by Emma Jane

13 Sep 2015

Learning to Act Like an Ally

A watershed is an area of land in which all water travels in the same direction, towards a common exit. Where I grew up, it was common to hear about the quality and quantity of water available in the headwaters, and how that might affect the health of the downstream communities. Although watersheds tend to cover very large areas of land, it is possible to get to the edge of a watershed. You won't necessarily be able to perceive the edge. You might be walking along through a forest and crossover from one watershed to another without even noticing. But there comes a point when the geology changes enough that water which falls to the other side of that point will sink into a different watershed and flow in a completely different direction. To exaggerate the idea, picture the ridge of a mountain. Rain falling to the left side of the peak will continue to slide down the mountain to the left; and water falling to the right will continue in its direction.

A "watershed moment" is a point in a person's life when they cross that line where the water stops travelling in one direction, and starts to travel in another.

In real life, there's nothing that prevents you from turning around on the trail and heading back into the watershed you've just left. But here's the thing: you don't always realise you're in a new watershed, so it's not always a trivial matter to simply turn around.

Recently I realised I'd entered a new watershed around the topic of gender identity. I've always done my best to be inclusive of everyone whose sex assigned at birth did not match their identified gender. I know I don't always get my words right, and I'm sure that I've unintentionally used the wrong words, or been unkind without even realising it. But the last year just seems, well, different. From the articles on sex vs. gender, to the media coverage of Chelsea Manning, and then Caitlyn Jenner, and Laverne Cox previously being named Woman of the Year, it seems like the world I live in has started to grow up in its respect and language when addressing transgender individuals. It's not like these events have been my first exposure to transgender individuals. But somehow, the response from the world just seems different.

Without being able to exactly track the geology of my history, I don't know for sure when the moment was when I entered a new watershed. I think it may have been Sara's article on identity, and forms, and triggers. Or maybe it was when I was applying for a job that had a diversity section which offered more than two options for gender. Or maybe it was when my friend asked me to sign a petition to allow people to self-define their gender. Or maybe it was something else. I'm not entirely sure. All I know is that I'm in a different watershed now and I can't stop seeing broken forms, and hearing language which conflates genotype and gender.

Most recently, I was asked to fill out a patient survey for NHS England to help the Ministry of Health correlate quality of care to different types of patients. The form asked my biological sex ("male" or "female") and it asked my sexual preference ("straight", "gay", "lesbian", "bi", there may have been other options, I can't remember now). In other words: from the acronym LGBT the "T" was missing completely from the form.

So I did what any cisgendered privileged British woman ought to do: I wrote a letter of complaint.

(Well. First I defaced the form and asked why there were only two options for "sex". Then took a picture and put it on Twitter. And then then I wrote my letter of complaint.)

This summer I filled out the GP Patient Survey. Unfortunately the survey did not have sufficient granularity with respect to sex or gender identity.

Under the heading of "sex" two options were provided "male" or "female". I did not attempt to fill out the online form, but I assume this was a binary option online and that only one box could be selected. I can only assume you mean "genotype" by this question? Additionally, there was not the ability to select an option other than "male" or "female" as should be provided according to the GDS manual for forms requiring sex (

On the final page of the form, I was asked to specify my sexual orientation, but not my gender. This means I could not:

  1. Identify my gender separately from my genotype.
  2. Mark my sex assigned at birth as being different from my gender.

As a result of these omissions in the questionnaire, it will be impossible for the NHS to correspond the good health care service I have received as being statistically significant compared to individuals who are (1) intersex, (2) transgender, (3) non-binary. I would like to know how you are surveying the level of care provided for these individuals.

Kindest regards,


Then I emailed my letter to the NHS, the survey company, the Ministry of Health, the Conservative Party, the Green Party, the Labour Party (LGBT wing), and the Lib Dems. And then I waited.

To date I have received a response from the Conservative Party from their policy book (we had a lovely back-and-forth while I clarified that I was, indeed, looking for the Party's policy):

You may be aware that the NHS constitution commits the NHS to providing a comprehensive service available to all, irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity, or marital or civil partnership status. The NHS also has a wider social duty to promote equality through the services it provides.

In addition, NHS England has created a gender identity clinical reference group which has developed a new service specification and clinical commissioning policy. It has also established a transgender network designed to hear the views of people and to influence the strategic direction of services.

The Government is committed to combatting discrimination and is determined to break down barriers that individuals may face when seeking to access health services. That is why the Department of Health has invested in a number of organisations, such as Stonewall, to improve awareness and deliver more personalised care to all.

And a response from the survey company conducting the NHS England GP Patient Survey:

Thank you for your email and for your feedback about the sex and sexual orientation questions in our survey. This is an issue which has been on our radar for some time now and is something we will look into as we develop our survey further. Methodological constraints and sampling methods mean that this has been a complex issue to resolve.

I appreciate that the questionnaire in its current format does not allow those for whom their gender identity is different from their sex assigned at birth, and I'm sorry that this has been the case for you and for others this affects. As you say, it is important for the NHS to gather data on how its services are providing for intersex, transgender and non-binary individuals and this is something that in the future we hope to provide.

I found neither of these answers entirely satisfactory, but at least I got a reply.

If you feel like it's time you came into your own new watershed, there are some great web resources I can recommend:

Years, and years ago I remember watching the tension in my local community as one of our neighbours made a public transition to a new identity. The support my friend Denise was able to provide was inspirational. She matter-of-factly asked what name and pronouns she should use, and began using them. There was no discussion or questioning or hesitation. She did it without judgement and then carried on just as she had before. This ability to switch her words from yesterday to today without skipping a beat or changing her behaviour still blows my mind. Denise remains one of my role models to this day for her very simple, gracious actions towards our neighbour.

May we all be able to achieve the grace Denise once demonstrated in helping every neighbour realise the identity they were born to be.

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