Advancing health equity for transgender and other gender minority people in the U.S.: Gender affirmation and health

Transgender persons need birth certificates that reflect their true gender identity as primary identity documents, to get jobs, to update other documents, and for their own wellbeing. Until recently, New York City (NYC) required proof of “convertive” (bottom) surgery to effect a gender-marker change on NYC birth certificates. The NYC Board of Health (BOH) provided a mechanism through which a change to this rule could be made. NYC Department of Health and Mental Hygiene proposed an amendment to the NYC BOH to amend the Health Code so that the gender marker may be changed with the sworn statement of a physician or certain licensed health or mental health providers. A public hearing was held and all 21 comments received supported the proposal, and the BOH approved the amendment, which became effective January 2015. Since implementation, over 120 transgender birth certificate applications were approved as of May 26, 2015. In contrast, in 2012 and 2013, 20 and 22 applications were approved each year. Easing requirements to change gender markers appears to have increased the accessibility of gender-concordance on birth certificates while still maintaining their integrity and security. This model could be implemented in other states and countries to improve health equity, and outreach is currently underway to raise awareness about NYC’s new rule.