Research has found that healthcare was the most common setting in which trans women experienced discrimination compared with other settings such as housing and employment (Xavier J et al. 2007). In the United Kingdom, trans women often face unique challenges in accessing equitable healthcare. From systemic biases to deeply ingrained power imbalances, these barriers create significant health disparities. This article explores how power gradients - imbalances in authority and influence - are affecting trans women’s healthcare experiences and outcomes.
Understanding Power Gradients in Healthcare
Power gradients are inherent in any hierarchical system where one party holds more authority or influence than another. In the context of medical care for trans women, these dynamics are particularly pronounced due to professional knowledge asymmetry, societal stigma, and structural barriers. Trans women frequently encounter significant challenges, particularly in healthcare settings, where a lack of understanding and systemic prejudice result in inequitable treatment.
Healthcare providers often hold significant decision-making powers regarding patient care, while patients may lack the medical knowledge necessary to challenge a provider's decisions effectively. Societal stigma further compounds these issues, leaving trans women in precarious positions when seeking healthcare. Research has shown that such power gradients exacerbate negative experiences for marginalized groups, creating barriers that directly affect health outcomes (Seelman et al., 2017).
The Impact of Legal and Social Backdrops
The UK has made strides towards recognizing gender diversity through legal protections, such as those outlined in the Equality Act 2010, which aims to protect individuals from discrimination. However, these legislative advancements have not always translated into equitable treatment within hospitals and clinics. A combination of negative media representation and the proliferation of anti-trans organizations has perpetuated harmful narratives, infiltrating layers of the NHS, law, and government. These biases manifest in prejudiced attitudes among healthcare professionals, further eroding trust and leading to poorer health outcomes (Trans Actual Survey, 2021).
Systemic Barriers to Healthcare for Trans Women
Healthcare providers often lack adequate training on transgender health issues, leaving trans patients underserved and vulnerable. For instance, studies have shown that trans women frequently feel pressured to conform to a provider's expectations or face the risk of being denied care (Seelman et al., 2017). Furthermore, systemic barriers include denial of services, misgendering, and inappropriate behaviour by healthcare professionals (Trans Actual Survey, 2021).
The Trans Actual Survey (2021) revealed that:
70% of trans people report experiencing transphobia in general health services.
57% avoid visiting doctors when unwell due to fear of discrimination.
14% have been refused GP care outright because of their gender identity.
These statistics paint a dire picture of healthcare inequity for trans women in the UK, further exacerbated by systemic power imbalances.
Government Stance, Systemic Injustice and Policy Failures
The UK government, under leaders such as Rishi Sunak and Keir Starmer, has failed to adequately address systemic biases in healthcare for transitioned women. Recent controversies, such as the legal battles involving Darlington Memorial Hospital nurses, and at Kirkcaldy’s Victoria Hospital, highlight how professional objections to trans inclusion policies undermine trust and confidence among trans patients and staff. When Health Secretary Wes Streeting met with the Darlington cisgender nurses advocating for the exclusion of transitioned women from workplace facilities but did not meet with groups supporting transitioned women, it clearly demonstrated the power gradient to the disadvantage of trans women.
Such policies and stances contribute to an environment where trans women’s concerns are dismissed, perpetuating discrimination and health disparities. These ongoing legal battles involving NHS staff against transgender inclusion significantly undermine any trust and confidence that transitioned women may have had in the NHS, including patients and staff alike. Furthermore, in the case at the Victoria Hospital in Fife, the trans doctor has not only been named, but exactly where she works has been published in the media. Judge Antoine Tinnion, despite being aware of the distress caused to the doctor by a public outing like this, claimed it was necessary for "open justice", such ill-informed decisions highlight the systemic plight of transitioned women in the UK. Furthermore, the hospital involved has now "paused" the development of its trans policy, significantly undermining any development of future protections for transitioned women. Furthermore discussions about whether the doctor "passed" as a woman were bent in favour of the cisgender nurse during the judicial review, something the tribunal outright rejected. Such discussions underline the erosion of privacy and dignity of transitioned women in healthcare.
Pressure by groups of cisgender women involved in anti-trans and/or sex-essentialist groups (such as “sex-matters”) often cite evidence that cisgender women have experienced high rates of sexual violence, or adverse childhood events as a reason to exclude transitioned women from such spaces. Ironically it is this very metric that places trans women in a unique and critical position of vulnerability. Trans women are disproportionately affected by violence and abuse, exacerbating their vulnerabilities. Research highlights that transgender women face higher rates of violence, including childhood sexual abuse (CSA), physical violence, and intimate partner violence, compared to their cisgender counterparts. For example:
Prevalence rates of CSA among transgender women are as high as 58.2% (Sizemore et al. 2022).
