Health Inequalities

Debate between Hannah Bardell and Colum Eastwood

Tuesday 10th March 2020 Commons Chamber

[Hannah Bardell]

The statistic in the Stonewall Scotland report is 52%. That is specific to Scotland. I do not have the exact number, but I am very happy to get it and to share it with the hon. Gentleman. It is a significant number.

One in six LGBT people have deliberately harmed themselves in the past year. One in four LGBT people have witnessed discriminatory or negative remarks against LGBT people by healthcare staff. One in eight LGBT people have received unequal treatment in the healthcare system because of their sexual orientation or gender identity. Almost two in five trans people have avoided healthcare treatments for fear of discrimination. One in four LGBT people have experienced healthcare staff having a lack of understanding of specific lesbian, gay and bi health needs, and nearly three in five trans people have experienced healthcare staff having a lack of understanding of specific trans health needs.

I understand that some of these matters are very technical. They are challenging and they require a level of expertise. That is why education, open discussion and proper resourcing in Scotland and across the UK is absolutely vital. We know how incredibly hard staff in the NHS work in all countries and parts of the UK. We salute them. However, the studies show that there is a bit more work to be done. I want to share some of the experiences that a number of lesbian, bisexual and trans women have been kind enough to contact me and offer. Their very personal experiences and perspectives are invaluable. It is right that today in this debate we give them a voice.

One trans woman who transitioned a number of decades ago in another country, but who now lives in the UK, contacted me with her experience. She says:

“Almost all of my medical appointments have been for general medical issues. The only time I have seen anyone in the GIDS”—

Gender Identity Development Service—

“pathway was once when I had a consultation with a surgeon…regarding a long-term consequence of the particular type of gender reassignment surgery I had, which was satisfactorily resolved.”

She mentioned issues with access to drugs, but that was not necessarily about her being trans; it was about two health boards in England not speaking to each other, and it was resolved. She said that all these appointments were handled in a very courteous, respectful and professional manner. “However,” she says,

“I suspect the combination of my age, the length of time since my transition, and especially my professional status may have afforded me a certain degree of privilege. I’m not certain others, particularly younger transwomen or those who are just beginning transition, would necessarily have the same experience.”

Interestingly, she says, although all of her doctors have been aware of her transgender status, as it affects some aspects of her medical care, no doctor has ever inquired about her sexuality or whether she is sexually active.

It may be useful to know that she is a registered clinical and forensic psychologist, a long-time member of the World Professional Association For Transgender Health, an affiliate member of the British Association of Gender Identity Specialists, and a member of the editorial board of the International Journal of Transgender Health. She has been a full-time faculty member at many universities and is, by all accounts, an expert in her field.

My hon. Friend the Member for Ochil and South Perthshire (John Nicolson) just passed me a note with some of the numbers. To go back to the point made by the hon. Member for Beckenham (Bob Stewart), there are up to half a million trans people in the UK, according to the Government Equalities Office. If we break that down in terms of the percentage of Scotland’s population, a significant number of people are being affected and are considering taking their own lives, so the seriousness of that is very important. I thank my hon. Friend for that wee bit of information.

The woman who got in touch with me advises that she was recently offered a position as a psychologist at a specialist clinic in the UK. That is good news, given her expertise, but there are a number of reasons why she declined the position. In her own words:

“The most important reason why I declined the position, however, was the horrendous amount of transphobia currently rampant in the UK, spurred on by what seems to be an ever-growing number of highly inaccurate, one-sided, or genuinely bigoted and hateful articles and columns in the press…I felt that to be a trans woman working within the GIDS would place me directly on the firing line for a barrage of hatred and abuse—something which, honestly, I was not willing to endure.”

Those are the words of someone who is highly professional with specialist training, who I imagine that the NHS would have been hugely fortunate to have. That is the lived experience of a trans woman in our society, and it should give us all pause for thought and reflection.

The reality of the services not being properly or fully funded was highlighted to me by another person who contacted me. They raised the issue of the very long waiting list to access the gender identity development service. They explained that there is a

“very long (2+ years) between referral and first appointment, leaving hundreds of children and adolescents in distress for extended periods. The UK government promised an inquiry into the massive increase of referrals, but it appears to have vanished. These”

young people

“are in desperate need of better care but are being ignored. GIDS say that they should be treated under Child and adolescent mental health services (knows as CAMHS) in the interim, but for the most part CAMHS won’t touch them once gender identity issues are mentioned.”

They advised me that they

“are lucky enough to be able to afford private therapy”

but that the

“the children’s GIDS service is failing and should form part of your debate.”

