What's the problem represented to be? A policy analysis of the Danish Health Authority's guidelines on healthcare related to gender identity
Author
Pagani, Josephine Møller Andersen
Term
4. term
Publication year
2019
Submitted on
2019-01-02
Pages
52
Abstract
Denne afhandling undersøger, hvordan transspecifik sundhed i Danmark bliver problematiseret i Sundhedsstyrelsens (SST) retningslinjer om sundhedstilbud relateret til kønsidentitet, som fulgte efter Danmarks beslutning i 2017 om at afmedikalisere det at være transkønnet. Med udgangspunkt i Bacchis WPR-tilgang (What’s the Problem Represented to be?) gennemføres en politikanalyse af retningslinjerne som sundhedspolitik, baseret på dokumentanalyse med grounded theory, kodning og diskursanalyse. Analysen informeres af teorier om magt og governmentality (Foucault), transrettigheder i menneskerettighedsdiskursen samt styringen af kroppe og medborgerskab. Afhandlingen identificerer to centrale problemrepræsentationer i retningslinjerne: (1) behovet for at afstigmatisere transpersoner som behandlingssøgende, bl.a. i lyset af tidligere erfaringer med magtesløshed og mistillid på Sexologisk Klinik; og (2) ønsket om at sikre, at behandlingssøgende er fuldt besluttede på at gennemgå transspecifik behandling for at undgå fortrydelse. Selvom sproget og terminologien i retningslinjerne er mere inkluderende og bekræftende end tidligere, påpeger analysen, at indholdet fortsat efterlader betydelige barrierer for adgang og forløb, herunder åbne og løse definitioner af kønsrelateret ubehag og psykosociale forhold, lange eller omfattende udredninger samt krav om at fremlægge seksualitetsrelaterede oplysninger. Afhandlingen peger dermed på et spændingsfelt mellem et mere inkluderende sprog og vedvarende praksisser, som kan vanskeliggøre adgang til transspecifik sundhed i en ellers egalitær velfærdsstat.
This thesis examines how trans-specific healthcare is problematized in the Danish Health Authority’s (SST) guidelines on healthcare related to gender identity, issued after Denmark’s 2017 decision to declassify being transgender as a mental disorder. Using Bacchi’s WPR (What’s the Problem Represented to be?) approach, it conducts a policy analysis of the guidelines as health policy, drawing on document analysis with grounded theory, coding and discourse analysis. The study is informed by theories of power and governmentality (Foucault), the inclusion of trans rights within human rights discourse, and the governance of bodies and citizenship. The analysis identifies two main problem representations in the guidelines: (1) the need to destigmatize trans people as care-seekers, including in light of earlier reports of disempowerment and mistrust at the Sexological Clinic; and (2) the aim of ensuring that care-seekers are fully decided about pursuing trans-specific treatment to avoid regret. While the guidelines adopt more inclusive and affirmative language than previous policy, their substance still leaves notable barriers to access and care, including open-ended definitions of gender-related discomfort and psychosocial factors, lengthy or comprehensive assessments, and requirements to disclose sexuality-related information. The thesis highlights a tension between more inclusive wording and persistent practices that may hinder access to trans-specific healthcare within an otherwise egalitarian welfare state.
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Keywords
Documents