A study of Californian adults found trans individuals at significantly higher risk of physical and sexual violence than cisgender women. (Closson et al., 2024).
The assumption that transitioned women can safely share spaces with men overlooks not only their physical body but also their heightened exposure to physical, psychological, and emotional harm. The current discourse in the UK always prioritizes the relatively better safety and health outcomes of cisgender women, while failing to address the unique risks faced by trans women.
Taking Action: Empowering Trans Women and Advocates
For trans women navigating the healthcare system, and for those committed to advancing equity, diversity, and inclusion (EDI), here are some possible actions to help drive change and demand equitable treatment:
Advocate for Comprehensive Training Programs: Push for the implementation of mandatory training for healthcare providers on transgender health. This should include education on trauma-informed care, mental health challenges, and the physical and emotional needs of trans women. Advocacy through petitions, outreach to local NHS trusts, or partnership with trans-led organizations can amplify this demand.
Know Your Rights and Seek Support: Familiarize yourself with the protections afforded under the Equality Act 2010 and the NHS Constitution. These legal frameworks exist to ensure fair treatment.
Create and Share Narratives: Sharing personal experiences - if safe and comfortable - can be a powerful tool to drive awareness and foster understanding. Platforms like Trans Actual's surveys, public forums, provide opportunities to highlight systemic barriers and push for accountability.
Engage with Allies and Build Community: Allies in the medical field, media, and public policy are essential to dismantling structural barriers. Trans women and EDI advocates can work together to promote inclusive policies and practices in healthcare and beyond. Grassroots movements and collaborative campaigns can create meaningful momentum for change.
Prioritize Self-Care and Safety: Healthcare systems can often feel hostile, but there are trans-affirming providers and resources available. Seeking out affirming care networks and utilizing peer-led support groups can help mitigate the emotional toll of navigating systemic oppression.
Advocate for Policy Reform and Accountability: Encourage policymakers to strengthen legal protections and hold institutions accountable for discriminatory practices. Support trans-led organizations in lobbying for these changes and amplifying trans voices in decision-making processes.
The path to equitable healthcare for trans women requires a collective effort. By advocating for systemic reform, leveraging community support, and empowering individuals to demand their rights, trans women and their allies can create a future where dignity, respect, and quality care are no longer negotiable.
References
Closson, K., Boyce, S. C., Johns, N., Inwards-Breland, D. J., Thomas, E. E., & Raj, A. (2024). Physical, sexual, and intimate partner violence among transgender and gender-diverse individuals. JAMA Network Open, 7(6), e2419137. https://doi.org/10.1001/jamanetworkopen.2024.19137.
Equality Act 2010. Equality and Human Rights Commission. https://www.equalityhumanrights.com.
Fernández-Rouco, N., Fernández-Fuertes, A. A., Carcedo, R. J., Lázaro-Visa, S., & Gómez-Pérez, E. (2017). Sexual violence history and welfare in transgender people. Journal of Interpersonal Violence, 32(19), 2885–2907. https://doi.org/10.1177/0886260516657911.
Seelman, K. L., Colón-Diaz, M. J. P., LeCroix, R. H., Xavier-Brier, M., & Kattari, L. (2017). Transgender noninclusive healthcare and delaying care because of fear: Connections to general health and mental health among transgender adults. Transgender Health, 2(1), 17–28. https://doi.org/10.1089/trgh.2016.0024.
Sizemore KM, Talan A, Forbes N, Gray S, Park HH, Rendina HJ. Attachment buffers against the association between childhood sexual abuse, depression, and substance use problems among transgender women: a moderated-mediation model. Psychol Sex. 2022;13(5):1319-1335. doi: 10.1080/19419899.2021.2019095. Epub 2021 Dec 26. PMID: 37397236; PMCID: PMC10311960.
Trans Actual Survey (2021). Trans Lives Survey. https://transactual.org.uk/wp-content/uploads/TransLivesSurvey2021.pdf.
Xavier J, Honnold JA, Bradford J. (2007) The Health, Health-related Needs, and Lifecourse Experiences of Transgender Virginians.
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