Gender discrimination in health care spaces: What clinicians and staff should know

People may face discrimination in health care spaces, such as this exam room, because of their gender

Public accommodation laws aim to help protect minority groups against discrimination. In the case of transgender people, such laws protect access to sex-segregated spaces including public restrooms, changing rooms and locker rooms. In a health care setting, rooming assignments and other sex-segregated environments are affected by accommodation laws, which can raise questions for staff.

To determine specific areas of concern, Elizabeth Boskey, PhD, Amir Taghinia, MD, and Oren Ganor, MD, in the Center for Gender Surgery at Boston Children’s Hospital examined information from 18 professional trainings conducted by Boskey at five health care facilities in greater Boston. They identified two common areas of concern during these trainings: the theoretical risk posed by the presence of transwomen in sex-segregated spaces, and feelings of unpreparedness for dealing with anti-trans bias. The team summarizes their findings in the November 2018 issue of the AMA Journal of Ethics.

Addressing unfounded fears

During these professional trainings, the primary concern expressed by staff was fear that a heterosexual, cisgender man could present as a transgender woman to prey on women in a sex-segregated space. This concern, says Boskey, is a form of gender panic and was typically raised by support staff rather than clinicians. Yet similar concerns were rarely raised about the presence of transgender men in sex-segregated spaces.

There is no known evidence to support the concern that cisgender men masquerade as transgender women to access women’s-only spaces. In fact, transgender women are actually at much greater risk of sexual assault compared to cisgender women. “When addressing the staff’s concerns, it helped to link the documented elevated risk of assault, stigma and discrimination faced by transgender women to the complete lack of evidence suggesting that cisgender men pretend to be transgender as a ploy to gain access to women’s spaces,” says Boskey.

Understanding discrimination

The authors also found that support staff repeatedly expressed concern that they didn’t how they to deal with people who expressed transphobic viewpoints or discomfort about transgender patients, such as sharing a room with them. Pointing out the similarity of gender identify discrimination to racial or religious discrimination helped staff realize that they already had the skills and experience to intervene, says Boskey. In addition, she recommends reminding staff that this issue could be more of a theoretical concern than a real one, since patients often neither know nor care about the gender identity of their roommate. “After all,” Boskey says, “most people don’t wear their gender identity on their sleeve, and if patients are seeing each other’s genitals, something else has probably gone wrong with care.”

“These questions aren’t theoretical,” says Boskey. “As we continue to try to improve the care we provide to transgender and gender variant patients and families, we have to remember that access to public accommodations have real, immediate implications for how we treat our patients and how our patients live their lives. When people go to the polls on November 6, I hope that they remember that it’s transgender individuals’ safety that is most affected by access to public accommodations, and vote Yes on 3.”

Learn about the Center for Gender Surgery.