‘It’s all about power’: Barriers to trans health care, intersecting systems of oppression explored in panel discussion

A “whisper network” has developed among transgender people, as they resort to unofficial channels to navigate the health care system, says Aoife Hazen of the group Femmes Against Empire.

Hazen described the relationship between trans people and the health care system as “combative,” saying that “doctors regularly paternalize trans people. They hand-wave common ailments as symptoms of their trans identity, and are ignorant of trans health care as they rely on outdated research.”

Hazen made the comments during the “Connections” panel series on systems of oppression, organized by the Saint John Community Coalition at Haven Music Hall. The topic was gender and sexuality.

“Gender is who you go to bed as, sex is who you go to bed with,” said Mariah Darling, an education coordinator at Chroma, a non-profit that supports 2SLGBTQIA+ people in Saint John. Darling was recently elected to Saint John city council in a by election.

Hazen believes there is one system of oppression with multiple arms. “Racism, sexism, patriarchy, and colonialism are all connected and support each other,” she said, adding that those hierarchies are not accidental but deliberately constructed.

Melanie Vautour, the executive director of Fresh Start Services — an agency combating homelessness — agreed. She said all systems of oppression are interlinked and enforce normative behavior. “It’s about power,” she said.

Vautour also noted that young cisgender, heterosexual men are taught to adopt toxic masculinity to gain power. They are punished for diverging from masculinity and are shunned for being feminine. “The perpetrator loses their own humanity before taking it from another,” she said.

Vautour oversees two shelters: one for men and one for women. “This gender-normative division presents a problem for homeless non-cis and gender-non-conforming people who are not sure if they will be welcome,” she said. She said that queer youth make up 40 per cent of the homeless population. She suggested that people ignorant of queer issues should be encouraged to ask questions.

Asked about their motivations for fighting these systems, Vautour said that she wants a better world for future generations. Hazen noted that material conditions can radicalize people into fighting.

As the conversation turned to transgender health care, Hazen noted that getting estrogen is often incredibly difficult for trans women. Trans health care is further restricted by financial and logistical barriers.

Many forms of gender confirming care are not covered by medicare, and the New Brunswick Health Council reports that only 79 per cent of New Brunswick citizens had a family doctor in 2023.

On being asked, “What does it mean to be a woman?”, the panelists noted that masculinity is the “default” and femininity is defined by what masculinity is not. It may be considered a “costume” or “fake,” with trans-women being “double fake.”

Trans-exclusionary feminists are known for gatekeeping the female identity. Hazen said that some trans women are told they are not women because they didn’t grow up being assaulted by men. “This attitude posits that woman-hood is defined by its oppression by men, and is a grim definition of femininity,” she said.

Hazen then pointed out the struggle between safety and improvement. “A trans person fighting these systems may be putting their safety at risk; but if they don’t, the systems of oppression will continue to worsen.”

“Some view hiding your trans identity as a failure to advocate for trans rights,” she added, also noting that conservative media promotes a fear of trans people. “They don’t know trans people, they know headlines.”

The need for ID and documentation is an important aspect of navigating the world and is often a barrier for oppressed people, including queer and gender diverse folks. How does this barrier relate to being housed?

Darling said that having the right identity documents is a complication that can make things feel “impossible.”

“Having inconsistent or inaccurate ID adds extra difficulty to moving and obtaining housing,” Darling said. “Chroma helps folks go through the process of ID changes with a map of steps [and] services. We offer financial compensation for the associated costs.”

Hazen added that “it’s a nightmare to navigate a name and/or sex change without ID or stable housing.”

She listed some of the costs and items required to update your ID, including a background check, a long-form birth certificate, and a commissioner of oaths. “It’s traumatizing for a lot of marginalized folks to deal with the police when requesting a background check, and all of these steps cost money.”

Vautour said that Fresh Start advocates for people to need less ID. “We do attestations for the houseless population at Fresh Start. We constantly work to reduce barriers as we believe you shouldn’t have to work so hard to prove who you are. It’s endlessly frustrating for folks.”

The panel ended with a discussion on organizing to dismantle systems of oppression. “I struggle to see the value of organizing in the present that isn’t focused against imperialism,” Hazen said. “Imperialism is at the root of queer suffering in the world. Anti-imperialism is our best option for effective organizing.”

Darling added that “people should stop pretending things are okay. Let’s be honest about where we are and what we’d like to do. Having hard conversations and getting uncomfortable is essential to organizing for the changes we’d like to see in the world.”

Vautour referred to the work and approach being taken by Fresh Start to deal with the systems of oppression their clients face. “It takes a huge effort for us not to inflict problematic systems of oppression within our own organization,” Vautour said.”We do our best to be a space and group of people working towards systemic change.”

In some of their final comments, the panelists noted that people should begin with small changes that will cause ripple effects in the world.

“These small actions may not make a change today, but they will add up in the future,” said Darling.

Hazen stressed that anti-fascist organizing should be “inclusive and welcoming for everyone.”

“Coalition and solidarity with all oppressed people is essential,” Hazen said “We want to avoid the co-opting of diversity into the fascist regime as this will not change or dismantle the systems of oppression.”

Brandon Flynn is a musician and organizer in Saint John.