Transformative Progress for Transgender People  
By Tom Inouye

            Although thousands of bills placing harsh restrictions on the ability of transgender people to access necessary services like gender-affirming care, anti-discrimination protections, and employment have been introduced to and passed in legislatures around the world, many countries have seen a trend toward more inclusive and protective policies for trans people.

            In a comprehensive study of 23 countries including Spain, Sweden, Russia, Poland, South Korea, Argentina, and others, the majority of respondents in all 23 countries supported the basic right of trans people to change their gender identifier to their preferred gender on government documents.[1] Further, the majority of respondents in 21 out of the 23 countries support anti-discrimination laws that protect transgender populations. While plenty of controversy surrounds whether or not transgender individuals should be allowed to use the bathroom of their choice, majorities in 15 out of 23 countries “support allowing access to public restrooms consistent with a transgender person’s gender identity.”[2] While the findings do show that many countries are slower to embrace policies that give transgender individuals full equality, general trends of social transphobia– especially among young people– are downsloping.[3]

Additionally, the number of individuals who self-identify as transgender and/or nonbinary has increased substantially over time, with younger generations more likely to question their gender identity and more likely to transition to a gender different from the one assigned at birth.[4] 700 individuals out of every 100,000 within the age range of 18-24 years old identify as transgender compared to 500 out of every 100,000 in the 25-64 age range.[5] Slowly, more and more individuals feel comfortable identifying as non-cisgender. With greater visibility and more accepting communities in multiple countries, it seems as though pro-trans attitudes among our younger generations are promising.[6]

            Although progress is slow, tedious, and frustrating for millions of transgender individuals across the globe, promising legislation is on the horizon in many countries. Some countries, like Iceland and Malta, have quickly embraced pro-transgender and genderqueer policies, as both countries have recently legislated to allow for social, economic, national, and personal security of transgender individuals. In this brief we will explore Iceland and Malta as promising case studies for the future of genderqueer and transgender populations and what circumstances led to their success.

 

Case Studies

 

            Malta

 

            Malta stands as a unique example of a country with multiple factors– namely religious factors– that might indicate less tolerance for the LGBTQ+ community overall. This, surprisingly, is not the case. Malta has some of the most robust laws to protect the rights of LGBTQ+ people in Europe. Since the early 2010s, Malta has managed to legalize gay marriage, decrease financial and social barriers to gender-affirming surgeries, and stands as the “friendliest country” to transgender individuals in Europe.[7]

            Why is Malta considered an unexpected success story with respect to LGBTQ+ equality? Malta’s population is 90% Catholic and Roman Catholicism is classified as the official religion of the small island nation.[8] While Christianity and queerness are certainly not mutually exclusive, the relationship between the Catholic church and the LGBTQ+ community has had a storied and controversial past. As explained in a letter written in 1986 by the Catholic Church, “Although the particular inclination of the homosexual person is not a sin, it is a more or less strong tendency ordered toward an intrinsic moral evil…”[9] Additionally, the Church’s perspective on transgender people is equally cautious and oppressive. A trans man in Spain was explicitly forbidden from acting as a baptismal sponsor nor was he allowed to serve as a godfather under the pretext that the man did “not possess the requisite of leading a life conformed to faith…”[10] Based on the frequent transphobic teachings of the Catholic church, onlookers were surprised to see that Malta’s policies on gay and transgender individuals are overwhelmingly inclusive. What has Malta’s government done to protect trans people?

In 2014, Malta legalized civil unions for gay and lesbian couples.[11] While this did not directly affect the rights of transgender people, Russel Sammut of the Allied Rainbow Communities nonprofit organization explains that “up until 2014, we had no rights here, but once civil unions were enacted, people changed their attitudes overnight.”[12] The act of recognizing queerness as legitimate and worthy of protection thus helped to move Malta toward the sphere of pro-trans policy. Just a year later, Prime Minister Joseph Muscat announced a groundbreaking policy that ensured that “transgender people in Malta will no longer need to have surgery, sterilization, and a diagnosis of mental illness to legally change [their] gender.”[13] The elimination of rhetoric that underscored transgender identity as a “mental illness” helped to destigmatize the genderqueer community and set the stage for further inclusive policy.

