During the early preparations for the Census 2021 there was a consultation about which topics should be included and a submission from the Scottish Government’s Equality Unit was received, stressing the need for collecting data on Gender Identity. Including this question, they said, would assist with the provision of the ‘very specific health needs’ of transgender people adding that it would ‘better develop and target service provision, particularly health services where there is a specific trans need.’
Here is a quote from their submission:
“In the UK, the number of people aged over 15 presenting for treatment for gender dysphoria is thought to be 3 in 100,000 (that is 1,500 per annum presenting for treatment for gender dysphoria).
However, in developing a new Gender Reassignment Services (GRS) Protocol in 2012, NHS Health Scotland and its partners completed a scoping exercise which estimated the number of people presenting for treatment for gender dysphoria to be slightly higher, at around 200 per annum.
Trans people have very specific health needs.
Having a more comprehensive understanding of the number of trans people and where they live will help to better develop trans inclusive services providing appropriate care and support.
The GRS Protocol provides a consistent treatment pathway for procedures exclusive to gender reassignment which should take place 18 weeks after referral, however, these targets for trans patients are often not met due to the shortage of Gender Identity Clinics and gender identity specialists in Scotland.
Including a question in the Census to help establish the actual number of trans people in Scotland and where they live would assist in providing more trans specific services in the areas with the most concentrated trans population.
Collecting Census data on this topic would help identify where the most concentrated groups of trans people live to help better develop and target service provision, particularly health services where there is a specific trans need. However, this data would also be useful to identify the population across remote and rural areas where there is a greater incidence of isolation and where a different approach to service delivery is necessary.”Scottish Government Equality Unit
The Equality Unit’s argument for collecting MORE data about a demographic makes perfect sense. However, the current position of the Scottish Transgender Alliance seems to disagree with them.
A recent twitter thread on 21/8/19 by Scottish Transgender Alliance stated:
“Requiring biological sex at birth would also not give as useful information – trans people can use single-sex services in-line with how we live, & our bodies are so diverse that predicting sex-specific health services we may need just by asking this question is difficult.
It therefore doesn’t make sense, with the Census a data collection tool for planning services, to force us to answer in any way other than how we are living.”Scottish Transgender Alliance
Further to that, Scottish Transgender Alliance’s initial submission to the Culture, Tourism, Europe and External Affairs Committee, during Stage 1 of the Census Bill, appears to be contradictory as it both:
1/ supports the need to collect specific data on trans people to identify their needs and inform service planning and
2/ then argues against this by stating the trans population is so small that any data collected would have no impact on planning.
“Despite the fact that there will be some under-reporting on trans status, the data will still be incredibly useful. Asking a question on trans status will provide the Scottish Government with some of the only data on trans people in Scotland, and their needs. The data will help to identify continuing inequalities experienced by trans people, and will be able to better inform policy development and inclusive service planning. It will also give us information, for example, on the distribution of trans people across Scotland.
Because the trans population is so small, and there is such diversity in their physical sex characteristics and subsequent health needs, this approach to trans inclusion on the sex question has had no impact on using sex data for, for example, health planning. “Scottish Trans Alliance
It is not then clear what the views of Scottish Transgender Alliance are on collecting data of the transgender population. On the one hand they state it’s important but then on the other they say it won’t provide useful information.
This is rather unusual, as wasn’t the argument for the collection of data the entire reason that a question on Transgender status was included within the 2021 Census?
(Stakeholders) told us that a reliable data source on the size and locality of the trans population in Scotland is required to justify policy developments that will reduce inequalities experienced by trans people, and for designing and enhancing public services to meet specific needs, particularly in relation to the provision of health services.
Because Scotland’s trans population is small and distributed widely across the country, the census was suggested as the only source which would be comprehensive enough to provide accurate information on that population.National Records of Scotland
Why are Scottish Transgender Alliance apparently now arguing against that?
