The Postcode Lottery: Gender-affirming Healthcare Provision across New Zealand’s District Health Boards

Abstract

Need for transgender health services has significantly increased in New Zealand, but public health service provision has lagged behind demand. Provision of transgender healthcare is further complicated by a lack of clarity around which gender-affirming healthcare services are provided by each District Health Board, and the process for accessing these services.AimsTo establish which gender-affirming healthcare services are available in each of New Zealand’s 20 districts and what process each District Health Board follows for providing these services.MethodsData were gathered using Official Information Act 1982 requests to each of the 20 District Health Boards. Two independent coders coded each response for availability of, and process for accessing, each service. Following this, interpretations of each response were returned to a District Health Board representative for an opportunity to confirm or update their response. ResultsOverall, responses showed notable inconsistency between District Health Boards regarding which services were available and funded. Four District Health Boards reported that they did not provide specific funding for any of the gender-affirming healthcare services listed. Responses to questions about the process of accessing gender-affirming healthcare produced similarly mixed results. ConclusionsThere is a need for consistency in gender-affirming healthcare provision across District Health Boards, and for the creation of clear health pathways and criteria for care.

“Being Trans Intersects with My Cultural Identity”: Social Determinants of Mental Health Among Asian Transgender People

“…3,4,[7][8][9] Transgender people in Aotearoa/New Zealand (hereafter referred to as Aotearoa) share a different gender-affirming care provision in context to other countries, and only a handful of studies have examined gender-affirming care as a social determinant of health for transgender people in this country. [10][11][12] In Aotearoa, gender-affirming care such as top surgeries (e.g., breast augmentation and chest reconstruction) and hormone therapy (except genital surgeries) can be accessed through primary care clinics or local District Health Boards (DHBs), although not all DHBs provide comprehensive gender-affirming care. 10,11 Transgender people who wish to be referred to publicly funded genital surgeries are required to undertake a readiness assessment from a health professional (e.g., endocrinologist or sexual health physician) who has gender-affirming health care expertise.…”

Rainbow experiences of accessing mental health support in Aotearoa New Zealand: A community-based mixed methods study

“…LGB young people were, however, three times more likely to experience significant depressive symptoms when compared to their heterosexual peers and had higher prevalence estimates of selfharm and suicidality (Lucassen, Clark, Moselen, Robinson, & Adolescent Health Research Group, 2014). Youth Wellbeing Study data supports these findings; in a sample of 1799 Wellington secondary school students, LGB young people were five times more likely to report lifetime engagement in self-injury than their heterosexual peers (Fraser et al, 2018). Results from the Dunedin Multidisciplinary Study and the Christchurch Health and Development Study, two large-scale birth cohort studies, also demonstrate increased rates of mental health difficulties and suicidality among sexual minority young adults (Fergusson et al, 1999(Fergusson et al, , 2005Skegg, Nada-Raja, Dickson, Paul, & Williams, 2003).…”

“…Eventually, I found ways to bring my interest in gender and sexuality together with my interest in psychology and mental health. I conducted research about self-injury among young people of different sexual orientations (Fraser et al, 2018), and the ongoing and problematic use of a male/female tick box to measure gender in psychological research (Fraser, 2018;Fraser, Bulbulia, Greaves, Wilson, & Sibley, 2019). I began to feel concerned about the level of rainbow cultural competence within my own fieldin the first few months of my clinical psychology programme one lecturer used the word 'transsexual' in class, another denied that 'they' was a valid personal pronoun, and I heard classmates speculate as to whether a client's sexual orientation could have resulted from a history of abuse.…”

“…Other gender-affirming healthcare services are provided by local DHBs (Ministry of Health, 2018a), however there is a lack of information regarding the current availability of these various services. In 2018 my colleagues and I requested information from each of the 20 DHBs about the gender-affirming healthcare services they provide and found remarkable inconsistency regarding which services were available and funded (Fraser, Shields, Brady, & Wilson, 2018). Trans people report widespread knowledge gaps among practitioners regarding trans healthcare in New…”

“…Several participants stressed the importance of increasing the funding available for trans healthcare, in order to make care more accessible: Here Bats argues that, although gender-affirming care is theoretically funded in New Zealand, in practice the amount of funding (and the system that facilitates funding availability) is inadequate to address the needs of trans people. Indeed, four of the 20 DHBs did not provide any gender-affirming healthcare services at the time of interviewing (Fraser, Shields, Brady, & Wilson, 2018), meaning that those in need would have to access private care or move to another region in order to access publicly funded care. Bats expresses frustration about the lack of progress being made in this area, and that they were not made aware that the information they were given regarding the availability of top surgery was limited to their DHB.…”