            By 2016, a bill banning conversion therapy was unanimously passed in the Parliament of Malta, which prevented both transgender and gay Malteses from the cruelty and trauma of being forced to confront their sexuality or gender identity as “demonic” or “unnatural.”[14] And most recently in 2022, the government of Malta announced plans “to cover the costs of gender-affirming surgeries, making them free for all trans and gender-diverse people in the country.”[15] All of these steps have set an inclusive groundwork for societal acceptance and even celebration of transgender identities.

How were these policies passed in a country with a massive practicing Catholic majority? There seem to be two key factors at play.

            First, the act of passing a single progressive policy that toppled the church’s monopoly on policy making. In 2011, Malta became one of the last countries across the world to legalize divorce, which it did through a referendum. Herman Grech of the Times of Malta explains:

 

“The referendum changed everything - and the results were pretty surprising for a country where the Church has been dominant… Suddenly people and the younger generation voted in favor as they realized it was one of only two countries that outlawed divorce… that tilted everything– people started saying we can start tackling other social issues.”[16]

 

            Eliminating a huge monopoly that Catholic religious groups had on pushing conservative policies thus acted as a catalyst for more policy. Then, in 2014 when same-sex unions were legalized by the Parliament of Malta, “people changed their attitudes overnight.”[17] As more progressive policies have passed– even if not directly related to the rights of transgender people– Malta has moved away from the Church as a legislator, which has increased social acceptance of the transgender and genderqueer community.

            Second, the Maltese government has acted with inclusivity as a lens for policy making. When Prime Minister Joseph Muscat was asked about his decision to pass pro-queer policies, he responded with: “‘Malta wants to keep leading on LGBT issues and civil liberties, to serve as a model for the rest of the world.’”[18] While this is likely not the sole reason that such progressive legislation was passed, it exemplifies the commitment that Malta’s government has to protect the rights and freedoms of minority populations. Additionally, Muscat’s statement seems to allude to how Malta was the second to last country to legalize divorce as a shameful “behind the times” part of its history. Instead of lagging behind progressive social trends, Malta now wants to increase inclusivity and act as a “model” so it doesn’t appear behind.

These policies have been successful at increasing access and reducing discrimination in Maltese society. Gender-affirming surgeries, which were announced by Muscat at Malta’s national pride parade, became completely free and financed by the National Health Service and were adequately funded by taxes.[19] The education curriculum passed through the “Gender Expression, Gender Identity, and Sex Characteristics Act” in 2015 was been successful at increasing access to gender-affirming care, transgender and nonbinary inclusive bathrooms and locker rooms, as well as emotional support and therapy for genderqueer individuals struggling with their identity.

            Malta stands as an important case of how pro-trans policy can happen in countries with a large religious population. By slowly passing progressive bills over the years, Malta has created a path on which social and political acceptance of trans people can be embraced. We will now examine Iceland as an example of a nation with a lively LGBTQ+ civil society.

 

 

            Iceland[1] 

           

            In 1996, The Althing, Iceland’s Parliament, was the first legislative body in Europe to recognize same-sex unions. 8 years later, it legalized adoption by gay people, and in 2009 it elected its first gay head of state. Iceland’s long past with pro-LGBTQ+ policies has set it up as a leader in transgender rights, protections, and security.

            Rights for transgender individuals in Iceland have had an equally impressive and quick ascent since 2010. Notably, Iceland’s recent policies have focused on solutions that allow trans youth to be correctly identified by their preferred names and pronouns. A 2019 bill passed in the Althing implements crucial policies, including an informed consent model for healthcare.[20] This model allows patients to decline diagnoses that might imply transgenderism as a “mental illness” as well as effective treatments including gender-affirming surgery and hormone therapy. In other words, the informed consent model rejects that transgenderism must be described as a disorder of any kind for it to be considered “legitimate” transgenderism.[21] Informed consent thus ensures the autonomy of genderqueer individuals to decide what medical help, surgeries, or therapies they want to pursue without social or medical stigma.

