On November 16th, the BC government announced that publicly funded genital reconstruction will now be available within the Province. Previously trans people had to travel to Quebec for a publicly funded option, leading to potential medical complications caused by the trip. More surgeons are also being hired to perform breast and chest surgery in Burnaby, Kamloops, Kelowna, Port Moody, Prince George, Vancouver, and Victoria. Before this the only public option for top surgeries were in Victoria or Vancouver.

Recovering from major surgery requires time off work and a social support network: two things that are unavailable to many trans women. Removing the additional burden of traveling to Montreal will make the process less daunting, so the decision by the NDP to provide publicly funded bottom surgery for trans people is very welcome, and potentially life changing for some of our working class trans comrades. However, the trans surgery system in BC is rooted in sexism, hypocrisy, and tired trans stereotypes. Unless there is a significant change in the way BC handles trans surgery, trans women will continue to face a double burden of transphobic and sexist policy.

A Broken System

The criteria for publicly funded breast augmentation for trans women is so tightly defined that it barely exists as an option. According to the Trans Care BC website, breast augmentation is only available if, after being on hormones for at least 18 months, you have had “little to no breast growth (smaller than a AA cup)” or “significant asymmetric growth” as determined by a surgeon. Meanwhile, chest construction surgery aimed at trans men does not require hormone therapy, or a certain cup size.

Even for the tiny minority of trans women who do qualify, the process of applying for breast augmentation in BC is based on the myth of the True Transexual: a heterosexual trans woman who has known she was a woman since birth and whose womanhood is defined by desire for surgery is the only kind of transsexual who isn’t faking it. Lydia Rabichuck, a trans woman who received public breast augmentation in Vancouver, says that in her qualifying interview for surgery she was asked questions like what books she read as a kid (girls books or boys books) and what toys she played with. Rabichuck felt that getting surgery rested on telling the interviewer what they wanted to hear: that she had been stereotypically emblematic of the patriarchal image of femininity her whole life.

Trans women have always had to lie or simplify our life stories to be granted the care we need because we are viewed as ‘artificial.’ The gap in requirements between breast augmentation and chest construction can be explained by the way trans women getting breasts is seen as cosmetic, frivolous, or sexual whereas trans mens’ surgeries are more likely to be seen as a serious need.

Surgery and Violence

The appearance of trans bodies is directly related to the violence trans people face. Strangers on the street regularly attack visibly gender nonconforming people, while in domestic spaces, sexual partners may get violent if they realize they are sleeping with a trans person, such as the infamous 2014 murder of Jennifer Laude in the Philippines by an American soldier. The Trans Care BC website says that surgery can give trans people “increased safety and comfort in public situations,” including while crossing borders and “interacting with police.”

If the BC government wanted to help the safety of trans women via surgery, why is there no funding for other surgeries such as facial feminization procedures? These set of surgeries are non-cosmetic in that they only undo the effects of testosterone on facial bone structures, rather than change the face’s appearance to fit a certain beauty standard. This surgery is wanted by many trans women but is unaffordable for working class trans women without massive fundraising or years upon years of saving. Facial feminization is by far the most relevant surgery when we speak of preventing violence against trans women because our faces are the most common way we are “clocked” as trans and then subjected to violence. Similarly, permanent facial hair removal is another obvious choice for funding, yet there are no resources for it.

No amount of surgery will truly protect trans people from violence we experience as women. Although bottom surgery and other feminization surgeries may reduce the amount of direct physical and sexual transphobic violence, these procedures do not inherently elevate the material conditions of trans women. We need housing and employment, convenient access to hormones and name changes, and sex work decriminalization. In the midst of our social and economic poverty, the BC NDP call for surgery remains a band-aid solution rather than a response to systemic violence against women.

The contradictions of trans care

So long as the government controls access to surgery, hormones, and other trans healthcare, every right trans people have won through struggle can be stripped away if the political climate changes. According to a primer on Sex Reassignment Surgery by Egale Canada, bottom surgery in BC was delisted from public insurance in 1988 until it was deemed a “medically necessary service” in 1993 and refunded. Electrolysis was covered in Ontario until that funding was repealed in 1991, and it has never been restored. Trans health needs under capitalism have always been bargaining chips that government can either dangle in front of us, in an effort to stifle militant activism, or take away to please a right-wing voting base.

The only option for working class people in terms of healthcare is to be dependent on the government for our medical needs so it becomes necessary to shut up and receive the marginal benefits the government provides us. Politicizing trans healthcare starts by teaching each other what to say to get the care we need, exposing the hypocrisies and abuses of the trans healthcare system while acknowledging that this is one of many ways to fight the co-option we face from non-profit and government services. The NDP does not care about trans people, nor has it had a change in heart. Bottom surgery is being brought to B.C because militant trans activists have shown in our decades of organizing that the Canadian healthcare system is inadequate. Instead of celebrating the State, let us celebrate our trans elders who fought in the past so the present NDP government had no choice but to begin to recognize our needs.