sou · H5B392 · 2017-11-28 00:00:00 — Utredningen ska, enligt direktiven, där det är lämpligt, undersöka levnadsvillkoren för personer med intersexvariation. Vi har tagit del av synpunkter från organisationer som representerar personer med intersexvariation, samt av forskning inom ämnet. Utredningen läm- nar följande förslag: Åtgärder för att förbättra vård och rättigheter för personer med intersexvariation •Regeringen tillsätter en utredning med uppgift att förutsättnings- löst utreda frågan om lagstiftning eller andra åtgärder gällande kirurgiska och andra ingrepp på personer med intersexvariation. •Socialstyrelsen ges ett uppdrag att utreda möjligheten att säkra patientens rätt till information om den egna medicinska historien. •Socialstyrelsen ges ett uppdrag att, i samarbete med organisationer som företräder berörda personer, ta fram ett kunskapsstöd för vården av personer med intersexvariation. Arbetet kan inledas med att göra en kartläggning och ska komplettera den tidigare gjorda kartläggningen. Utredningen har tagit del av resultat från en enkätundersökning, dsdLIFE, där svenska personer med intersexvariation svarade på frå- gor om sin livskvalitet. De flesta som svarat är nöjda eller ganska nöjda med sina erfarenheter men många menar att vården egentligen borde vänta med irreversibla ingrepp. Resultaten får tolkas med försiktighet. menar i en kommentar att kirurgiska ingrepp på spädbarn eller små barn inte ska göras utan medicinsk indikation eller på svag indikation med bristande kunskapsunder- lag. Mer kunskap efterfrågas, liksom stöd åt föräldrar och barn. Bland de organisationer som representerar personer med inter- sexvariation finns olika uppfattningar i frågan om kirurgiska ingrepp på spädbarn och små barn. Däremot finns konsensus rörande behovet av mer kunskap inom vården och tillgång till specialistvård. In this official report, the Inquiry concerning a Stronger Status and Improved Living Conditions for Trans People provides an account of the results of our survey of trans people’s living conditions. We also propose measures in several areas with the aim of strengthening the status of trans people. Context of the inquiry In these sections, the inquiry describes some of the policy areas that our proposals touch on. Beginning with the work undertaken to pro- mote human rights at the global and European level, we then move on to general human rights efforts in , action to promote the rights of LGBTQI people, efforts to combat discrimination and to promote gender equality and public health. We describe the design of A Strategy for Equal Rights and Opportunities Regardless of Sexual Orientation, Gender Identity or Gender Expression, the evaluation of this and some good examples of strategies from other countries. We also conduct a brief analysis of gender equality efforts from a trans perspective and provide an account, from a trans perspective, of some of the latest initiatives to tackle discrimination and promote gender equality. These chapters, as well as the chapter on living conditions, provide the background to the proposals under the following heading. Trans people’s living conditions According to its terms of reference, the inquiry is to investigate how trans people are affected by society’s cis and hetero norms, identify the barriers in society to trans people’s opportunities to live according to their gender identity and, where necessary, propose interventions to remedy any shortcomings. Among the inquiry’s conclusions is that efforts to improve trans people’s living conditions must be reinforced at a structural level, with the responsibilities and tasks of public authorities being set out clearly. The inquiry’s survey of trans people’s living conditions The inquiry’s results indicate that a relatively high proportion of trans people cannot live in accordance with their gender identity and that this has a detrimental impact on their health. Trans people are more likely than the population as a whole to rate their own health as poor. There is also a clear difference within the group, trans people, where non-binary people to a greater extent rate their health as poor, as is the case with those who state that they cannot live in accord- ance with their gender identity. trans people rate their quality of life as poorer than young cis people. Suicidal thoughts and attempt- ed suicide are more common among trans people than among the population as a whole. A majority of young trans people state that they have had suicidal thoughts. Not having the support of those closest to you is thought to lead to poorer health, with the results of several studies suggesting that trans people as a group have less support from those around them than the population as a whole. It is more common for trans people to experience harassment, degrading treatment and discrimination than the general population. Many trans people also feel they are made invisible in society, for example, through the use of gendered language, the format of Swedish personal identity numbers and because it is not possible to have a legally recognised identity other than as a woman or a man. Many trans people have experienced vulnerability and insecurity in various public spaces, for example, in restaurants, while travelling, or when accessing public toilets. Trans people are more likely than the general population to experience physical violence. In close relationships, there is a specific form of violence that affects trans people, specifically focusing on gender identity and gender expression. Trans people are also affected by hate crimes and honour-related crimes. One clear challenge is that the crime statistics are incomplete, partly, because many victims do not file reports due to a lack of trust or confidence that doing so will make a difference. Younger trans people state that they want more information about sexual health, for example, what impact hormone treatments can have on sexual health and sexuality. Regarding