I hope that the Minister will consider those matters and perhaps update not only the Chamber but me in writing, so that I can share it with the person who got in touch with me.

On gender recognition legislation and why it is needed, I was struck by a contribution by Time for Inclusive Education, which created a podcast called TIE Talks, which is well worth a listen. Mridul Wadhwa, a trans woman of colour who lives and works in Scotland, recently spoke alongside Sharon Cowan, professor of feminist and queer legal studies from Edinburgh on the podcast. They spoke compellingly about the Gender Recognition Act 2004 and the impact of the current system on the mental and physical health of trans people. I urge people to listen to it because it is hugely informative. I pay tribute to Jordan Daly and Liam Stevenson, who founded TIE, and the chair, Rhiannon Spear; they do remarkable work in Scotland for young people around LGBT education.

Mridul spoke about the patriarchal nature of the gender recognition panel and how a group of anonymous people decide other people’s future and fate in a way that echoes and has parallels, in her view, with the immigration system, which she has direct experience of. I was interested in hearing more about that and had a discussion with her about the differences and parallels of coming out as trans versus coming out as lesbian, gay or bi. She came out and transitioned in a different country, but she was clear that there are inherent similarities. I certainly remember people saying to me when I came out, “You can look forward to coming out every day.” I have to say, that is still pretty true nearly five years on, but what she told me was that as a trans person, there are so many hurdles to overcome. At times, she feels:

“how many people do I need to convince that I’m a man or a woman?”

I cannot imagine what it is like for someone to have to justify their very existence repeatedly. It must be exhausting and take a huge toll—as we saw from the statistics—on their mental and physical health. Back in 2013, a study in the US said, unsurprisingly, that legalising gay marriage might improve health and reduce healthcare costs. Another similar study last year found that legalising equal marriage could improve the mental health of same-sex couples. Wow—what a revelation! You can marry the person you love and live the life you want as the person you are, and it might actually make you happy and reduce the burden on the healthcare system.

[Colum Eastwood (Foyle) (SDLP)]

On behalf of the people of Northern Ireland, I want to thank every single Member who did the work that could not be done in Northern Ireland to ensure that our brothers and sisters were entitled to full equality where they had been denied it for far too long. One of the groups at the forefront of that campaign and of our work in particular with lesbian and bisexual women in Northern Ireland was HERe NI, but it is about to have its funding cut. Does the hon. Member agree that that cannot be allowed to happen and that the Northern Ireland Office and the Northern Ireland Executive have to do everything in their power to protect that vital service? One of the key things it does is look after the mental health of lesbian people in Northern Ireland. It cannot be allowed to happen.

[Hannah Bardell]

I agree with everything the hon. Member said. I was proud to vote for equal marriage in Northern Ireland and for abortion reform. I will not lie: it was a strange position to be in. I abstained several times to give Stormont the opportunity to get back up and running, but I was always clear that if it did not, and that if people there wanted it to happen, there would be no other option, so I was very proud to support that legislation and to see that happen. I pay tribute, as he does, to the many people who fought hard to make it happen. The thought that funding would be pulled is hugely concerning, so I agree with everything he said on that front.

We know that legislative change does not in itself necessarily change culture or fix the problem, but it is an important step. We all remember section 28— section 2A in Scotland—and how hugely damaging those discriminatory pieces of legislation were to LGBT people, not just then but now. I saw someone online recently ask how, because one of my colleagues had not even been born when that legislation came into force, it could possibly have affected her. What an outrageous and ridiculous thing to suggest. I did not have to fight for the equality I now have, but I certainly felt the effects of the discrimination that the legislation left behind, as have and do many people.

We are only now getting the inclusive education we should have had when that legislation was repealed in Scotland and across the UK. In Scotland, we are working with TIE, the Equality Network, Stonewall, the Scottish Trans Alliance and other organisations. TIE has been at the forefront of making sure that our Government in Scotland roll out inclusive education. I started school the year that that legislation came into force, and it was hugely damaging. The UK Government have also said that they are rolling out inclusive education, and I hope they stay true to that commitment, because we have to be resolved and determined to make those changes happen.

Such inclusive education is not necessarily about the details of sex of LGBT people; it is just about teaching children and young people that LGBT people exist, that some people have two mums, some people have two dads, some people have one mum, some people have one dad, some people have a mum and a dad, some people are brought up by kinship carers or grandparents. Family makeup across the UK is, and has been for many years, very varied, and we should welcome and celebrate that.

