May 2, 2016
Government of Saskatchewan
Dear Mr. Karkut:
RE: Proposed Amendments to the Vital Statistics Act, 2009: Respecting Change of Sex Designation on Saskatchewan Registration – Consultation Document
The Government of Saskatchewan released a “Consultation Paper” outlining proposed changes to the Saskatchewan Vital Statistics Act (VSA). The proposed changes are reflective of Saskatchewan’s recently adopted interim changes that allow adult individuals to change their sex designation on identification without undergoing gender reassignment surgery. Egale Canada Human Rights Trust (Egale) applauds the Government of Saskatchewan for taking this important first step in removing the requirements for surgical or medical intervention.
The Government has proposed that the VSA be amended to permanently implement the interim changes, and has asked for input on how they might proceed in permanently revising the criteria by which a sex designation may be changed on a Saskatchewan birth registration. With respect to the proposed amendments there are remaining concerns that we feel restrict trans persons in Saskatchewan from accessing their full and inalienable rights, and may expose the Saskatchewan Government to further contestation within the justice system.
For the purposes of the Saskatchewan Government’s request for input regarding a permanent change to the Saskatchewan Vital Statistics Act, Egale has reviewed the proposed amendments as per the “Consultation Paper” and compiled recommendations to inform public and Governmental discussion on this issue. Additionally, we have attached Egale’s general policy guidance regarding birth certficates and sex/gender markers. Notably this guidance includes, considerations and recommendations for removing such markers entirely.
The Government of Saskatchewan has proposed the Act be amended to permanently implement the current interim criteria in reference to the changing of one’s sex designation on a Saskatchewan birth registration. Egale’s responses and recommendations with respect to these criteria are included below with references to existing precedents both nationally and internationally.
I. Proposed Criteria: Letter from a Physician or Psychologist
“A letter from a physician or psychologist who is registered and licensed to practice in Saskatchewan, or another jurisdiction, confirming that:
- The physician or psychologist has treated or evaluated the applicant;
- That in the physician or psychologist’s opinion, the applicant identifies with and is maintaining the gender identity that corresponds with the requested amendment to their sex designation; and
- That the physician or psychologist is of the opinion that the change of sex designation on the birth registration is appropriate”.
Egale Recommendation on Criteria Required to Change a Person’s Sex Designation on a Birth Registration so that it Accords with the Person’s Gender Identity
It is the opinion of Egale that the Government should primarily consider four guiding principles during the course of this consultation with respect to requiring a letter from a physician or psychologist: 1) the right to autonomy and self-determination; 2) the right to free development of one’s gender identity; 3) the realities of access to competent, effective and non-reparative health care for trans people in the province of Saskatchewan; and 4) where there is a bona fide need to require attestation of gender identity beyond the individual’s self-determination that the options be expanded beyond those within the health care sector.
The single guiding criterion for changing a person’s sex designation on a birth registration should be self-determination following the right to autonomous determination of gender identity. Every individual in Saskatchewan should have the right to determine their own gender identity, rather than maintain exclusive authority of the health care sector over the legal recognition of gender identity. Every individual in Saskatchewan should also have the right to the free development of their gender identity overtime. In this regard, Egale recommends that the Government adopt a model similar to that of Argentina —an approach that privileges the inalienable right of all people to autonomy and self-determination and the free development of persons inclusive of their gender identity.
On May 8, 2012, the Senate of Argentina approved the “Right to Gender Identity” law, an unprecedented global example of respect for the human rights and dignity of trans people. The law begins with the following assertion:
“All persons have the right,
- To the recognition of their gender identity;
- To the free development of their person according to their gender identity;
- To be treated according to their gender identity and, particularly, to be identified in that way in the documents proving their identity in terms of the first name/s, image and sex recorded there”.
The Argentinian law enables trans people to change the sex designation assigned to them at birth upon the sole criterion that the individual does not identify their own gender with that designation. The law provides for a straightforward process by which an individual submits an application to the National Bureau of Vital Statistics requesting an amendment to their birth certificate along with a new first name, if desired. This process complies with the principle of self-determination as the individual is free to determine on their own which sex designation best accords with their gender identity. Furthermore, the law explicitly stipulates that in no case will surgery, hormone therapies or any other psychological or medical treatment be required to modify legal documentation, nor is there any requirement for corroboration by a third party.
