The healthcare battle for transgender people
Jennifer Shields (she/her) being a member of the community herself said, “I feel people’s frustration.”
Transgender healthcare in New Zealand has been under increasing scrutiny these past few years, due in part to the massive increase in demand as well as the lack of funding and resources. This has led to long wait times for certain procedures, and for some who live outside the main cities, a lack of affirmation care being available.
There is a lot of talk in the media about the problem that is inaccessible healthcare for transgender New Zealanders, but little in the way of solutions.
Fortunately, there are organisations lobbying the government to improve the healthcare situation for transgender New Zealanders. One of them is the Professional Association for Transgender Health Aotearoa (PATHA).
PATHA was founded in 2018 and is an interdisciplinary professional organisation, which works to promote the health, wellbeing, and rights of transgender people.
Jennifer Shields (she/her) is the Vice President of PATHA. She noted that “things have come a long way in terms of healthcare, but there are still big gaps that need filling.”
Shields being a member of the transgender community herself said that she understands the frustration of the community when it comes to healthcare saying, “it’s so hard” and “I feel people’s frustration.” She does say that lots of change is happening in the background, especially regarding national standards and pathways.
In 2023 PATHA published an article in the New Zealand Medical Journal titled PATHA’s vision for transgender healthcare under the current health reforms. Which the outlined their ideas for creating a more equitable and effective transgender healthcare system.
In New Zealand, increasing demand for care, high levels of unmet care and the so-called postcode lottery in where care differs from place to place have led to “serious health inequities.” To remedy the situation PATHA says “we need clear requirements and resourcing for the new healthcare system to provide accessible gender affirming healthcare.”
The first area of interest to PATHA is primary care. Primary care is “healthcare provided in the community for people making an initial approach to a medical practitioner or clinic for advice or treatment.” General Practitioners (GPs) for example are a provider of primary care. For transgender health some district health boards have been shifting towards primary care for gender affirming care. In Canterbury for example hormone initiation is led by primary care.
When it comes to primary care PATHA recommends “a person-centred model of care distributed among primary care providers.” Currently to access hormones transgender patients need to undergo a readiness assessment. Public mental health services are suffering issues caused by high levels of demand. If people were to go privately, that’s a high cost that isn’t covered by the government.
These are barriers to people accessing hormone treatment. PATHA believes “access to gender affirming hormones via primary care could reduce barriers through timely access care in settings that are closer to where people live and more connected with their communities.” A switch to primary healthcare would not only take stress away from secondary healthcare providers such as hospital specialists. It would also improve mental and physical health outcome for transgender people.
As well as primary healthcare, PATHA notes that access to gender affirming surgeries in New Zealand needs to improve. The Ministry of Health managed Gender Affirming Genital Surgery Service (GAGSS) has not received a funding increase since 2019. And as a result does not “seem to have the funding nor the capacity to meet the population need.” As well as a lack of capacity, no psychosocial support is provided to those in care and a readiness assessment is required.
Just like the assessment for gender affirming hormones, the waits for assessment are long, and expensive if done privately. In the Counting Ourselves survey only 15% of those wanting genital surgeries had applied to be put on the public waitlist. The primary reason people did not apply to be put on the list was the length of the waiting list, with 74% of respondents stating this. Doctor Rita Yang who is the only surgeon in New Zealand capable of genital reassignment surgery is only funded by the government one day a week, this funding is for surgery, admin, and training. Yang tries to focus on surgery.
When talking about other gender affirming surgeries what is available is limited and can differ from place to place. The Counting Ourselves survey saw high levels of need not being met for procedures such as breast augmentation and reduction. And PATHA noted hearing reports that requirements to access surgeries in certain DHBs can be more restrictive than national and international practice.
It is also recommended that funding for the GAGSS needs to be increased to meet the transgender populations needs. PATHA also recommends the “Ministry of Health funds a separate entity to manage the gender affirming genital surgery service.”
PATHA believes NZ is on the right track and that transgender healthcare just needs more prioritisation, especially for marginalised groups like Māori and Pasifika as well as the disabled communities.
