Working internationally on gender identity, gender expression and bodily issues


The World Health Organization’s (WHO) International Classification of Diseases (ICD) is the diagnostic resource used globally by governments and ministries of health, as well as by clinical researchers, pharmaceutical companies, health insurance companies, and healthcare institutions and providers. Trans* people are severely psycho-pathologized in the current version of the ICD used in most countries (ICD-10). The current categories have historically contributed to the exclusion of trans* people from basic human rights, including the right to identity and self-determination, and have aggravated stigma, discrimination and violence against trans* and gender variant people.

Moreover, ICD diagnoses are usually required to grant access to legal gender recognition and/or to transition-related healthcare. Similarly, intersex people face human rights violations directly derived from ICD – in particular, the erasure of their bodily integrity and decisional autonomy. Yet because of many years of advocacy, there are now unprecedented opportunities to push for meaningful depathologization for trans*, gender variant, and intersex (TGVI) people.

The ICD-10 is under a process of revision and reform, and the World Health Assembly will approve a new version (ICD-11) in May 2018. It has been more than 25 years since ICD-10 was approved making this a historic opportunity to change history by removing the pathologization of trans identities from the ICD chapter on Mental Health. We have been coordinating an international initiative focused on this process in pursuit of three core objectives:

Increase trans* gender-variant and intersex (TGVI) activists’ expertise and political mobilization on human rights in medical settings. It is necessary to increase the number of activists participating and the technical expertise of those involved in the ICD reform process in order to advance a global movement to increase access to human rights for transgender people without pathologizing them. We have built capacity and expertise among TGVI activists through the creation of toolkits, virtual trainings and in-person trainings. This array of capacity building training contains a mixture of technical skills development related to the ICD process and more general activists and organizational capacity skills critical for ensuring the sustainability of TGVI activists and organizations. Skill building addresses how to influence the ICD process and how to use lessons learned through the ICD process to support human rights advocacy at the national and regional levels.

Securing ICD reforms that depathologize TGVI people while granting their full access to legal recognition and healthcare. The process of ICD revision requires that we combine technical and political advocacy by sustaining and growing our transgender and intersex working group, organizing international expert meetings, monitoring the revision process, and coordinating regular communication with WHO staff and other key stakeholders. It also requires creating expert submissions, Content Forms and other technical documents.

Prevent the introduction of new ICD references pathologizing TGVI children. Despite positive advances in the revision process, the introduction of the proposed category of “gender incongruence of childhood” threatens to institutionalize the pathologization of gender diversity in childhood. Our work to counter this proposal utilizes our working groups and relies on the same types of regular communication with WHO staff and other key stakeholders.

Join us in creating a world where being trans* is no longer defined by a medical diagnosis or seen as a pathology- and where trans* people can enjoy full human rights, safety, and a right to identity every day, from their early childhood to their very oldest age.

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