by Offre Porsche Ntlali

This is a plea from intersex individuals whose human rights are violated. Several excellent findings have been published before on lesbian, gay, bisexual, transgender, and intersex (LGBTI) health needs and social care provision, as well as issues of access, education and the quality of care received. Both the intersex community and the transgender community have recommended better education for healthcare and public service providers to prevent discrimination. 

South Africa is the first African country to offer constitutional protection against discrimination based on sex, gender, and sexual orientation. Section 27 of the South African Constitution states that everyone has the right to have access to healthcare services – including reproductive healthcare. Section 27(3) states that no one may be refused emergency medical treatment. However, there are negative attitudes towards transgender and intersex people which directly correlates with the importance that society places on the binary gender model as well as the gender stereotypes, sexism and gender inequalities that exist within it.  

People who do not easily fit the norms set by a binary gender model, such as transgender and intersex people, often encounter numerous difficulties both at the practical level of everyday life and at the legal level. This is not acceptable. The reality is that on the one hand intersex individuals are often forced to undergo surgeries that are medically unnecessary from infancy. Whilst on the other hand transgender individuals are often denied desired medical treatment in adolescence and beyond. The question is why? Both communities grapple with a lack of recognition of their autonomy when it comes to decision making power over their own bodies. Society makes it difficult to transition physically, and emotionally traumatic to come out, because of the beliefs that categorise humans according to the binary “pink and blue.”  

Notably, Intersex Genital Mutilation (IGM) surgery on intersex people is different from gender affirming surgery, because IGM often takes place early in life before the person concerned can participate in the decision-making process, thus it is violation of the individual’s rights. IGM is a human rights violation that has consequences which affect intersex people throughout their lifetime. Many intersex adults are angry that surgery was performed on them whilst they were still young children and unable to give their informed consent as the outcomes of those surgeries have had a detrimental impact on them.

A primary concern of many trans people revolves around their access to appropriate gender   affirming healthcare, including psychological, endocrinological and surgical interventions. Not all trans people need all aspects of these healthcare services, and some may not require any of them. However, because of the binary gender model, both trans identities and intersex bodies are medicalised and pathologised because they do not neatly fit the norm established by the binary model. Trans and intersex people are rendered as patients with little say over their own identities and bodies, and the treatments that are made available to them are often not based on their personal needs or wishes, but on social and institutional expectations.

With the South African Constitution in consideration, there is still a lot of knowledge gaps with the implementation of the human rights principles that it enshrines. According to the law, transgender people can apply to change their sex description in the birth register in terms of the Alteration of Sex Description and Sex Status Act 49 of 2003. Section 2(1) act states that:  

“Any person whose sexual characteristics have been altered by surgical or medical treatment or by evolvement through natural development resulting in gender reassignment, or any person who is intersexed may apply to the Director-General of the National Department of Home Affairs for the alteration of the sex description on his or her birth register.” 

This act does not make it compulsory that an applicant must have undergone gender affirming surgery specifically, so hormone replacement therapy (HRT) should be sufficient. However, officials at the Department of Home Affairs are not educated on this and they often end up applying the Act incorrectly by turning away applicants who have not had any surgeries. Often times applicants have to wait for years to get a response. Both transgender and intersex communities need a system that is inclusive. One that caters for transgender individuals without requiring that certain boxes, such as medical transition, be ticked, as some trans people feel that surgeries and hormone replacement therapy (HRT) is not necessary. 

In conclusion, the difficult situation faced by trans and intersex people remains a persistent challenge in our societies – mostly due to the knowledge gaps and a society that has normalised the binary gender model. By better understanding the similarities and differences between these two groups, both the intersex rights and trans rights movements have tried to ensure that better policies are put in place and implemented, and have also worked to educate the public about the shared structural barriers facing both communities. When exploring health and care for trans and intersex people, the nuances of gender identifications and embodied desires need to be carefully negotiated

In the future, as with race or religion, sex or gender should not be a category on birth certificates or identification documents for anybody. Let us remember we all come from diverse backgrounds. No matter who someone is, or how they identify, let us break the barriers, the moulds and the stereotypes and create an inclusive environment for love. Let us educate not discriminate. Because intersex traits are further evidence of the gender variation in humans, rather than a form of biological abnormality that requires immediate surgical treatment.