Collecting Data About Gender Identity: Importance, Current Practices, and Exploring International Best Practices - Jody L. Herman, Ph.D. Scholar ...
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Collecting Data About Gender Identity: Importance, Current Practices, and Exploring International Best Practices Jody L. Herman, Ph.D. Scholar of Public Policy Williams Ins
WHY COLLECT GENDER IDENTITY DATA? • Demonstrate existence of gender minori1es • Learn about the size and characteris1cs of the gender minority popula1on • Increase visibility and des1gma1ze • Understand dispari1es of gender minority popula1ons compared to others (economic, health, social, etc.) and experiences of discrimina1on/s1gma • Inform the development of laws, policies, and programs that impact gender minority people
HOW TO COLLECT GENDER IDENTITY DATA? Gender Iden1ty in U.S. Surveillance (GenIUSS) Mission: To increase and beHer understand popula1on- based data about transgender people through the inclusion of gender-related measures (i.e., sex assigned at birth, gender iden1ty, gender expression, transgender status) on popula1on-based surveys, with par1cular considera1on for publicly funded data collec1on efforts. Ac1vi1es: GenIUSS will accomplish its mission by conduc1ng rigorous, scien1fic research on gender-related measures and making recommenda1ons regarding measurement research and data collec1on.
GenIUSS GROUP MEMBERS • Steering CommiHee Kerith Conron Gary Gates Scout Jody Herman • GenIUSS Group Members Bryn Aus1n Mara Keisling M.V. Lee BadgeH Emilia Lombardi Kellan E. Baker Phoenix MaHhews Kylar Broadus Sari Reisner David H. Chae Diego M. Sanchez Paisley Currah Kristen Schilt Masen Davis Gunner ScoH Alison Gill Ben Singer Emily Greytak Susan Stryker JoAnne Keatley Bali White
CONSIDERATIONS FOR GENDER IDENTITY MEASURES ON POPULATION-BASED SURVEYS 1) Correctly iden1fy people who are not gender minori1es as not being gender minority (e.g., iden1fy cisgender people as cisgender and not transgender) 2) Correctly iden1fy gender minority respondents as gender minori1es (e.g. iden1fy transgender people as transgender and not cisgender)
GenIUSS RECOMMENDED MEASURE
(Two-step Measure)
1. What sex were you assigned at birth, on your original
birth cer1ficate?
o Male
o Female
2. How do you describe yourself? (check one)
o Male
o Female
o Transgender
o Do not iden1fy as female, male, or transgender
(Based on the work of Reisner SL, Conron KJ, Tardiff LA, Jarvi J, Aus1n SB, 2013; Lombardi E, Banik S, Mitchell K, Zuber J)
GenIUSS RECOMMENDED MEASURE
(Trans Status)
Some people describe themselves as transgender
when they experience a different gender iden1ty from
their sex at birth. For example, a person born into a
male body, but who feels female or lives as a woman.
Do you consider yourself to be transgender?