Does this change of opinion only apply when it relates to the collection of data for the purposes of Health Planning i.e. when the subject matter being discussed is biological sex?
There is strong evidence that collecting the biological sex data of transgender people is needed. The National AIDS Trust, endorsed by HIV Scotland , requested that a Trans/Gender Identity be included in the upcoming census, stressing the importance of being able to identify a particular group i.e. Transgender women who have sex with men. This data would assist in the policy development, monitoring and research of this group, with the World Health Organisation(WHO) acknowledging their high vulnerability and specific health needs.
To meet this need from an HIV perspective, health authorities need to have access to reliable information about the number of people who identify as trans* in the relevant population.
This enables a better understanding of whether the burden of HIV is disproportionate in this population.
We therefore recommend that the 2021 census firstly includes ‘intersex’ and ‘other’ within its question on sex, and secondly asks whether a person’s gender identity matches the sex that they were registered with at birth.
This information is needed for policy development and monitoring as well as research.
The 2014 World Health Organisation (WHO) consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations, acknowledges the high vulnerability and specific health needs of trans* people, which they believe necessitates a distinct and independent status in the global HIV response.
Within existing data specific to trans* people WHO identifies that transgender women who have sex with men demonstrate a heavy burden of HIV. Within the WHO’s pool of data which contains transgender women (15 countries), it was found that transgender women had odds of HIV infection 49 times greater than the general population.
Given this indication of elevated incidence of HIV among the trans* population globally, there is a need to gather robust domestic data on the UK trans* population so that supportive legislation can be enacted, stigma and discrimination addressed and health services being made available, accessible and acceptable.
Capturing the trans* population in the census will be a key part of this.
Indeed, the WHO highlights mapping and population size estimates of trans* populations in a way that protects safety and confidentiality as a key part of their research agenda.National AIDS Trust
Stonewall Scotland supported the introduction of a question on Trans Identity, also emphasising the strong need for information that would assist with the provision of specialist medical support.
Many trans people will seek medical support (including psychological support) at some point, including through the process of transitioning. Long waiting times for specialist services such as Gender Identity Clinics suggest an astonishing lack of provision or capacity. They also show that as public awareness and acceptance of trans people has grown over the last years, the demand for support from GICs has also rapidly increased. Service provision in this area is likely to need to grow hugely in the coming years in order to meet demand.
Census information would give us a more reliable estimate of what proportion of the population is likely to require assistance, and therefore how much resource will need to be invested in specialist support.
Comparing information about the lives of trans people (such as their housing situation, health, employment and qualification level) across different parts of the UK would allow us to investigate whether and in what ways their lives differ across the country.Stonewall Scotland
It would seem however that it is not only Scottish Transgender Alliance who are downplaying the initial demands and scope of data collection. The inclusion of a Trans question which was once regarded as vitally important to enhance services and meet very specific health needs, has now been whittled down to being just about population size and geography. The Interim Equality Impact Assessment for the Census 2021 states:
The 2015 Topic Consultation highlighted a need for information on ‘gender identity’. Further consultation with data users refined this data need to being about the size and geography of the trans populationNational Records of Scotland
Also, the proposed census guidance for the Trans / Trans History question offers the following explanation for why this question is being asked:
As there is no data on the size and location of the trans population in Scotland, your answer to this question allows providers to plan and design services. It is also used for equality monitoring. “National Records of Scotland
Has this drastic shift occurred because the planning and service provision of the very specific health needs of trans people are no longer required, or is this shift politically motivated?
The current proposals by Scottish Transgender Alliance / Equality Network is for the Sex question to record a persons ‘lived sex’ and not what is on their birth certificate (privacy exceptions would apply to those with a Gender Recognition Certificate). Each of the submissions quoted above from the Scottish Government’s Equality Unit, National AIDS Trust, HIV Scotland and Stonewall Scotland all stressed specific medical needs as one of the main reasons for collecting data on the trans population. It therefore makes no sense to then not record the most basic medical data required – biological sex.
