an opportunity to build a coalition

[sophiaserpentia]

Since late last week there's been some controversy in the blogosphere regarding the New Orleans Women's Health Clinic, which was opened in NOLA in the wake of Hurricane Katrina by Incite! Women of Color Against Violence. After Katrina there was (and I understand there still is) a shocking gap between health care options available and the health care needs of the population. The hardest hit were, as always, women of color and women of economic disadvantage.

The controversy began when activists and bloggers in the trans community noted that while NOWHC's policy statement promises nondiscrimination on the basis of gender identity, they also explicitly state "We are currently not able to provide care to trans people who were male assigned at birth or who have had genital sex reassignment surgery."

Most of the discussion I've seen since has been confrontational, with accusations of hate and cissexism. I personally think that this is entirely the wrong approach to take. Certainly if the root of this is prejudice, that prejudice should be called out. But there is a qualitative difference between an institution of the kyriarchy, against whom the confrontational approach is entirely appropriate, and a radical organization, with (not against!) whom I believe we should adopt a different approach.

I've said before that there is no easy-mode radicalism. I've said before I think that adversarial confrontation is the wrong approach to take with other radicals. And, as I said the last time there was a dispute about transwomen's access to women's health space, when the dispute is with sister radicals, there is no victory in confrontation, or in making someone see things your way, but in learning how to coexist and converge paths.

The comments I made previously all apply to how I feel about this situation, too. I believe the better approach would be to approach Incite! and ask, what can we offer to build a stronger coalition? Is it a matter of resources? Is it a matter of volunteer time? Money? Or is simply a matter of dialogue in good faith and consciousness raising together? What can we do that will make it easier for us to walk together on this path?

The sad thing is, I don't feel safe saying this publicly in any trans community. I barely feel safe saying it here in my own blog.

Comments

[velvet-tipping.livejournal.com]

Why do you feel unsafe saying this?

[stacymckenna.livejournal.com]

I'd be interested in the answer to this as well.

[hugh-mannity.livejournal.com]

I think the first question that needs to be asked is "Why can't you provide transwomen with health care?"

Because the answer to that gives you a basis for action. Is it because they lack knowledge in that area? Has their major funder specifically excluded trans issues (like my HMO does)? Is it a lack of resouces leading them to triage things that way? Or is it prejudice amongst their ciswomen clients WRT transwomen?

But you're right, we are so used to confrontational and adversarial interactions that we react with anger and opposition, even to those who are, should, or might be our allies. American society is built on an adversarial "us vs. them" model. It permeates so many of our interactions: politics, employment, bureaucracies of all flavours, sports teams (Red Sox vs. Yankees being a prime example), high school pep rallies, men vs. women, kids vs. adults. "pro-life" vs. "pro-choice" (horrid and inaccurate as those labels are, they're the easiest ones to use here). It's all about making "the other side" do what you want.

We need to learn (and then to teach) negotiation and arbitration skills. How to find out why "they" chose the position they have, and how to work with them to ameliorate it. We need to become diplomats rather than warriors. But I'm not sure where to start.

[fall-of-sophia.livejournal.com]

There is almost nothing specific about day-to-day health care for trans women that a health service for [cis] women can't provide. We are not mutant alien species who require extra special knowledge just to read out blood test results. That's why I disagree with Sabrina here, and I don't think that holding cis women accountable for deliberate exclusion is all that unwarranted. Especially since what is at stake are TWOC's lives.

[hugh-mannity.livejournal.com]

*you* know that, and *I* know that -- but do they know that?

And do they also appreciate that the majority of health care for all genders has very little to do with the, for lack of a better term, reproductive system?

That's what I meant by asking them why they'd made that decision.

I've heard it bandied about that transpeople use "more than their fair share" of resources. However, apart from the hoop-jumping of counseling prior to transition, I doubt if that's true. Certainly transpeople (especially transwomen) often end up at the low end of the socio-economic scale and thus might well as a group be disproportionately in need of housing and employment assitance, but even so it's not like there's hundreds and thousands of transfolk lining up to get on welfare.

We're still a minority, even if we're more visible than we were 10, 20 or 30 years ago.

[fall-of-sophia.livejournal.com]

That would, at best, be laziness and oppression through inaction. Still inexcusable. I don't even know if I should be having this conversation here, however, as it is centering the feelings of white trans women, which itself is kind of fucked up.