o Yes, transgender, male to female
o Yes, transgender, female to male
o Yes, transgender, gender non-conforming
o No
(Conron; MA BRFSS; Reisner SL, Conron KJ, Tardiff LA, Jarvi J, Aus1n SB, 2013)
EXPLORING INTERNATIONAL PRIORITIES AND BEST PRACTICES FOR GENDER IDENTITY DATA COLLECTION June 17th, 2016 Data Collec1on Mee1ng Amsterdam • Develop a network of academics and other experts who study the collec1on of data about gender minori1es • Determine the desirability and feasibility of developing a set of interna1onal best prac1ces for the collec1on of data about gender minori1es • Consider what an interna1onal best prac1ces model might look like and determine what addi1onal considera1ons and steps are needed before beginning to develop these best prac1ces
EXPLORING INTERNATIONAL
PRIORITIES AND BEST PRACTICES FOR
GENDER IDENTITY DATA COLLECTION
• Steering CommiHee
Greta Bauer JoAnne Keatley
Walter Bock1ng Andrew Park
Jamison Green Sari Reisner
Jody Herman Sam Winter
• Mee1ng Par1cipants
Lukas Berredo Joz Motmans Ayden Scheim
Angelo Brandelli Costa Timo Nieder Alfonso Silva-San1steban
Madeline Deutsch N. Nicole Nussbaum Amets Suess Schwend
Rebecca Fox Robert Oelrichs Wim Vanden Berghe
Jack Harrison-Quintana Asa Radix Jaime Veale
Yuko Higashi Bernard Reed Joe Wong
Marc Lachance Elizabeth Saewyc
CURRENT DATA COLLECTION EFFORTS
(Official Government Activities)
• Asia and the Pacific • La1n America
o New Zealand o Uruguay
§ Sta1s1cs New Zealand § Trans Census (MSD)
o India & Nepal o Brazil
§ Third Gender § Admin Systems
• Europe • North America
o EU Agency for
Fundamental Rights o Canada
§ LGBT Survey § Sta1s1cs Canada
o UK § 2021 Census
§ NHS England
§ Equality & Human Rights
o United States
Commission § BRFSS & YRBS
o Netherlands § NCVS
§ Ins1tute for Social Research § State-level surveys (CHIS)ARE INTERNATIONAL BEST PRACTICES DESIRABLE? FEASIBLE? Yes, they are desirable • Provide guidance for data collec1on efforts • Foster comparability across countries • Hold governments accountable Yes, they are feasible • Involve affected communi1es • Safety of gender minority communi1es • Cross-cultural concerns • Ins1tu1onal support
RECOMMENDATIONS We recommend that governments and interna1onal ins1tu1ons… •Engage in and provide support for collec1on of data about gender minori1es and data analysis •Consider the inclusion and ac1ve par1cipa1on of gender minority communi1es in the process of suppor1ng data collec1on and analysis •Consider the safety of gender minori1es when considering and conduc1ng data collec1on and analysis
Best Prac*ces for Asking Ques*ons to Iden*fy
Transgender and Other Gender Minority Respondents
on Popula*on-Based Surveys
Exploring Interna*onal Priori*es and Best Prac*ces for
the Collec*on of Data about Gender Minori*es
Available at: hHp://
williamsins1tute.law.ucla.edu/Issues in developing trans-inclusive sex/
gender measures
Greta Bauer, PhD, MPH
Associate Professor and Graduate Chair
Epidemiology & Biosta;s;cs
Schulich School of Medicine & Den;stry
Western University
London, Ontario
22 June 2017
Wiliams Institute Webinar:
Collecting Data About Gender IdentityInclusion is urgently needed to remedy long-
standing erasure
All of this ;me that I’ve survived, I’m one of the
walking dead because we’re not counted; we’re not
represented anywhere.
And what’s the word? Erasure – which all of [us] are
familiar with as a theore;cal and prac;cal term. I
don’t think this is theore;cal; this is our lives.
Bauer, Hammond, Travers, et al. “I don’t think this is theore;cal;
this is our lives”: How erasure impacts health care for transgender
people. Journal of the Associa1on of Nurses in AIDS Care
2009;20(5): 348-361.§ Survey of n=311
who completed
two surveys
§ Cogni;ve
interviews with a
maximum diversity
sample of n=79
§ Canadian context:
§ Sedler-colonial
§ Mul;cultural
§ ∼ 20% immigrant
§ Mul;lingual
§ Genera;onal
language
differencesSet A: Mul;dimensional Sex/Gender Measure Are you … ? o Male o Female o Something else, specify: ___________________ Do you consider yourself to be trans (transgender, transsexual, or a person with a history of transiFoning sex)? o Yes o No o Don’t know
Following ques;ons are for only those who answered “Yes” or “Don’t know”:
What was your assigned sex at birth? Have you undertaken any of the following to medically
transiFon sex? (Check all that apply)
o Male
o Female o Hormone therapy
o Undetermined o Hair removal (electrolysis or laser)
o Mastectomy or chest reconstruc;on (an opera;ng to
remove breasts or construct a male chest)
o Breast augmenta;on (an opera;ng to make breasts larger
What is your felt gender? using implants)
o Hysterectomy (an opera;on to remove the uterus)
o Male or primarily masculine o Oophorectomy (an opera;on to remove the ovaries)
o Female or primarily feminine o Metoidioplasty (an opera;on to free the clitoris)
o Both male and female o Phalloplasty (an opera;on to construct a penis)
o Neither male nor female o Orchiectomy (an opera;on to remove the tes;cles)
o Don’t know o Vaginoplasty (an opera;on to construct a vagina)
o None of the above
What gender do you currently live as in your day-to-day life?