Argentina is not the only country to introduce a process in which the right to self-determine gender identity remains the primary guiding principle in the process of changes to sex designation on identification. Argentina is joined by New Zealand, Denmark, Malta, Colombia and Ireland in allowing trans persons to self-determine gender without undergoing intervention from the health care sector.
New Zealand adopted this approach in its revised passport policy Nov 30, 2012 which allows an individual to simply provide a witnessed Statutory Declaration with their passport application, outlining their circumstances and advising the gender identity they wish to be displayed in their passport.
On September 1, 2014, “The Danish Gender Recognition Law” came into effect in Denmark abolishing any requirement for medication intervention, inclusive of a psychiatric diagnosis or other testimony in order for birth certificates to be changed in accordance with an individual’s gender identity. As is the case in New Zealand, trans persons complete simple administrative procedures based on the self-determination of the individual in order to receive new identification documents.
On April 1, 2015, the Maltese Parliament adopted “The Gender Identity, Gender Expression and Sex Characteristics Act”. The law asserts the following:
“3. (1) All persons being citizens of Malta have the right to –
- The recognition of their gender identity;
- The free development of their person according to their gender identity;
- Be treated according to their gender identity and, particularly, to be identified in that way in the documents providing their identity therein; and
- Bodily integrity and physical autonomy”.
The law also states “4. The person shall not be required to provide proof of … psychiatric, psychological or medical treatment to make use of the right to gender identity” and goes on to state that no other evidence is required other than the individual’s declaration; “4. (3) The Director shall not require any other evidence other than the declaratory public deed”.
As of June, 2015, following the principle of self-determination, trans individuals in Columbia were given the legal right to change their gender on official identification documents without medical or psychological examinations. According to International Business Times Columbia’s Minister of Justice Yesid Reyes spoke of the requirement for a psychiatric exam that assessed for gender dysphoria as “profoundly invasive of privacy rights and rooted in unacceptable prejudice”.
On November 25, 2015, the Irish Government passed “The Gender Recognition Act” asserting that self-declaration will be accepted for the purposes of updating identification documents. Following the right to self-determination, Ireland does not include testimony from those in the health care sector to have gender recognized by the state and issue a change in sex designation for trans people.
The approach of self-determination, without intervention by the medical sector or attestation by anyone other than the individual her/their/himself, as taken by the aforementioned countries is unquestionably the most ideal and the most respectful of the rights and dignity of trans people, and is therefore the guiding principle most recommended by Egale in relation to the change of sex designation of one’s identification documents.
In accordance with the right to free development of one’s gender identity, Egale maintains that the ability to change one’s birth registration should extend throughout an individual’s lifetime, thereby allowing for the possibility that this may occur more than once for any given individual.
The right to autonomy and self-determination is not limited to a single instance and inherently holds the right to a natural unfolding and maturation of process as is afforded to other elements of identity. Just as the right to change one’s name or marital status is not limited to a prescribed number of opportunities for change, so should be the case for the change of one’s sex designation.
This right to an evolution in articulation of one’s identity is based on the understanding that discerning, naming and determining one’s gender identity is inescapably tied to one’s external, socially constructed environment and the linguistic framing available to capture one’s internally felt truth. Articulating one’s gender identity is a process that reconciles four different pieces of information: 1) The feelings you have within yourself about the gender identity and/or gender expression you experience; 2) How you experience the social system of gender in relation to these internally held feelings; 3) The language you have available to you to frame those feelings; and 4) The sense you have of how this will impact your interactions with other people in a social context and/or feeling of access to affirmation of your identity within social environments as influenced by institutions. With respect to the social landscape of Canada’s gender variant and trans communities, there is recognition of the constantly evolving language that is emerging to more accurately reflect and capture the lived realities of those whose felt identities differ from the historical gender binary afforded by governmental and social institutions. In understanding that the realities of identity construction, both on the individual level and within larger socio-linguistic domains, are complex and interrelated, one can easily account for the necessity to afford an individual the right to free development of their gender identity in relation to evolving understandings.
