UN envoy criticizes ‘one-sided’ WHO approach to trans health guidelines
The UN Special Rapporteur on violence against women and girls has accused the World Health Organization of taking a “one-sided” pro-medicalised approach to trans healthcare when developing new guidelines.
Reem Alsalem has found himself in a developing row over the composition of a recently announced WHO committee that will work to develop the organization’s first global guidelines on transgender care for adults.
The UN health agency last month published biographies of 21 experts invited to help formulate guidelines. The composition of the committee has raised concerns among a number of women’s rights and LGBTQ+ organizations, highlighting a lack of diversity of views.
Alsalem, who has previously weighed in on the debate on Scotland’s Gender Recognition Reform Bill, wrote to the WHO director-general to say she believed the composition of the committee presented “significant, unmanaged conflicts of interest” contained.
She added: “Stakeholders whose views differ from those of transgender activist organizations do not appear to have been invited. Such stakeholders include experts from European public health authorities who have taken the lead in developing an evidence-based and therefore cautious approach to gender transitions in young people (e.g. England, Sweden and Finland).”
Most committee members had “strong, one-sided views in favor of promoting hormonal gender transition and the legal recognition of self-claimed gender,” she wrote, adding that of the 21 committee members “not one appears to represent a voice of caution against the medicalization of young people with gender dysphoria or the protection of women-only spaces”.
The role of the UN Special Rapporteur is an independent position, given to human rights experts who offer expertise in specialist areas to UN bodies.
The WHO says the new guidelines will “provide guidance for healthcare interventions aimed at increasing access to and use of quality and respectful healthcare services by trans and gender diverse people.”
The guidelines will focus on five areas, including the “provision of gender-affirming care, including hormones” and “health policies that support gender-inclusive care, and legal recognition of self-determined gender identity.”
Organizations that have expressed concerns about the composition and objectives of the WHO Commission have complained that the UN agency has taken both the legal recognition of self-identification and the benefits of gender-affirming care as accepted principles, despite these positions being the subject of ongoing debate in many countries. How quickly the stated gender of young people with gender dysphoria should be confirmed is at the heart of discussions about NHS policy on trans healthcare.
Alsalem said it was an “important omission” that the committee did not include representatives who are experts in adolescent development, as “the vast majority of individuals contacting gender-related services worldwide are now adolescents and young adults who do not had a history of gender-related services. fear”.
She also expressed concern that the WHO’s three-week consultation period to provide feedback on the composition of the committee fell during a holiday period and ended on Monday.
The committee will meet in February at WHO headquarters in Geneva to examine the proposed guidelines. Alsalem said she hoped the meeting would be postponed until all concerns about the committee were addressed. She said she had not yet received a response from WHO to her January 4 letter.
The Clinical Advisory Network on Sex and Gender, a network of doctors mainly in Britain and Ireland involved in the debate about sex and gender in healthcare, wondered why the WHO seemed to be promoting gender-affirming care as always the best approach . “There are no robust randomized controlled trials supporting gender-affirming medical and surgical interventions, and therefore no studies that tell us about the efficacy of these interventions, in children or adults,” the organization said in a statement.
The WHO said it encouraged stakeholders to provide feedback, adding: “WHO guidelines are always based on weighing available evidence, human rights principles, consideration of harms and benefits and input from end users and beneficiaries.”