o Male
o Female
o Some;mes male, some;mes female
o Third gender, or something other than male or femaleSet B: Two-step method What is your current gender idenFty? o Male o Female o Trans male/Trans man o Trans female/Trans woman o Genderqueer/Gender non-conforming o Different iden;ty (please specify): _______ What sex were you assigned at birth, meaning on your original birth cerFficate? o Male o Female
Issues § Sensi;vity of ques;ons § Poten;al confusion for cisgender par;cipants § Number of ques;onnaire items required § Which dimensions of sex and gender are captured § Transness vs. trans iden;ty § Capturing the largest number of trans people § Gender non-conforming vs. non-binary vs. trans § Capturing cultural gender iden;;es § Self-report vs. proxy repor;ng § Translatability, ESL issues, stability of terminology § Move to administra;ve censuses
Missings
§ Two-step: 2 of 311 missing (0.6%)
§ 2 missing items
§ 1 addi;onal unclassifiable into detailed categories
(“somewhere between GQ and trans male”)
§ Mul;dimensional: 1 of 311 missing (0.3%)
Lesson: No major red flags for problems with skipping.No major confusion on sex/gender items
from cisgender par;cipants
§ cisgender male: Uh, truthfully... I found it
easy.
§ cisgender female: Um, well, I just kind of—
I’ve never really felt like a guy, I guess.
Lesson: No red flags for cisgender confusion on any of the items.9%
21%
30%
60% 19%
61%
Transmasculine Transfeminine
Bauer, Braimoh, Scheim, Dharma. Transgender-inclusive measures of sex/gender for popula;on surveys.
PLoS ONE 2017;12(5):e0178043.[T]here seem to be more
ques;ons now that have gone
from a gender binary to a
gender trinary [laughs].
Lesson: While an “other” op;on provides some flexibility, trans
people will not be iden;fiable from this kind of “trinary”
classifica;on. Even with an addi;onal ques;on assessing “trans-
ness”, gender spectrum will not be iden;fiable.ParFcipant:
20-29 yrs
White, Ontario
Trans, man
But for me like I don’t, I recognize that I have transi;oned but it’s not part of my
iden;ty. So, I don’t really iden;fy as a trans person, if really push comes to shove, if I
was in a doctor situa;on or whatever. But I generally do say like I’m a person with a
history of like, a medical history whatever, more so.
Lesson: “Trans” must be defined to include those who do not
iden;fy with the label “trans”.Comparing measures of gender iden;ty
MulFdimensional: Gender IdenFty
Missing Cis Cis Trans Non- Trans Non-
Woman Man Man binary Woman binary
(AFAB) (AMAB)
Missing 0 1 1 1 0 0 0
Cis 1 193 0 0 0 0 0
Woman
Two-step: Gender IdenFty
Cis 0 0 48 1 0 0 0
Man
Trans 0 0 0 15 1 0 0
Cohen’s Κ = 0.9081
Man
Non- 0 7 0 1 17 0 0
binary
(AFAB)
Trans 0 0 0 0 0 20 0
Woman
Non- 1 0 0 0 0 0 2
binary
(AMAB)
Lesson: For the dimension of gender iden;ty, these two
measures have near-perfect (chance-corrected) agreement.Except … Cis woman or transmasculine?
