By Michelle Eglovitch, MPH
Program Associate, Women’s and Infant Health; AMCHP
Although lesbian, gay, bisexual and transgender individuals experience more equality today than ever before, national-level policy needs to go further to address the negative physical, social and mental health outcomes of LGBT youth. LGBT youth are more likely than their straight peers to experience challenges such as violence and bullying and are more likely to be depressed, have suicidal ideation and behaviors and to attempt suicide. Research shows that transgender youth in particular are already at a high risk for self-harm behaviors: Forty-one percent of transgender individuals attempt suicide at some point in their lives, as compared with just 4.6 percent of the overall population.
In 2015 and 2016, multiple state legislatures considered and/or passed bills restricting access of transgender people in gendered public spaces, such as public bathrooms and locker rooms. These bills are primarily meant to prevent transgender people from accessing spaces consistent with their gender identity, as they mandate that people must only enter facilities based on sex assigned at birth. (Gender identity is the personal conception of oneself as being male or female.) Although many of these bills aim to restrict access statewide, some bills are specific to public high schools and subsequently restrict access for transgender youth. Proponents of such bills, colloquially known as "bathroom bills," argue that the legislation is intended to protect the safety of women by preventing assaults from transgender populations or men who identify as heterosexual. However, there is no evidence that such assaults have occurred in the past at an elevated rate or pose a legitimate threat in the future.
Even before this recent influx of bathroom bills, transgender youth have historically felt unsupported in accessing bathrooms and other public accommodation spaces. The Gay Lesbian and Straight Education Network’s 2013 National School Climate Survey of LGBT middle and high school students found that over 63 percent of transgender youth avoided bathrooms at school and 52 percent avoided locker rooms because they felt unsafe, compared with less than 40 percent of their non-transgender, or cisgender, peers. (Cisgender is a term used to describe a person whose gender identity aligns with the sex assigned to them at birth). Research shows that discrimination against LGBT youth in a public accommodation setting contributes to negative physical and mental health outcomes, such as feeling sad, upset or frustrated as a result of how they were treated based on their gender identity or gender expression.
Much of the physical and emotional harm that transgender youth experience comes in the form of bullying. The recent transformation of the Title V Maternal and Child Health Services Block Grant includes bullying as a National Performance Measure (NPM). NPM No. 9 is the percent of adolescents, ages 12 to 17, who are bullied or bully others. Emotional and behavioral problems experienced as a result of bullying may continue into adulthood and lead to long-term negative outcomes, including low self-esteem and self-worth, depression, anti-social behavior, vandalism and substance use. LGBT allies, including the public health community, express concern that these bills have the potential to exacerbate the bullying and harassment that transgender youth already experience.
For transgender youth to thrive in their schools and communities, they need to feel socially, emotionally and physically safe and supported. A positive school climate has been associated with decreased depression, suicidal feelings, substance use and unexcused school absences among LGBT students. The American Academy of Pediatrics released a statement opposing legislation that restricts transgender people’s access to gendered spaces on these grounds:
"Pediatricians in North Carolina and across the country know what children need: they need the stability and support of nurturing adults, they need the acceptance and compassion of their peers and community and they need to feel safe where they live and where they learn."
States that chose to focus on NPM No. 9 should consider the structures and systems they have in place to support all school-age children and adolescents within their jurisdictions. A specific focus on LGBT youth in policies and procedures would be a part of addressing this measure. Schools with clear policies on LGBT-related bullying report higher rates of feeling safe at school and are less likely to report harassment problems. (Model policies can be found here). In addition, schools and districts should consider providing training to school staff on being a supportive educator. LGBT students who report having many supportive staff members at their school are less likely to miss school because of feeling unsafe or uncomfortable, and they report feeling more connected to their school community. (GLSEN’s Safe Space Kit is one example of a resource geared toward educators.) If your state has proposed or implemented strategies to create inclusive school environments for LGBT youth, contact Michelle Eglovitch, program associate for Women’s and Infant Health, at email@example.com to share your ideas.