New N.S. gender-affirming policy a step in the right direction, but more needs to be done: advocate

Nova Scotia has implemented a new gender-affirming care policy, but one organization says it doesn't go far enough.

The province adopted the new policy on Friday. It aims to "ensure high-quality, timely, comprehensive, equitable, culturally appropriate and safe services" for transgender and gender-diverse people in Nova Scotia.

This includes improving access to gender-affirming health care, which refers to a wide range of treatments that align a person's body with their gender identity.

The policy also established a fee code for physicians delivering the care.

"It is definitely better than what the province was offering before," Riley Nielson-Baker, executive director of Gender Affirming Care Nova Scotia, told CBC Radio's Information Morning Halifax on Tuesday.

"But it's missing some incredibly key, important key pieces that we are disappointed that the province didn't take this time to act on, and we're hoping that they change their mind in the near future to correct that."

Nova Scotia has higher proportions of transgender and non-binary people than any other province or territory in the country, according to data released by Statistics Canada last year.

Halifax is the second-most gender-diverse city in the country, just behind Victoria, with about 4,800 people who identify as transgender or non-binary.

Nielson-Baker said Gender Affirming Care Nova Scotia was consulted during the policy's drafting process, but some important elements were left out.

They said the policy, although it does reflect the responsibility of practitioners to serve people seeking gender-affirming care, doesn't provide information about how and when practitioners will be educated on the matter.

"It's a half step and with that responsibility to serve, it doesn't actually outline any consequences for health-care practitioners who don't actually live up to their obligations to serve our community," Nielson-Baker said.

"And when you have a requirement without a punishment, if it's broken, it's not a requirement, it's a request."

Nielson-Baker said the province failed to expand the list of procedures covered by Nova Scotia's Medical Services Insurance (MSI) to include facial feminization and masculinization surgeries, laryngeal surgery, and hair removal and transplant.

"We explained to the province on several occasions how the list that is currently available doesn't actually meet the needs of the community that it's supposed to serve and outlined some procedures that we believe would help move us towards providing that holistic care," they said.

"And they didn't do it, and it's incredibly disappointing."

Access to care affects mental health: advocate

Nielson-Baker said not providing this kind of care, which is medically necessary, can negatively affect mental health and lead to suicide.

"If any other medical procedure was recognized to be medically necessary and wasn't provided in an efficient and timely manner, there would be outrage, it would be considered unacceptable," they said.

"But we're expected to accept [it]. … We don't want to be fully negative here, it is a great half step forward, but at the end of the day, we all know what happens when we don't provide care to trans people."

'Not the last step'

CBC News requested an interview with Health Minister Michelle Thompson about the new policy, but she wasn't available.

In a statement, Thompson said all health-care providers must follow a code of ethics that require them to provide care. If they cannot, they must refer a patient elsewhere. 

Health-care providers also have access to free training about hormone treatment, post-surgical care and other services involved in gender-affirming care, she said.

"In fact, for a physician to bill for gender-affirming care, this training is mandatory," Thompson said. 

"We are also working with academic institutions that train and educate health-care providers to ensure that the core curriculum integrates components on 2SLGBTQIA+ care, including providing gender-affirming health care."

Thompson said she appreciates the feedback from advocate groups, but some decisions would require more research and consultation.

"We agree that this is a step in the right direction — but want to assure [Gender Affirming Care Nova Scotia] and other community groups and individuals that this will not be the last step."