reproductive health and rights, there is also a lack of knowledge available concerning factors such as the need for support. The incidence of HIV among trans people in is not known because the statistics do not reveal gender identity or gender expres- sion as a variable. There is a demand for trans-specific information about safe sex. On the basis of this information, the inquiry proposes the following: Improving the coordination and structure of work to promote the rights of LGBTQI people •The Government develops an action plan for the equal rights and opportunities of LGBTQI people. This work should involve additional public authorities being appointed as strategic authori- ties and one assigned permanent responsibility for coordination. •The , the Swedish Authority, the for Education, the Ombudsman for Children in , and the forthcoming are appointed as new strategic authorities in addition to the existing five. •The new is given responsibility for co- ordination and an supportive mandate. An inquiry into the feasibility of a third legal gender •The Government establishes an inquiry to investigate the feasibi- lity of introducing a third legal gender in , as well as gender-neutral personal identity numbers. Improved knowledge about LGBTQI people’s living conditions •Changes should be made to the qualification criteria in the Swedish Higher Education Ordinance for relevant study programmes to ensure that these include knowledge of the living conditions of LGBTQ people and people with intersex variations. •The is tasked with investigating difficul- ties experienced by trans people when travelling. •The Authority is tasked with investigating the possibility to introduce the option X as a gender signifier on Swedish pass- port documents. accessible toilets and changing rooms •The Government establishes state funding to support develop- ment projects for trans-inclusive environments. •The Swedish Equality Ombudsman, in collaboration with , and Planning, is tasked with developing guidelines on designing trans-inclusive changing rooms and toilets. •All public agencies should provide gender-neutral signage on individual toilets. Stronger support for victims of crime •The Authority is tasked with implementing an internal skills development programme with an LGBTQI perspective and a distinct trans perspective regarding hate crimes, honour-related crimes and violence in close relationships. •The is tasked with including trans people in the Swedish Crime Survey. •A long-term grant for support activities provided by civil society to LGBTQI victims of crime is to be secured. Strengthened and improved efforts to promote sexual and reproductive health •The is tasked with reviewing the HIV transmission statistics to see how best to include trans people. •The Government develops a national SRHR strategy that inte- grates a specific LGBTQI perspective. perspectives on the living conditions of trans people The inquiry’s terms of reference state that we must apply an inter- sectional perspective to the task and explore how other grounds of discrimination such as ethnicity, disability or age intersect with issues pertaining to gender identity and gender expression. The inquiry must also have a life cycle perspective and highlight the barriers that impact the life of a trans person, as well as present the differences among trans people with diverse gender identities. In this section, we have specifically highlighted the situation for trans people at different stages of the life cycle in addition to, among others, the experiences of trans people who are being racialised and trans people with dis- abilities. The inquiry proposes the following: Strengthened trans and intersex perspective in efforts to promote children’s rights •The Ombudsman for Children in is tasked with talking to children and adolescents about issues pertaining to gender identity and to intersex variations, using its method as a basis. The aim of this is to improve society’s knowledge of how children’s rights according to the Convention on the Rights of the Child are fulfilled for young trans people and children and adolescents with intersex variations. •The Swedish Schools Inspectorate is tasked with investigating the situation trans people face as pupils in compulsory and upper secondary schools. The Ombudsman for Children has reported to the inquiry that there has been an increase in the number of children with trans experience contacting the office. It has been proposed that the Convention on the Rights of the Child becomes Swedish law and, according to the in- quiry, there is a need to include a trans and intersex perspective in the work to ensure that the intentions of the convention are adhered to. Many of the submissions received by the inquiry from younger trans people concern school. Of central importance is that everyone has an equal right to education and to be able to exercise this right without being subjected to harassment or discrimination. Strengthened LGBTQI perspective in efforts to improve the living conditions of older people •The is tasked with developing new know- ledge about the living conditions and specific needs of older trans people and investigate what initiatives are required to improve the psychological well-being of older trans people. •The is tasked with develop- ing recommendations concerning how municipalities can include an LGBTQI perspective, and a distinct trans perspective, in the plans and governance documents that pertain to elder care. •The is tasked with pro- ducing guidelines that set out how organisations within the field of elder care can work with issues related to gender identity, gender expression, sexual orientation, and sexuality. Knowledge about older trans people is limited. is known about the situation of older lesbian, gay and bisexual people, and of young trans people. In the ’s study, the older re- spondents were more likely to lack emotional support than their younger