RFSL, The Swedish Federation for Lesbian, Gay, Bisexual, Transgender and Queer Rights, published a new report: “In society I don't exist, so it's impossible to be who I am.” Trans people’s health and experiences of healthcare in Sweden.
Introduction
This report describes the health of trans people and experiences in both general healthcare settings and in gender affirming healthcare. The current report is a more comprehensive version of the Swedish country report in “Overdiagnosed but under served” (Transgender Europe, 2017).
472 trans people responded to the Swedish survey, 35.6 % were trans men, 36.4 % non-binary, 23.3 % were trans women. 39 % of our respondents stated that their general health is bad. In the Swedish general population this number is 5 % (Folkhälsomyndigheten, 2016). Nonbinary people have poorer health than respondents with other gender identities. People experiencing misgendering and people not being able to live according to their gender identity have worse self-reported health than other trans people, indicating that societal factors are impacting health.
People with a lack of support from their families also report poorer health than others. Many of our respondents delay seeking healthcare even if they need it, with 62 % stating that they have done so in the past 12 months because of their gender identity. Delaying healthcare is connected to being treated badly, which many of our respondents have experienced in the last year (23.2 %).
It is clear that practitioners in general healthcare need more knowledge about trans to be able to treat trans people properly, both when it comes to interpersonal relations and actual medical treatment. The satisfaction with the Swedish trans care is generally low, with approximately 40 % of our respondents rating the care as bad.
The respondents report problems in gender affirming healthcare with waiting times, the referral process and the actual treatment by the gender clinics. However, some (18 %) are satisfied with the gender affirming healthcare. Improvement of gender affirming healthcare is needed on many levels.
A recent doctoral thesis on the subject concludes that “one way to reduce the risk that the healthcare per se induces stress is by working together with the transgender population and their organizations to improve care”(Dhejne, 2017). 9.7 % of all respondents in this study had attempted suicide within the last year, so for many people this problem is very acute. 54 % have had serious thoughts of ending their own lives during the past year. All participants regardless of gender identity have the same, very high, risk for suicide ideation and attempts.
In this study we reached 172 non-binary respondents. It is clear from our results that non-binary people have worse self-reported health, more self-reported disability and are less happy with how society perceives them than do the men and women in the study. It is impossible to know for sure that the frequent misgendering and inability to live according to one´s gender identity leads directly to bad health. The theory and research about minority stress (Meyer, 2003) does however imply that the environment is the main cause of ill-health among sexual- and gender minorities and our research indicates that these factors do play an important part also for trans people’s health. It is apparent that actions are needed to improve non-binary people’s health both physically and psychologically.
Many measures are needed to improve trans people’s health in Sweden. These measures include improving quality and access to gender affirming healthcare, changing the law on legal gender recognition, improving access and quality of mental health services for trans people, improving the support systems for people and families who need it and improving the knowledge on gender identity and expression in general healthcare.