§ None of the 7 considered themselves trans when directly
asked, but identify as genderqueer or gender non-conforming
in response to the two-step questions
§ Write-ins: “queer”, “female genderqueer questioning”
Lesson: A “genderqueer / gender non-conforming” op;on for
iden;ty in the two-step (version recommended for tes;ng by
GENIUSS) may be too broad and will capture cisgender women
who are somewhat gender non-conforming.ParFcipant:
20-29 yrs
Mul;racial/mul;ethnic, Ontario
Trans, genderqueer, female
Well, my family is [religious] so that, that made it difficult to go one
way or the other with it. … but I think that’s the reason why I s;ll, I
s;ll like, choose to iden;fy my sex as female. […] because my
family is [religious] it’s easier for me to, like my sex, to iden;fy it as
female because then it’s, because otherwise it’s problema;c.
Interviewer: Right. And so have you, have you told your
family? Does your family know that you’re genderqueer?
No, no.
Lesson: Poten;al issues with proxy repor;ng of gender iden;ty
by family or household members.ParFcipant:
30-39 yrs
First Na;ons, Northern Ontario
DK if trans, genderqueer, AMAB
I do iden;fy as Two-spirited, but some;mes that more gender fluid and gender —
but having almost kind of like that balance of some;mes that I feel that I have—I’ll
have a more of a masculine day and more—as compared to having more of a
feminine day. … it fluctuates, and it’s not that—that I think that I’m transgendered
at all. I think whereas some people, they misunderstand that Two-spiritedness can
be—is considered to be something under the transgender spectrum, when really it’s
something that’s more of a spectrum in itself that is inclusive of sexuality and
gender iden;ty, gender diversi;es between gender and sexuality iden;;es, but very
exclusive to First Na;ons and Indigenous people. So—and some;mes it’s a lot—a
lidle more complicated than just saying gender fluid [laughs].
Lesson: Tradi;onal iden;;es may be more “gender fluid” than
“trans”, and more complicated than “gender fluid”. Different
paradigm.ParFcipant: ParFcipant:
40-49 yrs 40-49 yrs
White, Eastern Canada White and Japanese, Western Canada
Not trans, genderqueer, AMAB Trans, genderqueer, AFAB
I actually am non-binary and for me being trans is a predy broad term,
which includes anyone whose—whose gender is different than their
assigned sex at birth. And that’s not everyone’s understanding.
So I iden;fy as genderqueer, which I think of as a separate thing from
issues of transgender. … And I understand that that’s not a hundred
percent [laughs] how other people see that dis;nc;on, but that is
basically how I have always understand that dis;nc;on.
Lesson: The only thing people agree on with non-binary vs. trans
is that people don’t agree on the rela;onship between the two.Bauer. Making sure everyone counts: Considera;ons for inclusion, iden;fica;on, and analysis of transgender and transsexual par;cipants in health surveys. In: The Gender, Sex and Health Research Casebook. Vancouver: CIHR IGH, 2012: 59-67.
Recommend for further tes;ng/use in self-reported health surveys:
Mul;dimensional Sex/Gender Measure
Bauer, Braimoh, Scheim, Dharma. Transgender-inclusive measures of sex/gender for popula;on surveys. Under review.MSGM
§ No an;cipated confusion on the part of cisgender par;cipants
§ Avoids unnecessary op;ons for sex assigned at birth
§ Recognizes dis;nc;veness of Indigenous genders
§ Does not differen;ate between iden;;es as men or trans men (or
women or trans women)
§ Simple wording, with language that may change over ;me or have
meaning only to sub-groups kept to examples (also allows for
different examples in different languages)
§ Can be reworded for interviewer administra;on to include
response op;ons in the ques;on
§ Self-categoriza;on by par;cipants, acknowledging “best” op;on
may not be their individual iden;ty
§ Separate open-ended item for entering iden;ty prevents
unclassifiable entries (e.g. “just me”, “human”, “gay”, “trans male”
when AMAB)
§ Not suitable for proxy-repor;ng in most casesAddi;onal considera;on § Move to administra;ve censuses – how are sex/gender data captured in administra;ve records
Jessica Braimoh, PhD Ayden Scheim, PhD (c) Christoffer Dharma, MSc For consultaFon and feedback: For assistance: • Marcella Daye • Liz James • Seju;e Alam • Suzanne Desjarlais • Marc Lachance • Rachel Giblon • Eric Diode • Renee Masching • Fin Gareau • Nicole Nussbaum • Jody Herman • Caitlyn Paget • Randy Jackson • Jean-Pierre Seguin
THANK YOU!
