Groundbreaking NZ report on trans and non-binary health

A ground-breaking report released tonight shows that trans and non-binary people in Aotearoa New Zealand experience alarmingly high levels of psychological distress, suicidal thoughts and suicide attempts. They also face high levels of discrimination and violence, as well as significant barriers when trying to access health services.

Counting Ourselves is the first comprehensive study of its kind in Aotearoa New Zealand. It is an in-depth survey of 1,178 trans and non-binary people aged from 14 to 83. Participants were asked about their school, family and work life, physical and mental health including access to gender-affirming healthcare, experiences of discrimination and violence, and the support they received in their life.

“We found that trans and non-binary people experienced higher levels of sexual violence than the general population,” said Dr Jaimie Veale, the study’s Principal Investigator and Senior Lecturer in psychology at the University of Waikato. Almost a third of participants reported that someone had sex with them against their will since they were 13. This is more than four times the rate of this sexual violence in the general population.

“High numbers of trans and non-binary people experienced discrimination, especially trying to find a job or housing, or when they were at work or in public places,” said Co-investigator and human rights researcher, Jack Byrne. In the last 12 months, participants were more than twice as likely to have experienced discrimination than the general population.

Discrimination, and violence are known to cause chronically high levels of mental health problems amongst marginalised groups. “Trans and non-binary people were nine times more likely to report high or very high psychological distress compared to the general population,” said Dr Veale. In the last 12 months, more than half of the participants had seriously thought about attempting suicide, and 12% had made a suicide attempt.

Trans and non-binary people across the country also struggle to access healthcare. “One in five participants avoided seeing a doctor in the last 12 months because they were worried about disrespect or mistreatment as a trans or non-binary person,” said Dr Veale, who is also the inaugural president of the Professional Association for Transgender Health Aotearoa (PATHA).

The study found high levels of unmet need for all forms of gender-affirming care, such as hormones, counselling or surgeries. “Participants described not being able to access this medically necessary healthcare because of cost, limited information, fear they would be treated badly, or because the services were not available through their local District Health Board.”

The report also highlighted positive steps and sources of support for trans and non-binary people. “Our study suggests that when trans and non-binary people are supported by their families, teachers, classmates, workmates or community, it could save lives,” said Mr Byrne. “The rate of suicide attempts in the last year was almost half for those participants whose gender was supported by at least half of their family or whānau. Non-European participants who felt a strong sense of belonging to their ethnic group were also much less likely to have seriously considered suicide in the last 12 months.”

The report calls for measures to improve the wellbeing of trans and non-binary people, such as creating better laws, policies and training to protect trans and non-binary people from discrimination and violence; providing clear pathways for gender-affirming healthcare in each District Health Board; naming trans and non-binary people as a priority in mental health policies; and supporting schools to be safe and inclusive for trans and non-binary students.

The study, Counting Ourselves, was funded by the Health Research Council, with additional support from the Rule Foundation and the University of Waikato. It is supported by a community advisory group and led by trans researchers in collaboration with academics from seven universities, health professionals, community organisations, and policymakers across Aotearoa. Copies of the report will be available by 6am Tuesday 24 September at www.countingourselves.nz/.

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About the study:

Counting Ourselves is the first comprehensive national survey of the health and wellbeing of trans and non-binary people in Aotearoa. It was conducted between 21 June and 30 September 2018 and completed by 1,178 people age between 14 and 83 from all regions of the country. This is the first published report of its findings.

Terminology

The report uses the umbrella term ‘trans and non-binary’ to describe anyone whose gender is different from the sex they were assigned at birth, as these were the two most common identities reported by the survey participants.

Gender-affirming healthcare covered in the report includes non-medical care (such as, hair removal and counselling support) as well as medical care (such as, hormones and surgeries).

Selected key findings

Gender-affirming care

- High levels of participants wanted but were not able to access gender-affirming healthcare. This unmet need ranged from 19% for hormone treatment through to 67% of trans men wanting chest reconstruction surgery. Around half of trans women had an unmet need for voice therapy (50%) and feminising genital surgery (49%).
- Cost was the most commonly reported barrier for all surgeries, and few participants had been able to access these through the public health system.

Healthcare access barriers

- Over a third (36%) of participants had avoided seeing a doctor because they were worried about disrespect or mistreatment as a trans or non-binary person, including 20% reporting this in the last 12 months.

Mental health and wellbeing

- Five out of every seven participants aged 15 and older (71%) reported high or very high psychological distress, compared with only 8% of the general population in Aotearoa New Zealand.
- More than half of the participants (56%) had seriously thought about attempting suicide in the last 12 months. Almost two in five participants (37%) had attempted suicide at some point and 12% had made a suicide attempt in the last 12 months.

Discrimination

- More than two-thirds of participants (67%) had experienced discrimination at some point, and 44% had in the last 12 months, a rate much higher than the general population (17% in the last 12 months).
- Participants who had ever experienced discrimination for being trans or non-binary were twice as likely to have attempted suicide in the past year (16%) than participants who did not report this discrimination (8%).
- In the last 12 months, 57% of participants did not disclose at work that they are trans or non-binary because they feared discrimination.
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Safety and violence

- Almost a third of participants (32%) reported someone had had sex with them against their will since they were 13. This is a much higher rate of sexual violence than for women or for men in the general population. Participants who reported this were twice as likely to have attempted suicide in the past year (18%) than participants who did not report this (9%).
- Almost half (47%) reported someone had attempted to have sex with them against their will, since the age of 13.

Material hardship

- Compared to the general population, participants were almost three times more likely to have put up with feeling cold (64%) and to have gone without fresh fruit or vegetables (51%) in order to reduce costs.

Family/whānau

- Many trans and non-binary people have a lot of support within their family/whānau. Among participants whose family/whānau knew they were trans or non-binary, more than half (57%) reported that most or all their family supported them.
- Participants who were supported by at least half of their family/whānau were almost half as likely (9% vs 17%) to have attempted suicide in the last 12 months.

Community connectedness

Most participants (62%) felt proud to be trans or non-binary, 58% provided a lot of support for other trans or non-binary people and 56% felt connected to other trans or non-binary people.

Selected recommendations

In order to improve the health and wellbeing of trans and non-binary people in Aotearoa New Zealand, action is needed in all areas covered by this report. Some of the key recommendations are:

1. Create clear pathways for gender-affirming healthcare, including training, resources and culturally appropriate services
2. Improve trans and non-binary people’s mental health and wellbeing, as a named priority in mental health and addiction policies
3. Support schools to be safe and inclusive for trans and non-binary students
4. Better protect trans and non-binary people from discrimination
5. Protect trans and non-binary people from violence, including as a priority in sexual and domestic violence work
6. Support health and wellbeing initiatives led by trans and non-binary communities.

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