[hugh-mannity.livejournal.com]

Well, I'm not a white trans woman, I'm a white trans man. But that's a position of greater invisibility and, to a point, greater privilege.

But yea, we can't speak for, or worse, decide for others.

[sophiaserpentia.livejournal.com]

I think white trans women do have a stake in this discussion, even though the needs of trans women of color deserve the biggest focus.

[ex-voz-lati.livejournal.com]

My anger stems from the fact that we are getting the least.

[sophiaserpentia.livejournal.com]

*nods* I understand.

BTW I saw that you extended an invitation to Incite! to dialog with you about this, did you get a response? Have they given *any* response? It's been, what, at least a week now? I've not seen any statements or even blog posts from them. You and all trans women of color are owed at the very least an explanation for their discrepancy, and soon.

[ex-voz-lati.livejournal.com]

It was all done thru backchannels, and sadly, the details are not being shared.

Em is currently seeking care, and all efforts should go to obtaining that care.

I will say thin: the clinic denied itself powerful allies witht heir stance, but it may no longer matter.

A powerful lesson for oppressed cis people not to strike out at trans women, IMHO. We bring not only needs, but power as well.

They lost both. Such is life.

[sophiaserpentia.livejournal.com]

An unfortunate outcome -- I had previously thought of Incite! and similar groups as potentially stronger allies than GLB folks seem to be at present. I'm sad to hear it didn't hold up when tested.

Thank you for your efforts, both on behalf of Em and on the new project you've undertaken.

[sophiaserpentia.livejournal.com]

I don't think we really disagree all that much. I don't mean to imply that I'm any less appalled at the discrimination at the heart of this. But mainly I think that the way in which we call out cissexual prejudice in a radical organization should be different from the way we call out that prejudice in, say, the Catholic Church or the federal government. The latter are examples of organizations that tend to promote the status quo of oppression and have vast resources at their command. Women's centers, OTOH, are usually volunteer efforts on shoestring budgets that work against oppression and they need our help more than they need our demands.

IOW I think our community should come forward with an offer of give and take rather than starting out with a set of demands.

[velvet-tipping.livejournal.com]

"But mainly I think that the way in which we call out cissexual prejudice in a radical organization should be different from the way we call out that prejudice in, say, the Catholic Church or the federal government."

The thing is, I don't really see how the clinic in this case is not oppressing trans women of color perhaps in just as serious a way--I mean, this is about their access to healthcare, no?

[sophiaserpentia.livejournal.com]

The prejudice it reflects may be just as serious -- in which case it should still be called out. I'm not saying that prejudice in anti-oppression organizations is less serious, just that it should be addressed with a different tactic than you would use to confront a major cultural institution.

[stacymckenna.livejournal.com]

There is almost nothing specific about day-to-day health care for trans women that a health service for [cis] women can't provide.
I wonder if it's a matter of liability covering them for those rare cases where there is a specific issue they'd be untrained/ill-equipped to handle. Perhaps their insurance coverage or liability would be easier to manage if potentially complicated patients are avoided from day one instead of "We can do A, B, and C for you, but have to turn you away for Q"? They do say they refer to specialists, so you'd think they could handle it in that way, but if their insurers won't allow that in certain cases, they may be trapped between opening in a limited capacity and not opening at all. In such a case, of course, that insuring agency would need to be addressed in the typical "major oppressor" context.

[dorothy-android.livejournal.com]

Incredibly well worded.
Do you mind if I use this in my own journal if I link to yours?

[hugh-mannity.livejournal.com]

Go ahead.

[mirandapadgett.livejournal.com]

I agree with the above comment. My kneejerk reaction was that a lack of education concerning treating transgendered patients was most likely the cause of the issue, not rampaging cissexism. Many clinics are woefully undereducated in a wide variety of topics, and with this one, a labor of love, I can't imagine a deliberate effort to turn people away on their part. So, what's the fix? Open, non-confrontational discussion, education, and perhaps volunteers usedto working with the trans community. I don't know, maybe I'm too idealistic.

[sophiaserpentia.livejournal.com]

They even say in their mission statement that they intend to treat women regardless of gender identity. That in itself should imply that they would be open to having this discussion in good faith.

If all we bring to their door is a set of angry demands, when they're already stretched thin, how could we be surprised if they respond with defensiveness?

