The knowledge base
A report commissioned by the Norwegian Directorate for Children, Youth and Family Affairs (Bufdir) in 2012 on children with alternative gender expressions, stressed the need to raise the level of competence and change attitudes (3). The authors suggested that these children should receive support from local family counselling services. They did not, however, expect the required raising of competence levels to be rolled out nationwide, across all family counselling services. It was instead suggested that certain services should be selected, evenly distributed across the country.
In 2013, another Bufdir-funded study was published: All sorts of people. Living conditions and quality of life for people with gender identity issues (4). The report highlighted two findings. Firstly, that schools, employers, family members and public institutions in general have insufficient knowledge about, and little understanding of, gender identity issues. Secondly, that the Health Service is failing the gender incongruent.
In April 2015, a panel of experts appointed by the Norwegian Directorate of Health published a report entitled Right to right gender – health for all genders (5). Their mandate was to consider the stipulations relating to a change of legal gender, and the organisation of healthcare services for people with gender incongruence and gender dysphoria.
This work led to the introduction of new legislation concerning legal gender. Until June 2016 it had been a requirement that in order to be granted permission to change an individual’s gender as recorded in the National Population Registry, the individual’s reproductive organs would need to have been removed. Today, submission of a self-declaration to the Registry is sufficient. The requirement for body alterations has been abandoned. So far, more than 700 people have taken advantage of the opportunity to decide their own legal gender, irrespective of the gender they were assigned at birth and irrespective of body alterations. The report establishes that there are deficiencies and challenges associated with the current provision of healthcare services. Many who are entitled to health care associated with gender dysphoria do not receive the help they need and want. The report set out good and thorough recommendations on the best way to organise health services in order to meet the need for health care among the gender incongruent. This has yet to be implemented.
In January 2017, the Norwegian Ministry for Health and Social Affairs published an action plan entitled Talk about it! Strategy for sexual health (2017–22) (6). This replaced two separate action plans that focused on HIV and unwanted pregnancies respectively. It was a clear objective to highlight the importance of sexual health. The strategy document points out that all people of all ages must be given the necessary knowledge and skills to look after their own sexual health, and good sexual health must be assured for the entire population. The Health Service must ensure that the health and care sector promotes and disseminates knowledge about sexual health. Health professionals must respect and understand the sexual needs of service users and patients. When and not least, how, do Norwegian health authorities intend to turn their knowledge into practice?