counterparts. Within the field of elder care, there is a lack of knowledge and measures to ensure that the needs of older trans people are met. Strengthened support to LGBTQI families •The is tasked with in- vestigating support material needs for families where one or more of the parents are trans people and in families with trans children. •The Government establishes an inquiry tasked with reviewing the Children and Parents Code to make it gender neutral. There is a lack of knowledge about trans people and parenthood. In a survey by for Fundamental Rights, 58 per cent of the trans respondents stated that they were parents. Trans people who are parents are in need of trans-qualified care- givers within, for example, prenatal care and at child health centres. The lack of gender neutrality in the Children and Parents Code results in administrative problems when registering trans people as parents in the national population register. The proposals put forward by previous inquiries do not, according to the inquiry, address this problem in a satisfactory . According to this inquiry, there is a need to review the Children and Parents Code. Alternatively, an inquiry should be established with the limited task of suggesting necessary amendments from a trans and intersex perspective. Improved work for LGBTQI asylum-seeking people •The is tasked with improving the possibilities of continually evaluating the quality of the review of LGBTQI people’s asylum applications. These evaluations are to have a norm- critical perspective so that any stereotypical assumptions that may shape decisions are highlighted. •The is tasked with changing the format of the asylum seeker card so that it does not create barriers for trans people. •The is tasked with registering asylum-seeking people’s gender on the basis of self-identification. •The is tasked with ensuring there is safe accom- modation for LGBTQI asylum-seeking people. Asylum-seeking trans people with whom the inquiry has been in contact state they do not have safe accommodation. It is problematic that the asylum seeker card used to identify them does not reflect their gender identity and/or gender expression and that the ’s officers’ trans expertise varies. Legal counsel and welfare officers with whom the inquiry has been in contact paint a similar picture that includes decisions based on a stereotypical and arbitrary basis and vulnerability in the ’s residential facilities. has itself evaluated the quality of its decisions pertaining to applications on ‘LGBTQ grounds’ and con- cludes that there is room for improvement. Trans people’s mental health The inquiry’s terms of reference state that it is to identify, in con- sultation with the national coordinator for development and coordi- nation of interventions within the field of mental health (S 2015:09), how interventions that aim to improve mental health and reduce stress among trans people can be incorporated into the work being carried out by public authorities, municipalities, county councils and organisations within the field of mental health. The inquiry is also to propose how targeted interventions to prevent suicide and attempt- ed suicide among trans people can be accommodated in the ’s task of coordinating suicide prevention and propose how current alcohol, drug and tobacco prevention can ensure that the increased risk existing among trans people is taken into account. In addition, the inquiry has a general mandate to investigate trans people’s living conditions, which has been addressed in this chapter with a focus on mental health. The inquiry proposes the following: ’s work given a more distinct trans and intersex perspective •The is tasked with conducting educational interventions aimed at people with strategic responsibility for public health efforts. •The is tasked with focusing on trans people’s vulnerability and specific needs as part of its work on suicide prevention. This is to be achieved through means such as increasing, and making permanent, the recently established grant to support civil society organisations in this area. •The is tasked with mapping the incidence of eating disorders among trans people in and drawing up proposals for possible actions and identifying developing needs. •The is tasked with developing new know- ledge and support materials concerning LGBTQI people and alco- hol, narcotics, doping and tobacco (ANDT) problems. Support for peer-to-peer interventions and developing methods should be made available with the aim of facilitating smaller organisations that represent particularly vulnerable groups to apply for grants. A clearer ANDT strategy •The existing ANDT strategy should be updated so that it includes clear proposals concerning how particularly vulnerable groups are to be reached. A supplement to the agreement with SALAR •It should be included in the agreement for mental health between the Government and the Authorities and Regions (SALAR) that municipalities are to report in their county-wide action plans how they plan to promote mental health and prevent mental ill health among trans people. Surveys indicate that trans people are much more susceptible to stress than the general population. research about the situation for trans people in is needed regarding, among other matters, eating disorders and interventions that are effective, for example, in reducing susceptibility to minority stress. In Swedish surveys, a higher proportion of trans people state they have contemplated suicide or have attempted to take their own lives, compared with the general population. The agreement between the Government and SALAR regarding efforts to promote mental health includes the creation of county- wide plans for improving mental health. The LGBT group is named in 9 of the 21 plans as a particularly vulnerable group. The suicide prevention programme contains a national action plan, which is lacking an LGBTQI perspective. In addition, the national ANDT strategy lacks any