[ineffabelle]

I certainly think a confrontational approach is strategically both unwarranted and foolish, because all it will do is harden the opposition.
On the other hand when I read this:
"I believe the better approach would be to approach Incite! and ask, what can we offer to build a stronger coalition? Is it a matter of resources? Is it a matter of volunteer time? Money? Or is simply a matter of dialogue in good faith and consciousness raising together? What can we do that will make it easier for us to walk together on this path?"
Well, I'd have to disagree there too. I would not give one dime or one minute of my time to them unless there was a firm guarantee they were going to change their policy. Otherwise it feels too much like "the giving tree".
And my advice for the giving tree was always to stop giving.
Dialogue is fine. Certainly I'm willing to discuss anything. The question would be whether it's going to go anywhere or if it's going to turn into "transpeople justifying themselves on demand" again.
I guess you could say I have a sort of moderate position between the two you outlined in your post.

[sophiaserpentia.livejournal.com]

I would not give one dime or one minute of my time to them unless there was a firm guarantee they were going to change their policy.

Well, perhaps I wasn't clear in my post, that what I meant was, we should approach them by asking, "What would it take to make this go from 'currently not able' to 'currently able,' and if necessary, how can we help?"

[ineffabelle]

Ahh, I see. Sorry, misread you a bit there.

[sophiaserpentia.livejournal.com]

Yeah, I didn't even notice that. You wouldn't know it from the debates I've seen in the blogosphere where it seems to be assumed that they deal with overall healthcare services. If birth control and abortion counseling is the focus of what they do, then you're right, there's not really much they can offer trans women anyway, except possibly free condoms. (Maybe vasectomies for pre/non-orchi trans women, but there's a whole different politics around that than there is around abortion.) (ETA: or maybe STD screenings, if that is a service they also offer.)

[fall-of-sophia.livejournal.com]

Honestly, I think you're a lot better than this. Because what it looks like here is that neither of you read the relevant parts of the website before tone policing and suggesting that maybe we're just a bunch of freaked out pushy trans women trying to push our way into a space we don't need. When in reality, it IS about life-saving services.

[sophiaserpentia.livejournal.com]

Well, it's about a week now since the controversy first broke, and I've yet to hear about any kind of statement from Incite! or even of any dialog between Incite! and trans women of color. Their silence is starting to get a little deafening. They do owe the trans women of color of New Orleans at the very least some explanation for the disparity between their policy and practice.

[fall-of-sophia.livejournal.com]

Well just for one example, poor trans women in urban settings often have disproportionate rates of HIV not simply because of unsafe sex and vulnerability to rape (especially in correctional facilties), but because of lack of access to things like clean needles for hormone injection and basic, preventative health care due to transphobic providers.

And why would trans women "need" to go to this clinic? Let's look at their actual services provided:

• Comprehensive reproductive and sexual health education
• Care for women who partner with women
• Trans and gender non-conforming affirmative care*
• Pregnancy tests, option counseling, and support services
• Emergency contraception
• Abortion and adoption referrals
• Testing and treatment for STIs (sexually transmitted infections)
• Free anonymous, confidential and voluntary HIV testing and counseling
• Birth control information and supplies and prescriptions (if needed)**
• Cervical cap and diaphragm fitting
• Sexual behavior risk reduction education and planning
• Sexual and reproductive violence prevention and support
• Urinalysis/Weight
• Blood Pressure Checks
• Physical Exams
• Referrals to specialist and/or supportive services

Plus breast and [reproductive] cancer screenings...

Re: the ignorant peasant wonders yet further..

[sophiaserpentia.livejournal.com]

I don't know, honestly. I haven't had the heart to read through the whole debate, but I don't think the rest of it would be of significantly different tenor from what I *have* read.

It *might* be about plumbing, but they offer other health services as well, so I dunno. Things like STD and breast cancer screening for trans women is not anything they would need a specialist to deal with.

It might be a matter of their resources are so limited that expanding their clientele would put a heavy burden on them -- which is why I say the trans community should approach them offering assistance and resources if that is the reason for the exclusion, rather than banging on the door with a set of demands so to speak.

Re: the ignorant peasant wonders yet further..

[akaiyume.livejournal.com]

From reading the site, it looks like the clinic provides mostly sexual and reproductive health services with information and referrals for other issues. But I could be reading it incorrectly.