I know from my own experience that healthcare appointments can throw up unexpected issues. For many people, a smear can be a difficult and distressing thing, but for most people it will be fairly straightforward. At this point, I wish to mention the My Body Back clinic, an LGBT-inclusive clinic that provides specialist services for survivors of rape, domestic abuse and sexual violence.

A number of years ago, I went to my local service for one of my first smears after coming out. The nurse, wrongly assuming that I was heterosexual, asked what contraception I used. When I explained, “Well, for a start I am a lesbian”, her eyebrows went up and she looked a bit awkward. She said, “Oh, well, you will not need any then”, and brushed over the matter. That, unfortunately, was a wrong assumption, because lesbian and bi people do need and should be considering protection during sex.

I am going to go into some detail, which I hope will not make anyone feel too awkward. If it does, perhaps that should prompt the question of why it makes people feel awkward, and perhaps it demonstrates how important it is to discuss these issues. They are really important issues, but they are not widely discussed. Safe sex for lesbians and bi and trans people, and indeed non-binary people, is very important, particularly when it involves oral sex and the sharing of sex toys, and if you or your partner have had, or have, or suspect you have, a sexually transmitted infection or disease.

It seems that, sadly, the nurse who saw me was not apprised of those matters, but it is important for us to remember that we still live in a very hetero-normative society, and that it is not just heterosexual couples who need to ensure that they use protection against pregnancy and sexually transmitted diseases. That includes washing and the sterilisation of sex toys, but also the use of items such as dental dams. For the benefit of those who may be less well educated and not know what a dental dam is, let me explain. It acts as a barrier to prevent sexually transmitted infections from passing from one person to another. It sounds like something that would be used when people are having their teeth polished, and it was originally made for dentistry purposes and used to protect the mouth when dental work was being done, so that is not too far from the truth. However, it is now used as protection during lesbian or bi sex. Thinner versions were apparently later produced specifically for promoting safe oral sex.

I do not know whether anyone has ever tried to buy a dental dam, but they are nowhere near as readily available as condoms. In fact, they often have to be ordered via the internet. I do not want to put anyone off, but they are also not particularly nice or attractive things to use. It is interesting to note the huge innovation and investment that has been put into the development of condoms over the years—for instance, to make them thinner for maximum pleasure. They can also be ribbed, dented or flavoured. Dental dams do not come in quite the same range, for, I would imagine, a variety of reasons. The manufacturers and the marketers have not even seen fit to rename them. I think that that is an important point, and one that is little discussed.

We know how much women’s bodies are affected by contraception and the toxins that many of us put into our bodies, be they from the implant, the pill or the coil. I have been discussing that with one of my colleagues. So much of our sexual health is centred on heterosexual male pleasure, with heterosexual or bi women bearing the brunt of the responsibility for contraception.

“There is a common misconception that oral sex is ‘safe’”,

explains Simone Taylor, the education and regional lead at Brook, a sexual health charity for young people,

“But while you can’t get pregnant from oral sex, you can still catch STIs.”

In 2008, Stonewall published the results of a study of the health of 6,000 lesbian and bisexual women, which revealed that half of those who had been screened had an STI, and a quarter of those with STIs had only had sex with women in the last five years. It is very important for us to take account of those issues.

I have only a few more points to make. I know that a number of other Members want to speak. The specific health needs of disabled people who are also LGBT are often overlooked by healthcare professionals. According to Stonewall, which has produced some compelling briefings on the subject, disabled people in the LGBT community can be left with a lack of trust in their healthcare providers. Multiple needs are often not taken into account, which affects some of the most vulnerable people. LGBT people are not necessarily open about their sexual orientation and/or gender identity when seeking medical help, because of a fear of unfair treatment and invasive questioning.

Stonewall goes on to talk specifically about issues around PIP assessments and it has said that one in five non-binary people and LGBT disabled people have experienced discrimination. Similarly, one in five black, Asian and minority ethnic LGBT people, including 24% of Asian LGBT people, have experienced it. One of the testimonies it offers is from someone who was going through the PIP assessment. They said:

“I held out my hand to shake and the nurse didn’t look at myself or my wife after I introduced who she was and no eye contact throughout the interview. We felt we wanted to leave.”

Someone else who shared a testimony said:

“An NHS nurse asked about my recent gender reassignment surgery and then went on to compare me to being a paedophile as if being trans is the same thing.”

That testimony, from somebody in the east of England, was taken from Stonewall’s website and I have to say that it is hugely concerning. This reinforces the point about LGBT education and why it is so incredibly important that the misinformation that is out there and being used against trans people should be busted.