explicit trans perspective or an LGBTQI perspective. Attitudes within the health and social care sectors The inquiry’s terms of reference state that, on the basis of past studies, how trans people are treated within the health sector is to be explored. The inquiry proposes the following: Knowledge and privacy within the health sector shall improve •The is tasked with con- ducting a preliminary study of required training interventions for existing healthcare personnel. •The is tasked with in- vestigating whether the record systems used in for obstetric care and foetal monitoring are adapted to individuals with male personal identity numbers. •County councils and regions should secure that new record systems do not have a block against certain personal iden- tification numbers. •The and the for Education are tasked with updating Vägledning för elevhälsan (Guide to Pupils’ Health) with information about the living conditions of young trans people. Research indicates that up to one in four trans respondents have been subjected to discrimination or been treated badly within the health sector and that this leads to a reluctance to seek further care. Through its website, the inquiry has also received a large number of submissions concerning problematic treatment within the health sector, for example, at primary care centres, psychiatric services, in- cluding child and adolescent psychiatry, and young people’s clinics. We have noted specific challenges for trans men and non-binary people who are pregnant, relating to both the need for specific supports and technical difficulties with the records system. Trans people’s leisure time The inquiry’s terms of reference state that it is to propose concrete initiatives that improve trans people’s opportunities to safely parti- cipate in various recreational activities, in civil society, and in other social contexts, as well as propose measures that improve trans people’s opportunities to participate in exercise and sports. The inquiry proposes the following: Safer meeting spaces and strengthened self-organising •The for Youth and is tasked with allocating grants to actors that facilitate meeting places and activities for trans people and people with intersex variations, and facilitate relatives of trans people and people with intersex variations to form organisations. •The Government grant to LGBTQ organisations should be in- creased. •The Agency for Youth and is tasked with investigat- ing how trans people perceive their opportunities to participate in civil society. •The Agency for Youth and is allocated specific fund- ing to update educational materials and strengthen the trans per- spective in its efforts to support open and inclusive recreational activities. Access to meeting places specifically for their own group is some- thing that young trans people indicated is very important in a survey conducted by , now the Agency for Youth and . Forming organisations and contacts with other trans people is mentioned in several of the submissions received by the inquiry as vital to well-being. Relatives can also be in need of contact with other relatives. There can also be a need to organise groups with a specific focus on trans people with certain experiences, which is why it is im- portant that smaller organisations are also able to apply for grants. Increased opportunities for trans people to participate in sports and exercise •The is tasked with iden- tifying reasons for the sedentary leisure time of trans people, as well as suggesting initiatives to encourage greater activity. •The Government should initiate a dialogue with the Swedish Sports Confederation on the situation of trans people in sports. •The Government should design grants and terms of funding in such a way that only children and youth sports taking account of the child rights perspective receive funding. •The is tasked with developing indicators so that the state’s support for sports can be reviewed from a child rights perspective. Trans people have more sedentary leisure time than the general population. In a survey by for Funda- mental Rights (FRA), just over one in four trans respondents stated that they had experienced discrimination at sports facilities. Several studies indicate that young trans people also have negative experiences from their involvement in sports, have experienced harassment as- sociated with their trans identity, as well as a lack of support from coaches when this occurred. knowledge is required to address these barriers. Swedish sports policy has aims that include promoting public health and supporting the independent sports movement. cial support provided to sports is focused on children and young people and emphasises everyone having the opportunity to parti- cipate. The Sports Confederation is the umbrella organisation for Swedish sports and its role includes allocating grants. Trans people’s situation in the labour market The inquiry has been tasked with mapping, in dialogue with the social partners, the barriers to trans people’s opportunities to parti- cipate in working life on equal terms and, where necessary, with proposing concrete actions to improve the work environment and the labour market situation for trans people. The inquiry proposes the following: Increase knowledge about trans people’s situation in the labour market •The new agency, , is tasked with, on the basis of existing studies, developing basic information materials concerning work environment issues with an LGBTQ perspective, including a special focus on the situation of trans people. The information should target employers, as well as safety representatives and other elected representatives at the work place. •The Swedish Work Environment Authority is tasked with amen- ding or adding to the paragraphs in the work environment direc- tive, Workplace Design concerning the rules for changing rooms, washing and shower facilities, and toilets, with the purpose of including a trans perspective.