High profile protests that compare the answering of a Census sex question with your registered sex, to Margaret Thatcher’s Section 28 clause along with the declaration that it’s a ‘major threat’ and reversal of trans rights is perhaps not the best approach to take. Almost every study and poll reveals that, for the vast majority of transgender people, their main concerns are directly related to their health needs. It is not clear what possible benefits could be achieved from protests like this.
The following statement was made on day one of the three day protest at the Scottish Parliament:
In all previous censuses, trans men and trans women have answered using their lived sexJames Morton
A very similar statement to this was made before during the Stage 1 Census debate.
… in 2011 the 1 per cent of people who are trans were told to answer it according to the sex that they believed themselves to be. “Tim Hopkins
The accuracy of these statements is very questionable though. No one can possibly know how trans people answered the 2011 Census sex question.
How many people even knew about the existence of online guidance?
It would appear from the Stonewall Scotland submission that even they were unaware of this guidance. If the largest LGBT organisation had no knowledge of it then realistically what are the chances that this information would have been known to every trans person across the country?
In replying to the consultation, Stonewall Scotland:
- acknowledge that the 2011 census question is about sex NOT gender
- understand that very real differences exist between sex and gender
- acknowledge that changing it from sex to gender would cause data continuity issues
- state a question conflating sex and gender would be collecting inaccurate data about a crucial variable
The census currently asks for respondents ‘sex’, as opposed to gender.
Whilst historically these terms have often been used interchangeably, many people (including trans people) would draw a distinction between the two. Because trans people identify with a different gender to the one they were assigned at birth, asking a trans person their sex would not provide useful or accurate information regarding their gender.
Including gender options of ‘male’, ‘female’ and ‘other’ would best enable the census to collect information about non-binary people, making the data as accurate as possible.
Asking respondents about gender as opposed to sex could provide some issues with data continuity.
However, by conflating gender and physical sex the current questions are collecting inaccurate data about a crucial variable, which poses a greater problem. For example, a trans woman might describe her gender as ‘female’ but feel like her sex is more difficult to define.”Stonewall Scotland
If that wasn’t enough proof then the findings within the National Records of Scotland’s Sex and Gender Identity Topic Report along with many of the responses of the participants during testing of the questions also reveal no awareness that the sex question was actually supposed to be one on self identified sex.
From earlier testing it was apparent that trans and non-binary respondents were unaware that the sex question allowed them to answer with their self-identified sex instead of their biological sex
When shown the question on sex in isolation, respondents interpreted the word ‘sex’ as biological sex
The majority of the respondents interpreted the word ‘sex’ in … the question as biological sex.
Some respondents assumed sex referred to ‘biological sex’ or ‘assigned sex at birth’
The understanding of ‘sex’ as biological occurred in both the general population respondents and the trans respondents.
Sex as biological was the dominant understanding amongst trans respondents.
It should be noted that this group understood the term sex to refer to biological sex or assigned sex at birth. This was not the intended definition of the sex question using current NRS measurement objectives.Sex and Gender Identity Topic Report
It really shouldn’t surprise anyone that a question that asks ‘What is your sex?’ is interpreted as a question about biological sex. It doesn’t make sense that so much effort is being made to ‘convince’ everyone that the question is, and always was one about ‘self identified sex’
In keeping with the 2011 Census, our default measurement aim for this item was ‘self-identified sex’. However, one aim of testing was to establish whether this default measurement aim is working or not, and to explore alternatives.Sex and Gender Identity Topic Report
Despite the overwhelming evidence that a ‘self-identified sex’ question was NOT working, no alternatives were explored and it is STILL to this day being pursued by the National Records of Scotland.
Knowing that all this evidence is supportive of a biological sex question remaining within the Census, it has to then be asked, what could possibly be the real reason for it to be changed to one on Gender?
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