In order to enable trans people to obtain identification documents that accurately reflect their gender identity, the Saskatchewan Government must allow for the possibility that an individual’s articulation of their gender identity may evolve over time in an effort to more accurately reflect externally what they know and understand as their truth internally.
Removing the requirement for “gender reassignment surgery,” as currently required in the Saskatchewan Vital Statistics Acts, leaves the possible requirement of a health care evaluation or diagnosis. It is Egale’s resolute opinion that this option should not be included within the required criteria for changing one’s sex designation on a Saskatchewan birth registration as proposed in the amended criteria. To the contrary, it is Egale’s submission that the permanent criteria should be entirely excised from the purview of health care professionals.
Access to competent, effective and non-reparative health care in Saskatchewan, and indeed in Canada, is both extremely limited and impeded by many social and economic barriers. This applies both to medical care and to psychiatric or other mental health care services. Outside of large urban centers there are very few trained health care professionals who are either capable or willing to provide care to trans people. In fact, a 2011 study from Stanford University reported that Canadian medical schools offer a median of 4 hours of combined pre-clinical and clinical instruction on LGBT-related topics, with medical aspects of transitioning receiving the least amount of instruction. As a result, the majority of health care professionals are inadequately equipped to provide care to trans patients, whether that care involves emotional/psychiatric support, hormone replacement therapy or hormone blockers, physical or social transition, or assessment of gender dysphoria.
The lack of availability of competent health care services is compounded by social and economic barriers. High levels of discrimination against this demographic often inhibit access to employment, housing, education and other factors that impact earnings and, subsequently, access to various services. In Ontario, where the first and only available data in Canada have emerged following a study initiated in 2004, 50% of trans people reported personal annual earnings of $15,000 or less. It is unlikely that the reality of those in Saskatchewan differs greatly from that of trans persons in Ontario. The likelihood that conditions of discrimination are worse for trans persons in Saskatchewan, considering that education and public awareness initiatives in the area of gender diversity and gender equality have been less prevalent in comparison to Ontario, is quite high. As such, the costs associated with, for example, travelling from the Stony Rapids area to Saskatoon, or even from Weyburn to Regina, in order to access competent mental health care are often untenable and simply prohibitive.
To sustain the current practice of tying in any way the criteria for changing one’s sex designation to verification from health care professionals would in fact uphold a severe form of discrimination against trans people in Saskatchewan. It would, in effect, maintain a barrier which many trans people cannot overcome given the current socio-economic circumstances of trans people in Canada, particularly those in rural communities.
Constraining the principle of self-determination of gender identity by requiring supporting documentation from another person/other people may prolong anxiety and discrimination for trans people. For this reason Egale reiterates the recommendation cited in principle 1 that change of sex designation on one’s birth registration be based solely on the right to autonomous declaration of one’s gender identity. Egale does not agree with the assertion that corroboration is necessary particularly in this instance given that the vital event data being amended here was imposed at birth without consent. However, if the Government of Saskatchewan determines that corroboration is indispensable, then it is imperative that corroboration in this context be removed from exclusive jurisdiction of the health care sector and reframed from a more socially just perspective that is inclusive of varying demographics.
There are other viable, though less respectful, models for which precedent exists in expanding attestation of an individual’s gender identity beyond the limitations of the health care sector. One manner of achieving the desired effect of corroboration could be to adopt an approach similar to that used when applying for a Canadian passport: requesting a reference/guarantor who has known the individual for an appropriate period of time. Certain conditions could be established regarding who might serve as a guarantor, such as a minimum age requirement, citizenship status, length of acquaintance with the applicant, or occupation—provided requirements pertaining to occupation/professional group are not restricted to the health care field.
