Fuck the Daily Star. And fuck the Daily Express too. And fuck every goddamn shit-tastic tabloid that prints so many goddamn stories about how there’s outrage over the spending of money on people’s gender transition surgeries because they happen to be prisoners.
There is a simple principle at stake here. If you are a prisoner, you have the right to access the same NHS services as everybody else. If you had a broken arm, no civilised society would deny you treatment for your broken arm because you are in prison. If you get cancer, you can get chemotherapy. We are rightly coming to realise that healthcare is a human right and should be delivered to all. The NHS has universality as a founding principle: the NHS must serve everyone, free at the point of use, delivering healthcare according to clinical need, not ability to pay. Not treating people based on clinical need but based on opinion is ghastly and undignified.
If the cost of every gender reassignment surgery performed on prisoners is what it takes to guarantee that principle, it is well worth it.
The framing of these stories suggest that gender transition is some kind of privilege that should only be granted to people who “deserve” it. This attitude is a health version of the distinction between the deserving poor and the undeserving poor: the deserving transgender patients and the undeserving. There is literally a paternalistic level of control over the person’s new genitals: we paid £20,000 for your vagina, you better behave.
The implicit attitude of those who get worked up into a lather about this is that unlike, say, a broken bone or an infection, health services for transgender people aren’t real, they don’t serve an actual clinical need. If that is the case, they then need to make the case that gender transition ought to be unavailable on the NHS for everyone. Either it is a medical service being offered in response to a clinical need, in which case one’s status as a prisoner should not enter into it, or it isn’t a valid medical intervention that should be offered by the NHS. It would then be more like the sorts of cosmetic surgery which aren’t covered by the NHS.
I can’t say I know a great deal about trans issues: only what trans friends tell me, and what I read on blogs and in forums. I do know that for a lot of people, realising that they are trans and taking the steps they deem necessary to start living as their non-birth gender is one of those things that helps a person make sense of their life, that finally loosens the grip of unhappiness and a feeling that they are out-of-place in the world. There’s a reason why there is a 98% satisfaction rate for those who pursue medical gender transition. (If there were a medical intervention that made 98% of people with cancer or HIV/AIDS or multiple sclerosis satisfied, we’d see it as a medical miracle.)
If someone is in prison and commits a crime, it may be that they feel they have no stake in society, that the rules of society have no hold on them precisely because they feel so alienated and despondent at the world. As I said, I’m not trans so I can’t say whether this would be an accurate feeling, but certainly when I was in the closet about being gay, I had a lot less of a feeling of attachment or welcome in the world—it felt like I was just a passenger on a train I never decided to board. Certainly, I can only imagine, but if I woke up every morning thinking I was inhabiting the wrong body, that would make me fairly despondent and cynical about the world.
Perhaps, just perhaps, the prisoner who realises that they are transgender and then starts the gender transition process might feel a little less estranged from society, and now living a life in a body that they feel more comfortable with, turn away from crime. I don’t have any evidence of whether or not post-gender-transition prisoners are less likely to reoffend than, say, prisoners who are transgender but denied treatment.
And that’s the other thing. Nobody just decides one day: “you know what, I’m bored. I’m going to become a woman, just for a laugh and to piss off the taxpayer”.
Most people, quite rationally, do not think to themselves that putting themselves at greater risk of discrimination in housing and in the workplace, and greater danger of abuse, physical assault and even murder. Most men’s reaction to the thought of genital surgery is to protectively cup their testicles in defence, not think “yeah, that sounds like a good time, sign me up”. If you put yourself forward for it, and go through the lengthy process of meeting with doctors, psychologists, psychiatrists… perhaps it might actually be the case that you have actually thought about it and actually do want to go through with it for serious genuine reasons.
Even if, for flippant reasons, one decided on a whim to go through the process of what the tabloids always like to call a “sex change” (or worse a “sex swap”) they would first have to endure months, possibly years, of bureaucracy. Writing in The Guardian, Juliet Jacques said that “the pathway has felt like an endurance test” and usually the whole process from initial consultation to post-surgery takes two to three years.
In addition, the newspapers report but then very quickly gloss over the fact that the subject of the article is intersex: that is, they have “a variation in sex characteristics including chromosomes, gonads, and/or genitals that do not allow an individual to be distinctly identified as male or female”. Why would shitrags like the Daily Star sensitively cover a topic that most people have never even heard of, let alone understand, when making it into a slag-off story is so much easier? Utter arseholes.
Here’s a radical idea: we could accept that prisoners are human beings, that some human beings are transgender or indeed intersex, and in a civilised society, the responsible and dignified thing we do is provide people with healthcare rather than demonise them in newspapers for being scroungers and ne’er-do-wells. The continued existence of newspapers like the Daily Star, the Daily Express and the Daily Mail prove that we do not yet live in a sufficiently civilised society.