As far as plumbing - it can make a difference. I think you underestimate it.

The standard tests (most effective with lower cost) for things like chlamydia, gonorrhea, and the type of hpv most likely to lead to cancer generally rely on samples from some plumbing specific places. If a person doesn't have a cervix it is a urethral swab (I'm just guessing this is a bit more difficult) or a urine test which is more expensive.

Furthermore, transwomen have additional health needs that can fall well into the category that medical science refers to as "men's health". For example, African Americans are at high risk for prostate cancer.

It seems to me that offering some health services is better than offering none. Obviously breast cancer screening, testing for some STD's etc works exactly the same. However, it also seems irrepsonsible to offer sexual and reproductive health testing/advice etc to women (and potentially a false "clean bill of health"), when people trained in traditional women's health may lack knowledge about the needs of women born in a male-shaped body. This would take extra resources.

Re: the ignorant peasant wonders yet further..

[fall-of-sophia.livejournal.com]

I've had a urethral swab and while it's not exactly cupcakes, it kinda doesn't get more simple - a lot easier than scraping cells from a cervix. It doesn't require a speculum or any other specialized instrument, just a frigging swab. And I mean, I had one at a rural county health department. The actual tests for high-grade HPV strains is less reliable, but all of the same principles apply.

It is also debatable whether trans women even need prostate screening after HRT. I lean towards not worrying about it, myself, and I wouldn't expect a women's clinic to provide it for me.

Anal paps should be available to anyone who has receptive anal sex and it's kind of ridiculous that it's been framed as a gay men's health issue in the first place. But I think a clinic that fails to offer that could still do life-saving work for trans women.

AND all of this ignores the fact that they offer care to Intersex women (women with "DSDs," to use fucking Alice Dreger's term) who were female assigned but may still have non-normative "plumbing."

Re: the ignorant peasant wonders yet further..

[akaiyume.livejournal.com]

If the urethral swab procedure requires so little then yeah, no reason it shouldn't be offered. Thanks for the information.

I still think if a woman's clinic is going to treat transwomen they should be trained in the risk factors enough to suggest screenings/discuss what and why in a supportive way. Just like they should be trained in the risk factors to suggest/discuss the need for for colon cancer screening for all women -especially over a certain age - even if the service is not offered there. Such information is also lacking in many places.

And throat culture testing should be routinely included too.

I question the quality of care an intersex woman is going to get from a place that refers to the as women with DSDs. But then again I routinely question the care that older women, post-menopausal women, and women with conditions like PCOS or endometriosis (if said are ever diagnosed) receive. It seems like care other than to keep the baby making apparatus functioning ( in progressive cases "functioning on pause" and respecting the decision as to when) or to preserve breasts (there are sexist reasons why breast cancer awareness trumps awareness of other cancers in women) is given secondary consideration in the field of "women's health." Even a lot std literature aimed toward women is more aimed at protecting the baby-making apparatus and any potential babies than it is at women's bodies and general well-being, even when the dire "may cause infertility" only affects some women, whereas more general health issues affect all women.

When I say plumbing can make a difference in care received I mean it can. Not that it *should*.

I'm not arguing for exclusion of transwomen. As I said, offering some services is better than offering none. However, offering services without acknowledging that they are incomplete is irresponsible and harmful. Not just for transwomen, but I didn't want to bring up disparity in care among cis-women with plumbing that functions differently because that seemed a bit of a disrail. But perhaps it's not since best care for woman shouldn't be centered so around the idea that a woman is a life support system for a uterus -which it still seems to be even in cases where the woman's decision with what happens with her uterus is respected. Kinda of sad that respecting those decisions is all it takes to be considered "progressive" women's care.

[dorothy-android.livejournal.com]

Don't be concerned about saying something in your blog, dear.
Since I don't have a lot of knowledge about Trans subject matter, please bear with me :)

Are there special medications/equipment/procedures needed to properly care for someone who is transgendered?

I agreed that a reasonable approach is best. Radicalisim for the most part only pisses opponents off. Forcing someone to see your side very rarely (if ever) works.

[sophiaserpentia.livejournal.com]

Some special training might be needed to deal with post-op complications or hormone monitoring. But things like basic health, blood pressure, cancer, STD screenings, rape counseling... no, specialists are not really necessary, as fall_of_sophia said above it's not like we are an alien species with different biochemistry.