For this reason Egale was contented to see that the proposed amendment by the Government of Saskatchewan would allow further professional groups to be prescribed in the regulations that could provide a letter of support for a change of sex designation application. The examples specified in the consultation paper include nurse practitioners, registered nurses and social workers. To take this step the Government of Saskatchewan would follow the precedent set by Nova Scotia with respect to supporting documentation. In Nova Scotia, one must provide a letter from a “prescribed professional” in support of change of sex designation which opens the scope up beyond the health care sector, but limits it to social workers. Thus while Egale applauds this step of adding social workers to the list of professionals who can provide a letter of support, the proposed amendments continue to limit the scope of corroboration in ways that are discriminatory; particularly to certain demographics such as those with an Indigenous identity. For Two Spirit people, an elder or other religious or cultural leader may be appropriate; for others, a teacher, school counsellor, community member or relative may be both apt and accessible.
In terms of the length of acquaintance, consideration should be directed toward the reality that many trans people are cut-off from their family and friends upon openly identifying as trans—there continues to be a high degree of hate and fear motivated prejudice within Saskatchewan today that means many trans people endure a period of isolation where it may not be possible to secure a guarantor who has known the individual for an extended period of time. As such, Egale would recommend a period of no longer than six months.
Canadian precedent for expanding the scope of corroboration as entirely excised from the purview of health care professionals can be found within the province of Quebec where changes to one’s sex designation on identification requires one affidavit from a person who has known the applicant for at least 1 year. The specifics are broadly defined as “a person of full age who attests to having known you for at least one year and who confirms that you are fully aware of the seriousness of your application”.
Despite some inhibiting aspects, the example of Nova Scotia and the proposed amendments of the Saskatchewan Government demonstrate a clear trend in jurisdictions to implement processes for amending official documentation that honour a trans person’s right to self-identification without relying solely on intervention from the health care sector. However the continued restriction of supportive documentation beyond the health care field as limited only to social workers, constitutes continued discrimination, particularly to those who are Indigenous and/or identify as Two Spirit. If a guarantor of some kind is required, extreme care should be given by the Government to ensure that all trans people in Saskatchewan can meet the requirements without undue or inhibitive hardship. For this reason Egale recommends that the Government of Saskatchewan follow the precedent set by Quebec, in that it more closely follows the principle of self-determination, as well as allows for corroboration to reflect the realities of trans persons and maintains a more socially just approach.
II. Proposed Criteria: Individuals who are 18 years of Age or Older
“Under the interim criteria, individuals who are 18 years of age or older can apply to have the designation of sex on their birth registration changed by providing the following to the Registrar”.
Egale Recommendation on Age Criteria Required to Change a Person’s Sex Designation on a Birth Registration so that it Accords with the Person’s Gender Identity
It is the opinion of Egale that the Government should primarily consider three guiding principles during the course of this consultation with respect to limiting the age requirement to 18, without any course of action for those under the age of majority: 1) the right to self-determination without undue or inhibitive hardship as inherent to trans and gender variant persons of all ages, inclusive of children and youth; 2) the right to privacy, the right to safety, and the right to equal access in opportunity without discrimination; and 3) the relationship between discrimination and suicidal ideation amongst trans children and youth.
As mentioned earlier, the single guiding criterion for changing a person’s sex designation on a birth registration should be self-determination. This principle is not limited to those who have reached the age of majority, but is indeed inherent to all persons regardless of age. As such this process should be no more onerous or inhibitive than it is for any other person.
This is affirmed by the United Nations Convention on the Rights of the Child wherein Article 8 (1) cites that, “States Parties undertake to respect the right of the child to preserve his or her identity,” and Article 8 (2) cites that where there is a deprivation of some or all elements of identity States Parties shall provide assistance and protection. The right to self-define gender identity, inclusive of children and youth also keeps with The Yogyakarta Principles on the application of international human rights law in relation to gender identity. A principle that is honoured within Canadian human rights law, such as its reflection in the Ontario Human Rights Commission Policy on preventing discrimination because of gender identity and expression.