            Further, Iceland’s facilities including universities, public pools, and bathrooms more often than not have sections dedicated to “gender neutrality,”[22] which “provide a safe, private facility for transgender, genderqueer, and gender non-conforming people.”[23] A crucial aspect of personal security is privacy. By providing transgender people who may feel uncomfortable using a gendered bathroom with an alternative, Iceland leans into a philosophy of personal security that many other countries should attempt to emulate.






 

            Most importantly, non-cisgender youth have benefited from the right at nearly every age and nearly every circumstance to change their gender registration at Registers Iceland. While many other countries have blocks to prevent young people of certain ages from self-identifying with or without their guardian’s permission, Iceland allows all children under the age of 15 to change their gender marker with a parent’s permission. However, even if neither parent or guardian is supportive, trans youth under 15 years old can submit a “change of registered gender” request which is sent to an expert committee and can be approved and changed quickly on government documents.[24]

            Iceland’s progressive policies for the LGBTQ+ community can largely be attributed to long-standing external factors. Notably, the queer organizing group Samtökin '78, also known as the National Queer Association of Iceland, has been spearheading protests for gay and trans acceptance in society.[25] In 1982, four years after the organization was created, Samtökin ‘78 held the first public protests for LGBTQ+ recognition and rights.[26] Samtökin ‘78 today continues to directly consult with politicians and the Icelandic government to ensure the protection of transgender people.[27] The pressure that queer civil society puts on the government guarantees that the government of Iceland will not begin backsliding toward exclusive and anti-transgender ideology. Similarly, the non-profit organization, Hinsegin dagar í Reykjavik, which puts on the yearly Icelandic Pride festival, has been organizing pride parades since August 2000.[28] A celebration of queerness allowed for greater social and political exposure to the transgender and queer communities, ultimately increasing awareness and acceptance for both groups.

            There was another crucial factor in the success of pro-trans civil society groups: pressure from Nordic states that had already developed and passed their own pro-LGBTQ+ policies. Surrounded by Nordic Countries like Denmark, Sweden, and Norway, Iceland faced pressure from the Nordic Council in 1984.[29] This council pressured Iceland and other Nordic countries to pass anti-discrimination bills, which allowed gay and trans activists to speak out for their cause, knowing that Iceland’s allies were already placing significant importance on the protection of gender and sexual minorities.[30] Without external pressure from Iceland’s closest allies, most of whom held extremely progressive views of the LGBTQ+ community, civil society might not have ever had enough attention to catch the attention of the Althing.

            Iceland has stood as a symbol of accessible care and discrimination protections for transgender people over four decades. However, acceptance didn’t come overnight. Protests and pleas to government offices were needed to facilitate progression towards gender inclusivity.

 

How Do Pro-Trans Policies Increase Quality of Life?     

           

            Transgender policy that brings back full autonomy for genderqueer individuals to self-identify, determine how they want to present themselves and avoid discrimination are empirically effective at improving quality of life and reducing the likelihood of suicidal thoughts and negative mental health disorders.[31] Gender-affirming surgery for millions of transgender people suffering from dysphoria is a lifeline that reduces negative mental health effects. According to the National Institute of Health, “gender-affirming surgery in appropriately selected gender dysphoric patients is associated with decreased postoperative rates of SSRI or SNRIs use and improved mental health.”[32] The study found a 5.2% decrease in suicidal ideation and a 2.3% reduction in suicide attempts among individuals who received surgery.[33]

Further, effective anti-discrimination laws that ensure economic stability, housing access, and hate crime protection are all linked to a more robust quality of life for transgender people.

            However, there is only so much that legislatures can draft to prevent violence against genderqueer individuals. Even with the dozens of progressive bills passed in Malta, multiple accounts of discrimination and violence against trans women in particular have been reported even since those pieces of legislation were passed. Lauren Salerno, a 53-year-old transgender woman living in Malta and interviewed by Time Magazine explained: “On the surface, Malta is more accepting and there’s a lot less direct discrimination here… But when I tried finding work I was basically told that I didn’t look right, even for things like waitressing or shop jobs.”[34] While non-discrimination laws can certainly punish businesses that hold prejudices against trans people, verifying that prejudices were involved in a hiring or firing decision is much more difficult.