Trans health project
discrimination and healthcare among
Brazilian transgender population
Angelo Brandelli CostaTransgender in Brazil? → Travesti or transsexual (trans) men/women ▪ Assigned male ▪ Identifies as man, woman or travesti ▪ Affirms female gender ▪ Typically not undergoing genital modification
Trans-rights in Brazil
Covers:
• Hormone therapy
• Medical gender affirmation proceduresTrans health project ▪ Cross-sectional study ▪ Community infomed survey ▪ Healthcare needs and access barriers
Instrument
A Demographics
B Parentality / Conjugality
C Healthcare needs and access
D Hormones
E Body modifications
F HIV and STIs
G Sexual health
H Prejudice and discrimination
I Housing
J Work and income
K Substance use
L Well-beingGender identity assessment 1. At birth you were assigned as ( ) Male ( ) Female 2. Which of the following best describes your current gender identity? ( ) Woman ( ) Men ( ) Trans woman ( ) Trans man ( ) Travesti ( ) Other, _______________
Data collection Hospital-based Facebook-based
Demographics
Age 26.4 (18–65) Mdn 24
Racial/ethnic
White 70.3
Non-white 29.7
Education
Some 1.8
Primary 10.4
Secondary 62.1
Tertiary 20.6
Post-tertiary 5.1Participants
47
Sample
@ 429
710
Respondents 51
@ 183Gender assigned at birth
Assigned male
65%
Assigned female
35%Gender identy
Trans woman
25.5%
Woman
23.1%
Travesti
13.3%
Trans man
20%
Man
9.3%
Other
8.7%Cross-coded gender identity
Trans woman
42.2
Trans women Woman
61.9 37.4
Travesti Assigned Female
21.4 63.5
Other
Trans men 8.7 Assigned Male
68.3 36.5
Trans men
29.3
Men
31.7Participants
47
Sample
@ 429
710
Respondents 51
1361 @ 183Exclusion criteria
Assigned male x Man
Assigned female x Woman
OtherResults - Mental health
Depression Low self-esteem Suicide ideation Suicide attempt
58,8 60,4
72.9% trans-related
Trans women
33,2 39,6
Ideations 4x
72,4 69,9
Trans men
49,5 44,4
Attempts 14.5x
Botega, Marín-León, Oliveira,
87,5 67,6 Barros, da Silva, &
Queer
Other Dalgalarrondo, 2009
51,6 37,8
0,0 25,0 50,0 75,0 100,0Results - Trans-related violence
What? Where?
Physical intimidation and threats 67 Street 79,4
Verbal harassment 41,3
Sexual harassment
Educational context 53,3
40,4
Silent harassment 20,2 House or family 35
Physical violence 19,6
Sexual assault
Work 27,4
12,1
Experienced?
Yes 86,8
Reported the police?
Yes 10,2Results - Impact of violence
75
70,16
60,3
50 47,58
44,4
36,9
25
20,4
0
Physical or sexual assault Verbal harrassement or threat No harassament or assault
Suicide ideation Suicide attemptResults - Mental healthcare
Ever consulted Satisfaction
67.7 Very Dissatisfied
Dissatisfied
Trans Neutral
54,9
women Satisfied
32.3 Very Satisfied
57.0
Trans
58,5
men
43.0
26.9
Queer
Other 48,1
73.1Results - Healthcare avoidance
Avoided healthcare when needed? Discriminated
58,7 41,3
56,8
43,2
Never discriminated
82,2
Avoided 62,0
17,8
Never avoided
Healthcare
discriminationTrans health project
discrimination and healthcare among
Brazilian transgender population
Angelo Brandelli Costa
angelo.costa@pucrs.brYou can also read
