Martha de la Paz
“What is the essence of being a woman?”
This is a question often posed to celebrate women’s unconditional value and contributions to society. Sushmita Sen, Miss Universe 1994, answered that “being a woman is a gift from God, the ability to give birth to a child and to teach men how to share, care, and love.” Notwithstanding the importance of procreation among cisgender heterosexual partners and childbirth in the survival of humanity, trans women, as well as other gender- and sexually diverse women, may simply feel left out. I believe it is important to come up with an inclusive definition of womanhood, one that genuinely accepts the different forms of women and that goes beyond ostracizing social norms.
The essence of being a woman, for me, is the ability to persistently survive and fight amidst adversity, done in a manner that uplifts and empowers others.
It is important to celebrate the lives of trans women and expand the definition of womanhood to include their stories. The vehicle towards authentic gender equality should bring on board trans women of all races, ethnicities, and religions who have been fighting for recognition and equal rights. Since I came out, I have been fighting for my womanhood: from mundane things like going to the women’s restroom and buying women’s clothing to challenging the scope of health policies to address the inequities faced by trans Filipinas. Claiming and proclaiming my womanhood, however, does not only liberate me, but also constantly makes me vulnerable to discrimination and invalidation due to patriarchal ideologies of misogyny, sexism, heteronormativity, and cisnormativity—the same social justice issues that plagued women throughout history. That is why it is crucial for cis women to keep lifting trans women up and break the cycle of violence.
Intersectionality of the plight of cis and trans women
Through my project, “Institutionalization of LGBTQI+ Health in Universal Health Care,” I’m working to identify gaps within the Philippines health system that contribute to the inaccessibility of essential health services experienced by the LGBTQI+ community. Through key informant interviews, I was enlightened about the obstacles faced by trans women that go beyond social determinants of health. Because of misogyny, sexism, and transphobia brought about by colonialism, trans women throughout history have been killed, shamed, and forced into hiding. Additionally, we are taught that deviations from cisnormativity are unnatural. These injustices manifest in our communities as everyday experiences of rejection by families and peers, bullying, and physical and emotional violence. Even worse is how these injustices manifest in state-sponsored violence and negligence. They continue to hurt trans women’s chances of getting a quality education and employment, supportive social networks, and other necessary social determinants to achieve good health and well-being.
Through this project, I met beautiful and inspiring trans women from different walks of life sharing the same aspiration: acceptance and freedom to live as their authentic selves. I learned about their health needs and the responsiveness of the current health system by listening to their coming out stories and everyday lived experiences. Some quickly found acceptance from their families, while others had to find solace and acceptance from trans sisters after being shunned by their families. Some could medically transition because they were provided financial support by their families or finished college and found good-paying jobs.
Unfortunately, other trans women I interviewed did not have the same privilege. For example, one of my interviewees, John Rey, once identified as a trans woman. He shared that he used to self-medicate and rely only on the advice of trans sisters. But because his family shunned him at an early age, he could not support his education, obtain a good-paying job, and seek professional help. Cognizant of the risks of unguided hormone therapy by health professionals, he decided to stop his transition and live as a man. He shared, “I had to stop transitioning because it was the practical thing to do. I know that when I consult a health professional, I would not be able to afford the professional fees and treatments.” He expressed that he has found contentment living as a man and nowadays takes comfort in seeing other trans women on social media being able to freely transition. John Rey’s story depicts the inadequacies of health system reforms and highlights the need for intersectoral solutions to promote trans health and mitigate the stigma and discrimination we face daily.
The stories of trans women I interviewed share many similarities with cis women’s historical and present-day struggles. They are denied rights to education and voting. Their value is relegated to child rearing and other domestic roles. But, because of women’s rights activists who dedicated their lives for social change, significant strides have been made towards gender equality. Women now occupy leadership roles in states and organizations, a reality that was previously unimaginable. Feminist theory and queer theory share the same aspiration: equality. As we move forward, I can only hope that no woman—cis or trans—is left behind. I salute all the cis women who extend their support to trans women and participate in trans advocacy. Your kindness enables us, trans women, to continue fighting and moving the world towards acceptance.
Women supporting other women
In my previous blog, I highlighted the importance of support. I owe my strength to women that showed me how we continue to break barriers and create impactful changes despite everything.
Perhaps the most influential woman in my life is my mom. When my brother and I were growing up, she worked full-time while my dad stayed at home to take care of us and manage our small food transport business. But my mom wanted to spend more time with us, so she left her career and invested in our business; however, the business struggled, and my mom had to rework their finances so they could manage a small sari-sari store (community store). Despite the financial challenges that our family faced, she persisted and provided for our needs so we could pursue our respective dreams. Being raised by a strong woman molded me into one.
Apart from my mom, strong and intelligent women I’ve met at work have been instrumental to my advocacy. To name a few, Dr. Beverly Ho, Ms. Lorra Sayson, Atty. Faith Laperal, and Dr. Marife Yap accepted and celebrated my womanhood since my humble beginnings in the Department of Health and now actively support me in my endeavors in LGBTQI+ health. Because they recognized my potential as an emerging leader in global health, I was trusted to lead critical reforms on Universal Health Care and COVID-19 response. These experiences built my technical and soft capacities to ensure that health services are accessible and affordable to every Filipino, especially during the pandemic. Now, I am applying these lessons to increase awareness on LGBTQI+ health disparities and come up with strategies with the different offices in the Department of Health. Every day, I draw inspiration from my female mentors to keep moving forward and serve my fellow trans Filipinas.
Trans women in global health
Through this project, I have met trans women in global health, spearheading initiatives toward the improvement of trans health. Aside from social realities faced by trans women, our interviews revealed the hidden costs of trans health. Because of the system’s current lack of available and affordable trans health services, trans women often resort to self-medication, leading to complications (e.g., thrombosis) and more costs. In addition, with the prevailing lack of awareness of health workers, trans women put off seeking health services because of previous experiences of discrimination or fear of potential discrimination. Consequently, their health needs, including sexual and mental health, remain unaddressed and will cost more if conditions worsen. These realities have compelled trans women like me to start making changes. From community organizing and fundraising to providing access to gender-affirming hormone therapy and implementing nationwide HIV and STD prevention and control campaigns, these women have contributed to promoting trans health nationally.
LGBTQI+ health in the Philippines is not being conceptualized and built as a blank canvas. Rather, we are building and strengthening current initiatives led by members of the LGBTQI+ community, as well as institutionalizing their best practices to induce nationwide implementation. The Department of Health can learn a lot from civil society organizations on the implementation of inclusive health services and specialized LGBTQI+ health services. Thus, as I create the policy framework and recommendations for promoting LGBTQI+ health in the Philippines, it is essential to establish mechanisms that connect with fellow advocates who share the same passion and forge partnerships.
As the saying goes, Rome was not built in a day. Transphobia is difficult to eradicate. As you read this sentence, countless trans women continue to suffer and their health problems are left unaddressed. I cannot do this alone. I can contribute to addressing the problems of my community by building a next generation of trans leaders in global health. I aim for a day that I am able to provide opportunities to trans sisters and allies in the Philippines and all over the world and build their capacities to create a better future for the community.