An increasing body of research confirms the capacity of children to determine and articulate their gender identity, confirming what parents/guardians of trans and gender variant children have experientially known and affirmed all along. One’s knowledge of their gender identity is felt internally and in many cases well before children and youth are able to articulate this truth externally through full use of the linguistic environment of their social system. With respect to gender identity development, Psychological Science recently published America’s first large-scale longitudinal study of transgender kids. It concluded that transgender children as young as 5 years old respond to psychological gender-association tests just as consistently as children who are cisgender. In other words, the gender identity of “girl” was just as strong in transgender children assigned male at birth, as cisgender children assigned female at birth, and vice versa.[i]
In sum, children and youth under the age of 18 not only have the right to autonomous self-determination and legal affirmation of their identity, they are capable of determining and expressing their gender identity at any age. It is incumbent on the Government of Saskatchewan to allow for the extension of rights as inherent to all persons, particularly where the event data being amended was imposed at birth without consent, to include those under the age of majority and maintain compliance with international law.
Birth certificates constitute a foundational identity document requested for numerous purposes that range from the simple acquisition of a library card, to accessing health care services in the province. As one’s birth certificate is often the only form of government-issued identification held by a minor, this means that children and youth are routinely ‘outed’ as trans, without their consent, threatening their safety and exposing them to risk of harm. Often in the case of younger children this disclosure of their trans or gender variant identity occurs without their explicit consent, and often without the consent of their parent(s)/guardian(s). A lack of Government recognition of trans identities for children and youth is an urgent health, safety and human rights issue that if not rectified may expose the Government of Saskatchewan to further contestation under the law. Egale recommends that a mechanism be provided for minors to amend the sex designation on birth registrations in Saskatchewan.
Forced outing may result in significant experiences of discrimination for the child as well as result in harassment and even violence. The risk of this occurring is substantial, and proves to be the lived realities of trans children and youth across Saskatchewan, increasing their risk for physical, mental, emotional, sexual and spiritual harm.
Trans youth face an alarming degree of discrimination and harassment in today’s Canadian climate. Egale’s national study of homophobia, biphobia and transphobia in Canadian schools, Every Class in Every School, starkly demonstrates this disturbing reality:
- 78% of trans students feel unsafe at school, with 44% having missed school because of these feelings;
- 74% of trans students have been verbally harassed because of their gender expression;
- 49% of trans students have been sexually harassed in school within the past year; and
- 37% of trans students have been physically harassed or assaulted because of their gender expression; and
- 52% of trans students identified both school washrooms and physical education change rooms as unsafe spaces: the two areas of a school that are most gender-segregated.
One critical solution to this unacceptable reality in Canadian schools is to enable trans youth to safely socially transition and to provide them with access to safe spaces that accord with their gender identity and expression. However, one of the most significant barriers to this is the inaccessibility of accurate identification documents for trans youth. Without accurate legal recognition of a youth’s gender identity, many schools are extremely reticent to recognize the student’s chosen name or to accommodate their access to spaces that match their gender identity.
Unfortunately, access to the safe and discrimination free use of washrooms in one’s school is only one of numerous ways in which children and youth are exposed to threat through inadvertent outing of their trans identity. To understand further how forced, non-consensual outing through an inability to change birth registration for minors translates into the everyday lived realities of trans and gender variant children and youth in Saskatchewan, let us take a moment to outline instances in which this occurs:
- Students’ school records are consistently outing them to principals, vice-principals, educators and administrative staff who have access to the information contained within. Dependent on the level of homophobia and transphobia present within that individual, this may result in a drastic shift in treatment towards that student through prejudicial attitudes, behaviours and actions that are harmful and damaging.
- For example, a new principal will automatically gain access to the transgender identity of a student where there is a discrepancy between the child’s birth assigned sex according to school records informed by the birth registration, and their expression of their gender identity (through chosen name, gender expression, articulation of washroom choice, etc). In the face of information regarding the child’s birth assigned sex the principal may request that the child use the washroom corresponding to their sex, rather than their gender identity. In this way they out the child to the entire school community, and place this child at considerable risk for mental, emotional, physical and even sexual assault and violence. In some cases such a request can cause serious medical conditions such as kidney and bladder infections in children who feel unsafe to use the washroom during school hours.
- Other examples of outing a child regularly throughout the school year without their consent include schools that include gender notions on class lists.
