Mr. Broden Giambrone:

I wish to echo Vanessa's comments and thank you, Chairman. You have been a great ally to the transgender community and we really appreciate your support. I also thank the committee for joining us today.

There are urgent health care needs facing the transgender community of all ages in Ireland. However, I will take a few minutes to talk about another crucial issue that affects the transgender community, which is legal gender recognition. At present, transgender and inter-sex people in Ireland are unable to obtain birth certificates that show their true gender. Ireland has an obligation, as yet unfulfilled, to provide a pathway by which amended birth certificates can be issued. The State's obligation arises from international and European commitments on human rights. It is more than five years since the High Court declared Ireland to be in breach of the European Convention on Human Rights. So far, we have failed to find a remedy to this situation and the transgender community has waited too long.

Gender recognition is a public health issue. Birth certificates are foundational documents and are required for daily living. They are required for official purposes such as obtaining a personal public service, PPS, number, accessing social welfare and getting married. Individuals regularly come to TENI who are unable to travel because they cannot get identity documents in the correct gender. People have been denied placements in college because their leaving certificates are under one name and gender identity and the college has dismissed them because it thought that was an error. It is not an abstract thing but a very practical matter for many people.

A person whose gender does not match their identify document runs the risk of daily difficulties, but they also run the risk of being consistently outed as their birth gender. This can result in transphobia, discrimination and, in the worst case, violence. The transgender community across the world has high rates of violence perpetrated against it. In large part, this can be due to the confusion around the gender that people present and the gender as which they are legally recognised. The possibility of having legal gender recognition acknowledged by the law can have a profound impact on the daily lives of transgender people. It can facilitate people's ability to enter education, gain employment and access health care and other social services. Ultimately, it leads to a better sense of well-being. As Vanessa said, the rates of suicide attempts and suicidality in Ireland are off the charts. They are higher than anything I have ever seen. At 40%, we have a real obligation to do whatever we can to make people's lives easier.

In 2011, the Government created the interdepartmental gender recognition advisory group, which we call GRAG. It recommended what the process for gender recognition should be. It proposed that in order to be recognised an individual would have to provide a certain amount of evidence. I will not go through all of it because the report is in the public domain but I wish to refer to one issue, the medical evidence and the validation criteria. The group proposed that in order to be recognised one must have a diagnosis of gender identity disorder or have had gender reassignment surgery. This is a highly problematic proposal. First, by tying recognition to a diagnosis of gender identity disorder the Government will automatically exclude people who are inter-sex, because they will not be able to avail of the rights within the recognition. Three births in 200 are inter-sex affected, so this is not a minor community. It is a real issue for people as this is a significant proportion of our population. Furthermore, the nomenclature for the way we define diagnosis is already changing. The American Psychiatric Association has changed from gender identity disorder to gender dysphoria. It would be pointless to put an archaic definition into our law.

However, it is not just about terminology or who will not be included. It is also the fact that the approach has increasingly shifted. International human rights discourse has stressed the need to depathologise gender recognition and to acknowledge that legal rights should not be contingent on medical treatment pathways. Having a diagnosis of a mental illness can really reinforce stigma. Transgender people have often been seen as sick or mentally ill and have had their gender identity seen as something that needs to be fixed. This is not dissimilar to the fact that homosexuality also featured in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders some decades ago. Transgender people are still in it. There is a real stigmatising element in putting that into law. As one transgender person told me, "I am not disordered, I am just me". This issue must be highlighted and we strongly feel that it should not be codified in the legislation being brought forward.

At present, the current best practice in gender recognition exists in Argentina. Last May, it brought forward the best practice gender recognition legislation. It allows an individual to self-declare who they are. They are the arbitrator of their own identities and they can say that, put it forward and have it recognised by the state as such. This avoids the pitfalls of many of the GRAG's proposals, particularly surrounding the medical validation process. We advocate that gender recognition decouples medical interventions from legal recognition. We propose that the State use a statutory declaration process that affirms the transgender person's identity but also provides a legally robust process. It would not require any surgical procedures, hormonal therapies or any other psychological or medical treatments for an individual to be accorded their basic human rights. This position has been supported by the World Professional Association for Transgender Health, which is a professional body of over 650 physicians and mental health professionals who are engaged in clinical practice in this area. They are the international experts. This position has also been supported by the HSE.

At present, the Government is in the process of drafting heads of a Bill that will be put before the committee on education and social protection in the autumn. However, two Private Members' Bills have been produced. Last week, Senator Katherine Zappone, supported by Senator Jillian van Turnhout, introduced a Bill in the Seanad. The Bill was informed by best practice. It came from the transgender community and it is rights compliant legislation. We urge the Government to take up this Bill or to introduce a similar Bill.

There is no doubt that medical treatment and access to health care for transgender people are absolutely necessary. Vanessa made a very strong statement to that effect. However, transgender people, like all people, should be availing of the health system when they have a health need, not to obtain a legal right or to be legally recognised. Transgender people's health needs should be addressed by the health system and their legal needs should be addressed by rights compliant legislation. Anything else would run contrary to principles of human rights and dignity.

We are here to urge all Deputies and Senators to support legislation that will ensure that transgender people have a process to have their affirmed gender recognised under law, without having to go through restrictive or burdensome processes that will negatively impact on their health and their human rights. I thank the committee.