Previous research has provided important evidence demonstrating how stigma operates to disadvantage marginalized groups and impact health outcomes, including for sexual and gender minorities (SGM). However, much of the stigma literature has focused on the individual and interpersonal levels, leaving a paucity of research on structural forms of stigma. In response to this knowledge gap, we conducted a review of human rights policies and protections for SGM in North America in order to quantify between-country levels of structural stigma across time and place. Using an index initially developed in Europe by the International Lesbian, Gay, Bisexual, Trans, and Intersex Association (ILGA)- European chapter, data on legal and policy protections for SGM in Canada and the United States (US) were extracted from government reports, policy documents and legal archives in 6 domains: equality and non-discrimination; family; bias motivated speech/violence; legal gender recognition; freedom of assembly; association and expression; and asylum. Data were translated into numerical scores and summed and weighted in accordance with the ILGA Index framework. The current overall score for Canada was 98.08% and for the US 77.03%, (out of 100%). Generally, Canada had higher scores in each domain than the US, and consistently over time. Establishment of an SGM structural stigma index for North America provides a key piece of evidence for country-level differences in health disparities for SGM populations. Improved understanding of the impact of structural sigma on SGM identification and disclosure, and ultimately on health outcomes, has application for policy decision makers and public health practice.