- This effectively outs students to teachers and substitute teachers exposing them to the potentially discriminatory behaviours and attitudes held by those individuals.
- Schools can sometime post these class lists (with gender notations) within the school, thereby outing students to the entire school community, exposing them to physical, mental, emotional and sexual harassment, violence and assault.
- With respect to accessing medical care, one’s trans or gender variant identity will be disclosed to any individual with access to their medical information. For example, when visiting a walk-in clinic to receive treatment for an injured thumb the child may face constant discriminatory behaviours such as misgendering and rudeness by front desk staff, and doctors.
- These interactions restrict their access to health care;
- some of these interactions can cause considerable, lasting trauma and psychological distress among trans and gender variant children and youth.
- In Saskatchewan drivers licenses are issued at the age of 16. During the years before the youth reaches 18 they are at risk for a routine traffic stop that could result in a jail stay where they are relegated to the sex-segregated space opposite from their gender identity, putting them at considerable risk for physical, mental, emotional and sexual assault and violence.
- Passports, as informed by the birth registration, set up children and youth for incredible stress, and the threat of mental and emotional violence at airports, even for domestic flights effectively restricting their mobility rights.
- In many cases this creates a situation where international travel is too great of a risk for the child that it becomes an impossibility.
Without a means to change their primary identification document, children and youth will be placed in situations where they are unable to access opportunities in education, health care, social programming, employment, travel etc. equally and free from discrimination. This has harmful affects on the lives of trans and gender variant children and youth that follow them into adulthood.
The relationship between the kind of victimization noted above and the risk for suicidal ideation and behaviour among trans youth must be noted. The impact of bullying disproportionately affects sexual and gender minority youth; that is, stigma and discrimination—as forms of victimization—are demonstrably correlated to suicidal ideation and behaviour among LGBTQ youth to a degree that is not true of their non-LGBTQ peers.
For these reasons, it is critical to the safety and longevity of trans youth that the requirements for changing the sex designation on their birth registration not be made even more onerous or inhibitive than they are for any other person. In fact, given that a birth certificate may be the only form of government-issued identification that a young person possesses, every effort should be made to ensure that trans children and youth can access an amended birth registration with relative ease. The criteria for youth under 18 should not be different than those applied to adults. This is consistent with international law that the application of human rights entitlements should take account of the specific situations and experiences of people of diverse gender identities, and in relation to all actions concerning children the best interests of the child shall be a primary consideration. In Egale’s view, to not include trans and gender variant children and youth under the age of majority would be considered inconsistent with the best interests of the child.
In the event that the Ministry decides to implement a process of corroboration as part of the new criteria, certain additional considerations should be raised in relation to youth. The degree of discrimination, ignorance and hostility toward trans people in Canada has been demonstrated. It must be noted that, all too often, this discrimination and hostility is manifest within the relationship between parent(s) or guardian(s) and child. One need only consider that 23% of the homeless youth in the city of Toronto are LGBT, a significant portion of whom identify as trans, having been kicked out of their homes because of their trans identity. As such, any criteria for changing legal sex designation that are applied to youth must allow a reasonable and accessible means of doing so without parental consent.
In Manitoba, for instance, an individual under the age of 18 may be considered a “mature minor,” in which case the requirements for changing a sex designation on a birth certification from that province are no different than for an adult. In other provinces, a child’s parent(s)/guardian(s) must consent. If parental consent is deemed necessary, an alternative mechanism must be provided in the event that two parents/guardians disagree, or where neither is supportive of the child. In such cases, the law might provide for a properly trained court official or children’s aid organization to assess the best interests of the child.
