History of GCS in Ontario

Coverage for gender confirmation surgery (GCS) has a long a complicated history in the province of Ontario. These procedures, previously and incorrectly referred to as sex reassignment surgery (SRS), became delisted under the provincial healthcare plan in 1998 in the early days of the new Conservative government. It was only through the fervent work of transgender activists throughout the province that coverage was eventually reinstated in 2008. 

Martine tells the story of coverage for GCS in Ontario before the 1998 delisting. During this period, individuals had to complete a rigorous program at the Gender Identity Clinic of the Clarke Institute of Psychiatry (later CAMH), as well as other requirements from government agencies such as OHIP. In particular, Martine shares how one of the hurdles imposed by the health care system in Ontario at the time was requiring individuals to publicly live in their genders for a period of two years before accessing GCS. This included changing their names and designations where possible, a process that she recalls as extremely challenging given that there was an 18-month backlog just to change the name on a birth certificate. In addition, the Gender Identity Clinic would subject patients to a number of physical and psychological tests that individuals often found uncomfortable, offensive, and inappropriate. After completing the extensive program at the Clinic, individuals would then be referred for GCS, which at the time did not cover breast operations in transgender women. 

However, the newly-elected Conservative government under Mike Harris suddenly delisted coverage for these procedures in 1998. Martine recalls going through newspapers at the Toronto Reference Library and finding out that the governmental push to delist coverage for GCS started in 1992. At the time, the New Democratic Party in charge considered delisting coverage for the procedures as part of its austerity package at the time, deciding to retain it at the last minute as it was considered an essential service. This decision was criticized by the Conservative party, who argued that such funding should not persist while other cuts are being made. This reaction started a chain of events where coverage for GCS was used as a minor but present partisan issue throughout the 1990s, as Martine discovered that in 1995 the Conservative party once more denounced to the NDP government that coverage should be removed. Indeed, Martine recalls Jim Wilson, the Minister of Health of the newly-elected Conservative government, publicly expressing that "sex changes have gotta go" as one of his first statements while announcing a set of OHIP rollbacks in 1996. Interestingly, Wilson retained coverage for GCS as he ultimately deemed it a necessary service, angering the Conservative party and resulting in his eventual replacement with Elizabeth Witmer. Witmer eventually followed through with the Conservative goal to delist coverage for GCS, which became official on October 1st, 1998. As of this date, no patients who hadn't already been approved by the Gender Identity Clinic for GCS could receive provincial funding for the procedure.

This decision caused immediate uproar in the transgender community. A number of influential transgender activists, such as Susan Gapka, Martine Stonehouse, and Ki Namaste pressured government officials, community members, and academic researchers in order to raise awareness of the precarious state of transgender health and wellbeing in the province. Narrators describe the Harris years as challenging and demoralizing for the queer and transgender liberation movement. Nick Mule, for example, recalls how this administration completely ignored the results of Project Affirmation which looked at the state of LGBTQ2+ health in the provice. While some of these challenges endured during the subsequent Liberal government in 2003, many narrators agreed that they were able to push forward with their demands during this period. George Smitherman served as Minister of Health for this administration, and as an out gay man, many LGBTQ2+ rights activists took advantage of this connection to pressure the government for better access to health care. During this time, Martine together with other three transgender people had a case against the province at the Ontario Human Rights Commission, which started as a result of the delisting of GCS in 1998. Although the pressure surmounted for the Liberals to relist coverage it would still be a few years until they did so. 

During this decade, activists worked nonstop in their push for queer and transgender liberation. Rainbow Health Network emerged as a group of volunteers who met at Sherbourne Health Centre to discuss the state of LGBTQ2+ health and wellness in the province. RHN, together with SHC, were successful in drafting the proposal for what would eventually become Rainbow Health Ontario, a province-wide LGBTQ2+ health framework. As well, the Trans Lobby Group formed as an offshoot of the RHN, as it wanted to centre transgender lives and narratives away from the largely theoretical focus on gay and lesbian rights employed by the latter. This group, partly composed by Susan Gapka, Rupert Raj, and Martine Stonehouse, had a long history of lobbying and engaging politicians on the matter of transgender rights and health care, often crashing political events to push forth their liberationist agenda. 

On June 3rd, 2008, after nearly an entire decade on relentless activism from the transgender community, the Liberal government quietly reinstated coverage for GCS under OHIP, to the surprise of many in the community. Worryingly, the guidelines employed by CAMH and used until 1998 would be used after the relisting, which alerted many activists. Susan Gapka, in particular, was instrumental in communicating to the government how harmful and damaging these policies were, as they asked individuals to live in their genders for two years before being considered for GCS. These policies required transgender patientd to be approved by a number of specialists and boards before receiving recommendation for their surgery, placing an unjust restriction on their right to access publicly-covered medical procedures. These guidelines were eventually ammended through the work of transgender activists as well as Rainbow Health Ontario, which emphasized the role of local, primary health centres in providing transgender healthcare away from relying on the centralized power of CAMH. This model proved successful in allowing transgender patients to access most of their mental and physical health needs through their primary providers, although some narrators lament how many surgical procedures can only be provided by a handful of centres, particularly the GCS clinic in Montreal. 

Despite the hurdles and challenges associated with the delisting and relisting of GCS, most narrators agree that this fight helped solidify the transgender liberation movement in Ontario, breaching some of the divides and ruptures existing within the community. As well, many argued that this fight eventually led to the passage of Toby's Law, otherwise known as Bill 33, which added gender identity and gender expression to the Ontario Human Rights Code. This decision was the result of a triparty agreement and at the time was the most comprehensive of such laws in North America, extending to area such as housing and education. However, some narrators like Cheri DiNovo argue that it is not enough to add protections for transgender people under human rights law, but rather, this has to extend to every extent of social law and public programs as well.

The fight for transgender rights in Ontario has existed for as long as transgender people have resisted and organized against their marginalization, disenfranchisement, and exclusion from the legal system and mainstream society. The activism around the delisting and relisting of GCS represents only a fraction of the hard work that many transgender people have contributed to demand rights, freedom, and justice. Nonetheless, it symbolizes the undying spirit of many who fight this cause, and the large amount of work that remains to be done in order to ensure that Ontario is a welcoming space for all transgender people. Moving forward, the trans rights movement in the province needs to centre those who are the most excluded from our present social, political, and economic systems. By engage with decolonial, anti-racist practices that centre the voices of First Nations and Black individuals in the fight for trans liberation, this movement can adequately fight the systems of oppression that continue to marginalize transgender people across the world.