👩‍❤️‍👩LGBTQIA+ inclusive policies

Implement LGBTQIA+ inclusive policies. This includes the following policies and guidelines:

Non-discrimination

Non-discrimination policy that protects LGBTQIA+ patients on the grounds of sexual orientation, gender identity, gender expression and sex characteristics.

Sample of policy non-discrimination policies:

• “[Hospital] does not discriminate against any person on the basis of gender expression, actual or perceived gender identity, sexual orientation, intersex status, intersex traits, Disorders/Differences of Sex Development, and/or atypical sex characteristics,

• Kami memberi perkhidmatan kesihatan berkualiti tinggi tanpa mengira umur, gender, seks atau jantina, orientasi seksual, bangsa, agama, kewarganegaraan, taraf perkahwinan, atau status lain.

• We provide the highest quality of healthcare and services to all persons without discrimination on the grounds of age, gender, sex, sexual orientation, race, ethnicity, religion, nationality, or other status.

• “It shall be the policy of the [ABC] to maintain and promote a safe environment for all youth in the facility’s care. All [ABC] staff, volunteers, and contract providers are prohibited from engaging in any form of discrimination against or harassment of youth on the basis of actual or perceived race, ethnicity, immigration status, national origin, sex, disability, sexual orientation, gender identity, and gender expression…”

Health proxy

Many LGBTQIA+ people may not feel comfortable including their biological family members in their healthcare information or treatment plan due to their relationship with them, not being out to them. Therefore, broad definitions should be used in policies governing carers and support people so that those who are not legally considered family members can be included in the patient’s health care treatment.

Sample policy:

• When there is a person trusted by the patient, including but not limited to relative, next-of-kin, legal guardian, intimate partner, cohabitating partners and friends, is available, and the relationship well established or confirmed, the consent may be obtained from such a person if an elective or non-emergency operation is necessary from a medical practitioner’s considered opinion. (adapted from Malaysian Medical Council Guideline: Consent for Treatment of Patients by Registered Medical Practitioners.)

Data protection

[TBC]

Staff handbook

[ABC] staff must model appropriate and affirming behavior at all times. This means that bias, discrimination, bullying or harassment by staff or by youth towards youth and/or families are not tolerated, and immediate action to intervene in any such situation must be taken by staff.”

Access to facilities

• “When transgender patients present for healthcare, they will be addressed and referred to on the basis of their self-identified gender, using their pronouns and name in use, regardless of the patient’s appearance, surgical history, legal name, or sex assigned at birth. If the patient’s family members suggest that the patient is of a gender different from that with which the patient self-identifies, the patient’s view should be honored”

• “Hospital staff members will not use language or tone that a reasonable person would consider to demean, question, or invalidate a patient’s actual or perceived gender identity or expression.”

• “Hospital staff members will not ask questions or make statements about a transgender person’s genitalia, breasts, other physical characteristics, or surgical status except for professional reasons that can be clearly articulated. Information about a patient’s transgender status or any transition-related services that the patient is seeking and/or has obtained is sensitive medical information and hospital staff members will treat it as such.”

Hospital Guidelines

Specific hospital guidelines for affirming care for the transgender population, non-binary population, intersex population, and others.

Non-discrimination (for trans people)

• “When transgender patients present for healthcare, they will be addressed and referred to on the basis of their self-identified gender, using their pronouns and name in use, regardless of the patient’s appearance, surgical history, legal name, or sex assigned at birth. If the patient’s family members suggest that the patient is of a gender different from that with which the patient self-identifies, the patient’s view should be honored”

• “Hospital staff members will not use language or tone that a reasonable person would consider to demean, question, or invalidate a patient’s actual or perceived gender identity or expression.”

• “Hospital staff members will not ask questions or make statements about a transgender person’s genitalia, breasts, other physical characteristics, or surgical status except for professional reasons that can be clearly articulated. Information about a patient’s transgender status or any transition-related services that the patient is seeking and/or has obtained is sensitive medical information and hospital staff members will treat it as such.”

Room Assignment

• “Where room assignments are gender-based, transgender patients will be assigned to rooms based on their self-identified gender, regardless of whether this self-identified gender accords with their physical appearance, surgical history, genitalia, legal sex, sex assigned at birth, or name and sex as it appears in hospital records. That a transgender patient’s physical appearance or genitalia differ from other patients who share the same self-identified gender is not a bar to assigning the patient to a room in accordance with his or her gender identity. Sufficient privacy can be ensured by, for example, the use of curtains or accommodation in a single side-room adjacent to a gender-appropriate ward.“

Access to personal items

• “Transgender and gender-nonconforming patients may have access to personal items that facilitate gender expression (e.g. clothing, makeup) to the same extent that other patients have access to these items, regardless of gender. In addition, transgender and gender-nonconforming patients may also have access to other personal items that assist in their gender presentation, such as those used in binding, padding and tucking.”

Access to hormone therapy:

• “Transgender patients that have been receiving hormone therapy prior to admission should have that therapy continued without interruption pending evaluation by a specialist absent urgent medical reasons to the contrary. Healthcare providers unfamiliar with this aspect of care will consult with providers who have this expertise as well as with the patient’s prescribing physician if possible.”

In order to have effective internal policies and robust policy application and implementation, health practitioners should consider ways and strategies to communicate these policies to their patients, staff and other stakeholders. Consider the following tips and strategies when creating and implementing any of the above policies.

• Post it on the hospital website and in patient waiting areas and employee work areas;

• Include it in materials routinely given to patients at admitting/registration or at other times;

• Include it in materials routinely available for take-away in patient waiting areas;

• Include it in materials routinely given to employees at orientation; and

• Include it in periodic training for employees.

Policy making tips

Some tips for ensuring policies are inclusive of LGBTIQA+ people

• Include sexual orientation, gender identity, gender expression, and sex characteristics (SOGIESC) as protected grounds of discrimination. Alternatively, ‘other statuses’ can also be used to protect LGBTQIA+ people from discrimination

• Ensure that the understanding of ‘gender’ is not binary. Gender often subsumes sex characteristics and sexual orientations, as in a patriarchal context, everybody is expected to exist within the binary male-female cisgender heterosexual category.

• Ensure that your policies are not endosexist, cisnormative, or heteronormative by taking into consideration the needs of LGBTQIA+ people and the socio-legal context. For example,

  • given the lack of legal gender recognition and criminalisation of LGBTQ people, it is important to ensure data protection policies treat some data related to gender identity and sexual orientation as personal sensitive data.

  • ensure policies do not restrict health or other proxies to family members and next of kin.

  • ensure non-discrimination policies affirm trans people’s access to facilities based on their gender identity

• Create new guidelines, Standard Operating Procedures (SOP), and other measures to support staff in providing LGBTQIA+ affirming responses. For example, you may need a shelter policy, telephone counseling SOP for LGBTQIA+ clients, GBV response for LGBTQIA+ children based on your organisational needs.

Remember, while it’s important to have policies in place, it is equally important to train everyone in your organization to ensure these policies can be implemented.