Twenty years after the delisting of gender confirmation surgeries in Ontario, the recent return of the Conservatives to power forces us to remember the ten year struggle for relisting that resulted from this decision.
On October 1st, 1998, the newly-installed Conservative provincial government removed coverage for gender confirmation surgeries under the Ontario health care plan (OHIP). The delisting of these procedures, formerly referred to as sex reassignment surgery (SRS), was part of a broader plan of cuts to public services and the provincial welfare system as influenced by neoliberal austerity, widely popular amongst Western governments by the end of the 1990s.
The delisting took the transgender community in Toronto by surprise. Those who were undergoing their transition at the time and were in the process of obtaining approval for their surgery were left with no other options as public coverage for their procedures ended in such a sudden manner. As a result, many transgender Ontarians saw themselves embracing the role of activists as they now had to fight for their rights and those of their community. For some like Martine Stonehouse this led her to take her case to the Canadian Human Rights Review Panel in 1999, eventually launching into a human rights case against the Province of Ontario.
Several trans activists formed collectives and coalitions in order to come together and press for the needs of their community. One of them, the Trans Lobby Group, formed in 2001 as activists and community members organized to lobby politicians about the social determinants of health for transgender people, emphasizing the effects of societal and institutional transphobia on the life and wellbeing of this collective.
NM and Susan Gapka, one of the project interviewees
Inspired by the need to raise awareness of the dire state of transgender health in Ontario in the 2000s, Sherbourne Health Centre oversaw the creation of the Trans PULSE Project as a community-based research endeavour. The Trans PULSE Project resulted in many studies on the status of transgender health in Ontario based on a series of surveys conducted in 2009 and 2010 with over 400 members of this community. Although all of them offer insightful details about the social determinants of transgender health, one particular report sheds light on the challenges and difficulties that arise when transgender people have inadequate access to health care. Worryingly, the report claims that by 2009 a number of transgender Ontarians had engaged in non-prescribed hormone use, while a smaller number of participants had performed surgical procedures on themselves. As the data collection for the Trans PULSE Project took place shortly after coverage for gender confirmation surgeries was reinstated, it can be assumed that these individuals were led to oversee their own transitions due to the faults and shortcomings of the provincial health care system during the delisting years.
In a province with a tradition of universal health care, excluding transgender people from accessing coverage for vital procedures for ten years is a demonstration of how easily transphobia can get institutionalized under a hostile administration. While coverage for gender confirmation surgeries was eventually resumed after the return of the Liberal party to power, the ten years that transgender Ontarians had to live without access to vital surgeries permanently scarred this community and initiated a generation of relentless trans health care activism.
Twenty years later, and at the dawn of a new Conservative government after fifteen years of Liberal grip over the province, the landscape for LGBTQ+ rights and activism is perhaps as dire as it was in 1998. While Doug Ford has not necessarily made any direct attacks or threats against the transgender population, the cancellation of the OHIP+ program and the decision to revert back to the 1998 sexual education curriculum lead us to believe that this administration has no qualms about cutting back socially progressive policies.
Amidst a hostile environment in North American politics where right-wing politics are ever more enmeshed with anti-trans sentiment, the next four years of Conservative leadership hold a fair amount of uncertainty and anxiety over the state of transgender health in Ontario. As LGBTQ+ Ontarians, we can only hope that two decades of lobbying, organizing, and activism have solidified the severity of our claims, and therefore that we will not see a return to the ten years without coverage that left many in Ontario without a hope to live their true lives.