Health Committee on May 7th, 2019

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

[Lorraine Grieves]

Can I speak to one point on that?

Just with regard to chest and breast surgeries, in many provinces there are really narrow criteria for trans women to access funded breast augmentation surgery, and often there is more open access for trans masculine people to get chest surgery. That's a discrepancy that's been noted in our context. There are far fewer breast surgeries than chest surgeries.

[Jack Woodman]

Thank you for saying that, Lorraine. I didn't mention that.

I want to add one point to that. Because of the variability across the country in which provinces cover which procedures and various people needing different procedures or are having different procedures, there are also, in upper surgeries, those who are having chest surgeries where some provinces cover a fuller procedure, which includes chest masculinization and not just breast removal, while other provinces don't cover that. There's just variability across all provinces in terms of what is covered, so that's a real challenge.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you. I think you just illustrated to me the inappropriately binary nature of my next question. I was going to ask which provinces do and don't pay for gender transition surgeries, but it sounds like it would be a complex answer depending on the surgeries and the provinces.

[Jack Woodman]

Yes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Are there any provinces that are not paying at all for surgeries?

[Lorraine Grieves]

On the east coast, I think it's a newly funded procedure.

[Jack Woodman]

New Brunswick.

It's very complex. I'll pull out a document here that I'll leave you. It's a map of what is publicly funded gender-affirming care across the country that CPATH developed with a union. It outlines it, because there are so many procedures as well. It's not like there's one surgery for this and one surgery for that. There are over a dozen types of surgeries that are included and each province has different ones that they cover.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you. That will be helpful.

Washington, I'd like to ask you a couple of questions. One of them is—I was just thinking about this when you were all testifying—are the requests for gender identification on documents broadly speaking, passports and everything, as necessary as they are ubiquitous? I'm just wondering why we even ask. If you're applying for a passport, why do we need to put a check box for that? There's date of birth, name, picture. With your experience in having to fill out these very difficult choices, do we really need to have as many of those boxes as there are?

[Washington Silk]

I don't know how accurate that is in identifying who you are. For example, for me to travel here today I had my gender marker removed from my ID, which obviously we're happy about, but I can't fly with my ID anymore even within Canada because it doesn't have a gender marker, so I have to bring my passport and click on boxes that don't represent me.

It would be easy to say that's not a big deal, but it is a significant deal. It really wears on you.

The trans PULSE studies found that having one piece of ID in your affirming name, with your gender marker, reduced suicide ideation by, I think, 96%.That's significant, so I would happily remove all my gender markers.

[Don Davies, NDP, Vancouver Kingsway, BC]

So that's airlines requiring that identification? I wonder if this would be—

[Washington Silk]

I'm not sure, but—

[Don Davies, NDP, Vancouver Kingsway, BC]

What regulation requires the mandatory identification revelation of gender identity to access what is essentially a public—

[Washington Silk]

And beyond that, how do we adequately capture people who are intersex? That is erasing the identity of a lot of different people.

[Don Davies, NDP, Vancouver Kingsway, BC]

I am going to come back to you because I have limited time, and then we'll have another round, I think.

Lorraine, I think you used the term “neurodiverse”. Can you give us an explanation of what that means?

[Lorraine Grieves]

It's a term that gets used sometimes for those who would be on the autism spectrum, or have diversity in how their brains work. Interesting numbers are being seen in the research literature around those who are neurodiverse more prominently presenting as gender-diverse as well. Sometimes that presents a barrier for a young person in getting care, for example, because they will find there is much more gatekeeping around accessing gender affirmation because they may also have an autism diagnosis.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay, I see.

[Lorraine Grieves]

In the end, once those young people are assessed and get through all those gates, they're often affirmed in their gender and are allowed to be themselves.

It's an area of particular attention around working with young people right now.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Sarah, a 2015 meta-analysis of 21 Canadian studies on the health of LGBTQ2 youth found that young individuals from those communities are at greater risk of pregnancy than their heterosexual counterparts.

Do you have any ideas why that is, and any suggestions of how we can address that?

[Sarah Chown]

Yes, that's one of the things I had to take out of my 10-minute statement, so I'm glad that's already been presented.

I think the main reason is that health care providers make assumptions about who does and does not need contraception based on how people present their gender and sexuality, and those assumptions are often incorrect.

I also think that, as everyone on this panel has said, when queer and trans youth expect the health information that's being presented in their classrooms or by their doctors does not to apply to them, we stop paying attention. Even if contraception is covered in a gender-affirming way, which is pretty unlikely given the state of what we know is happening about sex ed, people might already have made the assumption and already listened to most of the sex ed that wasn't that relevant, so they stopped listening.

[The Chair, Liberal, Bill Casey]

Mr. Davies, your time is up, sorry.

Now we'll go to Dr. Eyolfson.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, Mr. Chair.

Thank you, everyone, for coming.

There has been some really amazing, and quite frankly, alarming testimony that we've heard during this study in a country where we consider ourselves a human rights leader, and yet we hear from people with some very shocking stories of how they're treated institutionally. We're hoping we can improve that.

Speaking from the point of view of the medical profession, I've heard a lot about how non-binary people, LGBT are having such difficult and bad treatment in the medical system. I am a medical doctor; I practised emergency medicine for 25 years. I witnessed some of that treatment.

This is open to anyone. What avenues...for advocating for changes? Have you been talking to medical schools or provincial licensing authorities or anyone? What else would be a good idea on how to address this with medical and nursing professions?

[Lorraine Grieves]

That's the point. We have been in conversation in B.C. with various professional bodies and with the medical schools, and in partnership with the UBC medical faculty and online, we've been building a set of online modules that will be CME accredited.

Most importantly, we're very interested in how to get this training into pre-service curriculum so we're signalling that this is a normal part of health care all the way through to those who are getting trained to be in those professions.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Good.

Are they receptive to what you're saying?

[Lorraine Grieves]

More and more so, and I think a lot of physicians are seeing more and more people present for this care in their practices. We've been barely able to keep up with the demand for training in our province. Actually, there aren't enough of us to train all of those reaching out for training by us.