Health inequalities in lesbian, bisexual and trans women

Speech in the House of Commons on a motion raised by Hannah Bardell MP

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I beg to move, That this House has considered lesbian, bisexual and trans women’s health inequalities. It is a pleasure to move the motion and to speak in this very important debate on lesbian, bisexual and transgender women’s health in the week we have been observing for considering such issues. The aim of the LBT Women’s Health Week is to raise awareness about lesbian, gay, bisexual, trans and queer women’s health inequalities, to make it easier for service providers to empower service users and to make it easier for communities to support LGBTQ women. Up front, I will declare an interest as a lesbian, who also suffers from anxiety and other mental health issues.

I know that my own experiences have taught me a huge amount. In recent months and years of reflection since I came out in 2015, I have had a little bit of time, despite the political storms we have lived through in recent years, to reflect on some of the reasons why it took me so long to come out.

I am very grateful to the Backbench Business Committee for granting this debate, and to the many charities and organisations that operate in the LGBTQ space that have provided briefings for today, as well as our healthcare professionals—I know we will discuss them today, but we must pay tribute to them—and to the Women and Equalities Committee and the Parliamentary Office of Science and Technology, which have done much work and produced reports that many of us will draw on. I know some controversial issues will be discussed today, but I am certain that we will hold this debate and have our discussions with respect and integrity.

I also want to thank the many folk who contacted me after I put a shout-out on social media asking for lesbian, bisexual and transgender women’s experiences of health inequality. I am sure that everybody in this House will agree on the ills of social media, but I also hope we can agree that there are times when it can be incredibly positive and constructive as a tool to help us engage. At a time when this Parliament and the politics of this place can seem very far from folks’ lives, I have appreciated the ability to reach out to the public via Twitter and other social media channels, and I will shortly share some of the experiences that members of the public have shared with me on this issue. I know that some of them were very painful and very difficult to relive and to recount. There are many facets to the debate on the healthcare of LGBTQ people and women in the LGBTQ community, and the fact that there is a specific week to raise awareness when there are so many other issues going on is really helpful.

The Science and Technology Committee report states that there is “emerging evidence demonstrates that lesbian, gay, bisexual and trans (LGBT+) people experience significant health inequalities across their lifespan, often starting at a young age.”

I came out literally as I was being elected, initially to myself, then later to my family and friends and publicly ​sometime after that, and that was challenging. It is fair to say that the impact on my mental health was profound. As most of us who have been here since 2015 will know, there was not exactly time to process any personal challenges or issues. But my experience of coming out publicly was hugely positive. Social media played a part in that, such as taking part in a photograph of LGBTQ MPs and peers, which then went online and attracted much attention; that showed the solidarity not just in this place and at the time in the other place for LGBT politicians, but across wider society. It was hugely positive, but I am also very conscious that I had an incredibly supportive network of family and friends, and that I have a very privileged position; in many ways I came out with the cover of political privilege. That is something that very few other people across the UK and beyond have, and we must always remember the challenges that folk across the UK and beyond face in coming out and those in the many countries where it is still illegal and people are persecuted for being LGBTQ.

For me, and for many other people, in coming out later in life there is an element of regret, and in fact mourning, for a life not lived as my authentic self, and it is hard to describe what that feels like. I try very hard to look forward—to make the most of what is in front of me, not to look back and have regrets that I was not living my life as my true self. There are many reasons why people come out later in life, and there is also much research around the profound impact that that has on people’s mental and physical health.

Coming out as lesbian, gay or bisexual can be a very different experience from coming out as trans. I cannot imagine how incredibly difficult that is, particularly in the current climate. We owe it to our trans and non-binary citizens to support them and ensure that discussion around changes in legislation or any matters relating to their lives and healthcare is conducted in a respectful and decent way. Sadly, I think we can all agree that there have been times recently when that has not happened.

We know the LGBT community, including lesbian, bi and trans women, experience significant health inequalities and specific barriers to services and support.

Stonewall Scotland’s survey of LGBT people in Scotland found that half had experienced depression in the past year, including seven in 10 trans people, and that more than half of trans people have thought of taking their own life in the past year. Let us just reflect on that. Half of trans people have thought of taking their own life in the past year. So when we think about and reflect on the debate that is currently ongoing, we must look at that statistic and take it very, very seriously.

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.

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.

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.

We know that it is sometimes the most vulnerable children who are being taken out of schools who need that relationship education. That is causing huge issues. As we know, there are many LGBT young people who are suffering profoundly for various reasons, whether it is their parents taking them out of school or the schools not yet providing that education. My own sex education in high school was literally about putting a condom on a banana and a quick discussion about the pill, and that was it. It is frightful to think that that is what children were being taught, and we have come a long way, but there is still a long way to go.

The work that Time for Inclusive Education—TIE—and Pink Saltire are doing in Scotland is hugely important. In 2019, TIE delivered 41 education sessions across Scotland, and found that 85% of the pupils it worked with who had previously held negative views or had a negative attitude towards LGBT peers reported that their opinions had changed positively after TIE had delivered a session. I have seen and been involved with some of the materials that TIE has produced. Its work is not just around sexuality; it is also around harmful gender stereotypes, which have a hugely negative impact. The learning outcomes highlighted that all the young people involved had an improved understanding of challenging those stereotypes, being true to themselves and speaking up if they were struggling.

The testimonies that TIE shared with me included an S1 pupil saying that they had learned “to never bottle anything up and to speak to someone about problems”. Another said they had learned that “no matter how bad things are it can get better if you try”. Another had learned that “it’s ok to ask for help…that you shouldn’t be afraid of who you are”. Another had learned “that it’s ok to be a bi girl and that things will get better”. Another had learned that “it is fine to be LGBTQ+ and as a lesbian I felt a lot better about myself after this”. A poster created by pupils in Primary 7 read: “Girls can play football, we’re all equal!” I could not agree with that more.

In closing, I just want to say how grateful I was to Members of this place, to the Speaker and to the House authorities when I recently suffered homophobic abuse—that is the only way to describe it—from a Member of the other place. I named him at the time, and I am not going to name him again, but it had a profound impact on my mental health. I also want to mention the support that I have had from the police. That was the first time I had ever experienced that kind of discrimination in my workplace. We all know that there are workplaces across the UK where LGBT people are facing discrimination, but to have experienced it in such an acute way, with a Member of the House of Lords saying homophobic things about me in the press, is still something that I find utterly incredible. There is not very much I can say about it, because the matter is ongoing, but I do want to say how grateful I am to the Members of all political parties who supported and contacted me, and to the public. The Member in question is a former MP from Northern Ireland who now sits as a life peer in the ​House of Lords. I received a number of emails from people in the Northern Ireland LGBT community, telling me about the damage he had done to their community over many decades. I did not know who he was before I came across him.

I am glad that we are having this debate. I hope all Members will agree that there is still a long way to go and that debates such as this one are part of the picture of making sure that good and proper healthcare is available for everybody in the LGBT community. We as Members must do everything we can to make sure that no one suffers from poor mental or physical health just because of their gender, sexuality or gender identity. We are all equal. At the end of the day, we are all human.

Link to Hansard for full speech, interventions and speeches by other MPs.