*Co-author: Bachittar Singh (Rising 3L at Alabama Law; NHeLP summer intern 2023)
In 2017, California made headlines as Governor Gavin Newsom signed into law the California Gender Recognition Act (S.B. 179), landmark legislation in the arena of LGBTQ+ rights. It was a monumental step towards recognizing non-binary identities, setting a precedent for inclusivity in state programs. Despite this advancement, the transition towards comprehensive inclusivity across California’s Health and Human Services programs has been slow. More needs to be done, not only in terms of data collection but also in promoting cultural competency in health care services for non-binary people and the broader LGBTQ+ community.
What is “non-binary”?
Non-binary is an umbrella term within the LGBTQ+ community for individuals whose gender identity doesn’t align with traditional binary categories of male or female. People identifying as non-binary may see themselves as being both genders, neither, somewhere in-between, or outside the gender spectrum altogether. This broad identity category includes various specific identities such as genderfluid, androgynous, gender non-conforming, genderqueer, Two-Spirit, Māhu, Fa’afafine, or Khwājā Sirā. It’s important to note that while some non-binary individuals also identify as transgender (indicating a difference from their assigned gender at birth), others do not.
Pathway to Truly Inclusive Healthcare
While California has made significant strides towards equality and inclusivity, there remains an urgent need to infuse these principles in every layer of the health care system.
California has proven its commitment to the LGBTQ+ community with the California Gender Recognition Act (S.B. 179). However, there’s still a journey ahead to create a healthcare system that is truly inclusive, equitable, and culturally competent. Addressing these issues will not only benefit non-binary and other LGBTQ+ individuals but enhance the health care system’s cultural competency as a whole, leading to better outcomes for all Californians. We need to push for these changes now, so the next generation of Californians – with an estimated 9.1% (or 2.7 million individuals) identifying as LGBTQ+ including 27% (or 796,000) of California youth between the ages of 12 to 17 identifying as gender nonconforming – can access health services that fully acknowledge and cater to their needs. Our journey toward LGBTQ+ health equity is far from over, but with intentionality, empathy, and persistence, we can create a healthcare system that is truly inclusive and equitable.
To begin, the comprehensive collection of data related to sexual orientation, gender identity, and sex characteristics (SOGIC) is paramount in understanding health disparities within the LGBTQ+ community. SOGIC data provides insights about health risks and health care outcomes amongst the community, essential for crafting effective interventions.
Inclusive Information Collection: The Next Step
However, inclusive data collection goes beyond these analytical aspects. It is about acknowledging and respecting the diverse identities and experiences of individuals. Inclusive data collection is about ensuring all LGBTQ+ individuals receive appropriate and culturally competent care, an aspect that is often overlooked but fundamental in delivering equitable health care services.
For instance, a lesbian cis-woman may be assumed to be at no risk of an unplanned pregnancy. However, this assumption could be gravely mistaken if her female partner has a penis. For example, as per a 2019 article in the American Journal of Public Health (AJPH), as a result of the disparity which currently exists in health care in relation to “sexual minority women (SMW; e.g., queer, bisexual, lesbian, pansexual)”, they “have an elevated risk for unintended pregnancy” when compared with “their heterosexual peers[.]” By collecting more detailed and inclusive information about a patient’s body and that of their partner(s), health care providers can offer accurate advice and counseling about reproductive health and pregnancy.
Moving beyond SOGIC data collection, there’s an immediate need for broader, more inclusive information collection strategies across health care services. The language used in health care documentation should mirror the diversity of individuals seeking medical care.
For example, the traditional use of “Mother” and “Father” on pediatric forms fails to acknowledge same-sex, or non-gender conforming, parents. By using more inclusive language such as “Parent 1” and “Parent 2”, health care providers can avoid unintentional marginalization and ensure that all families feel seen and respected.
Similarly, it may be essential to ask about specific body parts a patient and their partner(s) possess rather than making assumptions based on a patient’s sexual orientation. This inclusivity ensures accurate counseling about reproductive health and pregnancy, a crucial aspect of providing patient-centric care.
The Impact of Inclusive Practices
Inclusive practices in health care have profound impacts on the mental and emotional well-being of LGBTQ+ individuals. A 2022 study by The Trevor Project, investigating the link between the availability of identify documents that match one’s gender identity and the incidence of suicide attempts among transgender and non-binary youth, found that allowing transgender and non-binary youth to change their legal documents to reflect their true identities correlated with lower rates of suicide attempts. This finding underscores the significant role inclusivity plays in creating a supportive and affirming health care environment.
Inclusive paperwork, while seemingly a small step, has significant implications. It communicates to patients that their identities are acknowledged and validated, thereby encouraging them to seek and continue medical care, leading to improved health outcomes.
 Person & Hans Johnson, California’s LGBT Population, PUBLIC POLICY INSTITUTE OF CALIFORNIA (2023), https://www.ppic.org/blog/californias-lgbt-population/ (last visited June 12, 2023).
 Rachel Dowd, 27% of California Adolescents Say They Are Viewed as Gender Nonconforming, Study Finds, UCLA: HEALTH + BEHAVIOR, https://newsroom.ucla.edu/releases/27-of-california-adolescents-are-gender-nonconforming-study-finds (last visited June 12, 2023); see also Brooke Migdon, Here Are the States Where You Can (and Cannot) Change Your Gender Designation on Official Documents, CHANGING AMERICA, May 31, 2022, https://thehill.com/changing-america/respect/diversity-inclusion/3507206-here-are-the-states-where-you-can-and-cannot-change-your-gender-designation-on-official-documents/ (last visited June 12, 2023).