Though a paragon for its accommodation of trans adults, the Argentinian law has an added layer of paternalism for those under 18 which may, in principle, provide some direction in this regard. The law requires that procedures for changing the sex designation of a minor be directed through their legal representative(s) (e.g. a parent or guardian). Where a minor cannot obtain consent from their legal representative, the law provides a process for a judge to determine whether the change is in the best interests of the child. While it is encouraging that the law provides for a supplementary avenue in cases where a parent/guardian may be unsupportive, the fact remains that the final decision in such cases is entrusted to a legal professional and not to the individual. The practice of detaching a minor from making a final decision on their own gender identity may induce greater trauma for trans youth, certainly if they encounter an unsympathetic judge. Unfortunately, encountering an unsympathetic or unknowledgeable judge in Saskatchewan is not yet entirely improbable. Further, implementing a process that requires access to the judicial system in this way would be cost-prohibitive to the vast majority of trans youth in Saskatchewan. Nevertheless, where the criteria are different, the provision of an alternative means for those under the age of majority to obtain commensurate identification is essential.
The Province of Saskatchewan has an opportunity to not only meet international standards—such as those set by Argentina—in honouring the human rights of trans people, but also to model leadership in putting equality into practice. The recent adoption of community consultation by the Saskatchewan Government in relation to change of sex designation on birth registration, combined with the addition of “gender identity” to the list of prohibited grounds of discrimination in Saskatchewan’s Human Rights Code, provide both the impetus and duty to do so. By adopting the recommendations outlined in this submission, the Government of Saskatchewan would be taking a step forward in truly creating a just society in which the human rights of all people are placed second to none.
We genuinely appreciate the opportunity to provide input on this vital initiative and would welcome the opportunity to further discuss the recommendations outlined in our submission. Ryan Dyck, Director of Research, Policy and Development, is available to address any questions you may have. They can be reached at firstname.lastname@example.org or 416-964-7887 ext. 7201.
 Government of Saskatchewan. Consultation Paper: Proposed Amendments to the Vital Statistics Act, 2009 Respecting Change of Sex Designation.
 Argentina. Derecho a la identidad de género (In Spanish).
 Ibid., sec. 3.
 Ibid., sec. 4.
 New Zealand Passports. Changing Sex/Gender identity.
 Denmark. Lov om ændring af lov om Det Centrale Personregister (In Danish).
 TGEU. Historic Danish Gender Recognition Law comes into Force.
 Malta. Gender Identity, Gender Expression and Sex Characteristics Act.
 International Business Times. Columbia Allows Transgender Community to Change Sex on IDs Without Physical Exams.
 Ireland. Gender Recognition Act.
 Obedin-Maliver. Lesbian, Gay, Bisexual, and Transgender–Related Content in Undergraduate Medical Education, 973.
 Bauer et al., E-Bulletin #1: Who Are Trans People in Ontario?, 1.
 Nova Scotia: Vital Statistics. Changes of Sex Designation.
 Quebec. Change of Designation.
 United Nations Human Rights Office of the High Commissioner. Convention on the Rights of the Child.
 The Yogyakarta Principles. Principles on the application of international human rights law in relation to sexual orientation and gender identity.
 Ontario Human Rights Commission. OHRC submission regarding MMGS Consultation: Change of sex designation on a birth registration of a minor.
 Association for Psychological Science. Transgender Kids Show Consistent Gender Identity Across Measures.
 Taylor et al., Every Class in Every School: The First National Climate Survey on Homophobia, Biphobia, and Transphobia in Canadian Schools.
 Kim and Leventhal. Bullying and Suicide: A Review.”
 Gaetz, O’Grady, and Buccieri. Surviving Crime and Violence: Street Youth and Victimization in Toronto, 23.
 Derecho a la identidad de género, sec. 5.
Association for Psychological Science. Transgender Kids Show Consistent Gender Identity Across Measures, 2015. http://www.psychologicalscience.org/index.php/news/releases/transgender-kids-show-consistent-gender-identity-across-measures.html
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Gaetz, Stephen, Bill O’Grady, and Kristy Buccieri. Surviving Crime and Violence: Street Youth and Victimization in Toronto. Toronto: JFCY & Homeless Hub, 2010.
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Obedin-Maliver, Juno. “Lesbian, Gay, Bisexual, and Transgender–Related Content in Undergraduate Medical Education.” JAMA: The Journal of the American Medical Association 306, no. 9 (September 7, 2011): 971.
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Quebec: Directeur de l’état civil Change of Sex Designation. 2016. http://www.etatcivil.gouv.qc.ca/en/change-sexe.html
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