Trans communities in the United Kingdom are currently in the midst of an extensive period of social upheaval. Websites and social media have enabled an otherwise largely invisible and often geographically isolated population to socialise, organise politically, provide mutual support and share advice and/or information (Whittle, 1998). The language of trans identity is undergoing a rapid evolution, feeding into the emergence of an increasingly diverse repertoire of gender variant identities (Hines & Sanger, 2010; Pearce, 2012). Trans activists have successfully lobbied for provisions within legislation such as the Gender Recognition Act 2004 and the Equality Act 2010, and for Government schemes such as the Transgender Action Plan (Home Office, 2011). Moreover, the growing visibility of trans people within public life has been reflected in an increasing media interest in topics such as trans parenthood and trans youth; this in turn has bolstered the membership of advocate groups such as Trans Media Watch.
The above changes are taking place against a political backdrop that can be said to represent both the triumph of liberalism, and an ideological crisis born of contradiction. The increasingly visible role of trans people within public life – enabled in part through interventions undertaken by both Labour and Conservative/Liberal Democrat Coalition governments – reflects a wider shift towards liberal social attitudes within the UK. This shift is characterised by an increasing acceptance of social diversity, arising from ‘rights’-based discourses of tolerance and acceptance in regards to minority groups and social difference. Such discourses have benefited trans people within (for instance) public realm, the legal realm, and also within the realm of healthcare provision. Bodies such as the National Health Service now provide advice and guidance on trans issues for medical practitioners, with documents such as Burns (2008), Curtis et al. (2008) and Fish (2007) emphasising the importance of patient ‘choice’ whilst advocating a recognition of trans diversity. Similarly, the most recent edition of the World Professional Association for Transgender Health (WPATH) Standards of Care is predicated upon a discourse of ‘difference’, in contrast to previous guidance that presupposed trans ‘deviance’ (WPATH, 2011).
The increasing liberalisation of social attitudes within the UK has taken place alongside the liberalisation of economic policy as successive governments prioritise the ‘individual’ over the ‘social’ (Rose, 1996). Public services such as health provision are increasingly marketised and/or privatised; this trend is now accompanied by a programme of public sector cuts. Such moves tend to impact negatively upon the minority groups who rely most upon these services (McQuaid et al., 2010). The widespread public and professional disquiet over the NHS and Social Care Act 2012 reflects concern that a further ‘opening up’ of the UK health system will undermine the provision of treatment, with providers prioritising market efficiency over service delivery. The NHS reforms will undoubtedly have a major impact upon trans people.
My research examines the emergence, propagation and contestation of discourses relating to trans healthcare provision in the UK. I explore how discourses of trans health are shaped by (or are resistant to) one another. The research is taking place in the context of community, activist and professional sites on the Internet.
This project therefore has the following aims:
1) To examine UK-based discourses of trans healthcare provision in a variety of online contexts, thus providing an insight into:
Trans ‘community’ and ‘activist’ accounts of healthcare provision in the UK
- Perspectives on the provision of both tertiary (specialist) and primary (nonspecialist, ‘everyday’) care
Any impact that demographic differences might have in shaping trans narratives of health provision
- The processes by which discourse is shaped by the hypertextual medium of the Internet
- The impact of liberal hegemonies (incorporating discourses of ‘rights’, ‘choice’ and market efficiency) upon the above.
2) To chart the impact of contemporary social, political and legislative changes (such as the Equality Act 2010 and the NHS and Social Care Act 2012) upon discourses of trans health.
Curtis, R., Levy, A., Martin, J., Zoe-Jane, P., Wylie, K., Reed, T. & Reed, B. (2008)Guidance for GPs, other clinicians and health professionals on the care of gender variant people. London: DH Publications.