To say that transgender equality would be suddenly achieved if full legal equality to noncisgender people was granted is a misnomer. A reduction in social stigma, including bullying, exclusion, and violence targeted at trans people must come with a sustained commitment to not just effective policy enforcement, but also time.[35] Social attitudes, which take time to change and develop are equally important to the rights and protections of transgender people. Lauren Salerno emphasizes that while some of Malta’s policies must go further to protect young people from the harms of gender dysphoria, the policy decisions have slowly improved acceptance for queer Malteses.[36]

In the next section, we will examine what economic, social, and governmental factors affect what makes transgender policies successful.

 

Successful Factors and Steps Forward

            Although advising on specific steps that could easily convince politicians to pass pro-transgender policy is nearly impossible, certain factors can clearly improve the chances of improved quality of life for trans and genderqueer individuals.

            First, although religion is certainly a significant roadblock to progressive pro-trans politics, Malta shows that religious affiliation doesn’t necessarily mean that legal and social acceptance is impossible. By passing a single pro-LGBTQ+ policy, social acceptance increased significantly for the entire community and snowballed into a comprehensive list of protections for the transgender minority in the small island country. Further, the existence of a liberal Labor Party in Malta meant that those in power could liberate genderqueer people from oppression without much direct influence from the conservative group within the Roman Catholic church.

            Second, Iceland’s active civil society has held the Althing accountable to the queer population. Whether it be protests organized by Samtökin ‘78 or pride parades organized by Hinsegin dagar í Reykjavik, queer groups have uplifted the queer community while pushing out transphobic or negligent rhetoric and policy. Thus, civil society in Iceland serves as a model of the effectiveness of an outspoken queer population. Additionally, pressure from allied nations of Iceland increased the development of funding for gender-affirming surgeries, non-discrimination clauses specifically protecting trans people, and a greater swath of rights for genderqueer youth.

            While other factors certainly affected the success of Maltese and Icelandic inclusivity, these factors are generally accessible to countries across the globe. Progressive, pro-trans parties exist in many states; socially progressive policies– not even directly about transgender people– have been ushered in; civil society is vibrant and expanding, especially in queer spaces; and a growing consensus of countries from all different regions is showing an increased desire to recognize transgender people as worthy of respect, celebration, and protection.[37]

            While the future of transgender people may often seem dim, many countries have implemented policies that will truly make the lives of genderqueer individuals better.

 

[1]  Flores, Andrew | December 2016, “Public Support for Transgender Rights: A 23 Country Survey.” Williams Institute. https://williamsinstitute.law.ucla.edu/publications/trans-rights-23-country-survey/.

[2] Flores.

[3] Parker, Kim, Juliana Horowitz, and Anna Brown. 2022. “Americans’ Complex Views on Gender Identity and Transgender Issues.” Pew Research Center’s Social & Demographic Trends Project. Pew Research Center. June 28, 2022. https://www.pewresearch.org/social-trends/2022/06/28/americans-complex-views-on-gender-identity-and-transgender-issues/.

[4] Nolan, Ian T., Christopher J. Kuhner, and Geolani W. Dy. 2019. “Demographic and Temporal Trends in Transgender Identities and Gender Confirming Surgery.” Translational Andrology and Urology 8 (3): 184–90. https://doi.org/10.21037/tau.2019.04.09.

[5] Nolan.

[6] Nolan.

[7] Sopelsa, Brook. 2020. “Europe’s 10 Most LGBTQ-Friendly Countries.” n.d. NBC News. https://www.nbcnews.com/feature/nbc-out/europe-s-10-most-lgbtq-friendly-countries-n1207761.

[8] “Maltese Culture - Religion.” n.d. Cultural Atlas. https://culturalatlas.sbs.com.au/maltese-culture/maltese-culture-religion.

[9] Human Rights Campaign. n.d. “Stances of Faiths on LGBTQ Issues: Roman Catholic Church.” Human Rights Campaign. https://www.hrc.org/resources/stances-of-faiths-on-lgbt-issues-roman-catholic-church.

[10] Human Rights Campaign.

[11] “Parliament Meets Today - Bill on Civil Unions Tops Agenda.” 2013. Times of Malta. September 30, 2013. https://timesofmalta.com/articles/view/20130930/local/parliament-meets-today-bill-on-civil-unions-tops-agenda.488310.

[12] Samuelson, Kate. 2016. “Why Malta Has Europe’s Most Progressive Gay Rights.” Time. December 15, 2016. https://time.com/4597632/malta-gay-rights-conversion-ban/.

[13]  Guilbert, Kieran. 2015. Review of Surgery and Sterilization Scrapped in Malta’s Benchmark LGBTI Law. Reuters. Reuters. April 1, 2015. https://www.reuters.com/article/idUSKBN0MS4ZD/.

[14] Sreenivas, Shishira. 2021. “What Is Conversion Therapy?” WebMD. December 3, 2021. https://www.webmd.com/sex-relationships/what-is-conversion-therapy.

[15] Castagnaro, Giulia. 2022. “Malta Announces Plans to Cover the Cost of Gender-Affirming Surgeries.” GenderGP Transgender Services. October 10, 2022. https://www.gendergp.com/malta-offers-free-gender-affirming-surgeries/.

[16] BBC News. 2016. “Malta’s Paradox: A Beacon of Gay Rights That Bans Abortion,” December 8, 2016, sec. Europe. https://www.bbc.com/news/world-europe-38235264.

[17] Samuelson.

[18] Grech, Herman. 2017. “Catholic Malta Embraces Gay Marriage,” July 3, 2017. https://www.bbc.com/news/world-europe-40459125.

[19] Castagnaro.

[20] Pink Iceland. 2019. “Trans Friendly Iceland.” Pinkiceland. August 5, 2019. https://www.pinkiceland.is/post/trans-friendly-iceland.

[21] Cavanaugh, Timothy, Ruben Hopwood, and Cei Lambert. 2016. “AMA Journal of Ethics ® SECOND THOUGHTS Informed Consent in the Medical Care of Transgender and Gender- Nonconforming Patients.” AMA Journal of Ethics 18: 1147–55. https://journalofethics.ama-assn.org/sites/joedb/files/2018-07/sect1-1611.pdf.

[22] Pink Iceland.

[23] “Inclusive Use Restrooms.” n.d. Www.dcc.edu. https://www.dcc.edu/student-life/lgbt-resources/inclusive-use-restrooms/default.aspx#:~:text=Gender%2Dneutral%20bathrooms%20provide%20a.

[24] Pink Iceland.

[25] Samtökin ’78, “The National Queer Organisation of Iceland.” n.d. Samtökin ’78. https://samtokin78.is/english/.

[26] Thorhallsson, Baldur (2018-10-03). Small States and Shelter Theory: Iceland's External Affairs. Routledge. p. 118. ISBN 978-0-429-87180-1.

[27]  Samtökin ’78.

[28] “About Us - Reykjavik Pride.” 2022. March 14, 2022. https://hinsegindagar.is/en/about-us/.

[29] Thorhallsson.

[30] Thorhallsson.

[31] Chou, Jesse, Lee H Kilmer, Christopher A Campbell, Brent R DeGeorge, and John Y Stranix. 2023. “Gender-Affirming Surgery Improves Mental Health Outcomes and Decreases Anti-Depressant Use in Patients with Gender Dysphoria.” Plastic and Reconstructive Surgery. Global Open 11 (6S): 1–1. https://doi.org/10.1097/01.gox.0000944280.62632.8c.

[32] Chou.

[33] Chou.

[34] Samuelson, Kate. 2016. “Why Malta Has Europe’s Most Progressive Gay Rights.” Time. December 15, 2016. https://time.com/4597632/malta-gay-rights-conversion-ban/.

[35] Juhie Bhatia. 2020. “Global Acceptance of LGBTQ on the Rise.” US News & World Report. U.S. News & World Report. June 25, 2020. https://www.usnews.com/news/best-countries/articles/2020-06-25/lgbtq-acceptance-growing-in-us-and-other-countries-over-time.

[36] Samuelson.

[37] Flores.

gay rights movement?