Wednesday 18 April 2018

TRANS WOMEN BELONG IN WOMEN'S PLACES - a personal view on Ladies' toilets and other facilities for women. The call to exclude some women because their chromosomes are male is addressing a non existent problem.

I am deeply saddened by the rhetoric of supporters of the “Women’s Place” movement who recently met in Cardiff. Trans women may upset some people because they were born as male infants, but gender, like sexuality is something directed by your brain rather than your physique or chromosomes.

Trans people have always been with us but until the last century were restricted to dressing and acting like the gender they preferred and there are many historical accounts of those who chose to do so, sometimes so successfully that their biological,  natal gender was never revealed or only discovered after their deaths.

Trans people, like gay people, are not mentally ill and the Transgender Pioneer Dr John Randell, a Welsh man, was the first doctor in the UK to provide an NHS service to the trans community. A psychiatrist himself, he realised the "problem"was resolved by helping his patients to live in the gender they knew they really were. 

 In the 60s and 70’s his treatments were restricted and cautious not only because they were new but also as Randell feared the hostility towards providing this treatment on the NHS, which some of his medical colleagues expressed at the time, would be fed by any patient who regretted having body changing surgery or hormone treatment. John died in 1982. At that  time there was no way for trans people officially change their gender but now it could soon be a simple process.

The majority of people now agree with equality for homosexual people and favour gay marriage and are comfortable with gay people having equality. I doubt that there is any serious opposition to trans people changing their gender more easily on their official documentation. 

However, the  “feminist” group called “Women’s Place” seems to want to restrict the activities of trans women by claiming that women need their own special places – these include, according to various speakers : female public toilets, female changing rooms in shops, the girl guides and Labour Party All Women Shortlists.

Trans women feel equally female as the natal (or “cisgender”) females who wish them to restrict their movements into these special places for women. The argument is that these natal males are men, and as such they will use these places not to get changed in privacy or check their make-up as one might expect a reasonable person to, but to upset or even assault women.

Former Plaid Cymru AM Helen Mary Jones discussed her opposition to the new proposals to allow trans people to freely officially change their gender on her Facebook page on 10th March 2018. The rights of women and girls are in her opinion threatened. She said:

At first glance one might say, 'why not? Can't a person be whoever they want to be?' And this was what I at first thought.
But I have reflected. This means that a male bodied person would then have the legal right to access all women's spaces - from changing rooms in shops and swimming pools to rape crisis centers, domestic abuse refuges, and women's prisons. Simply because they say they feel they are a woman and therefore they are one. The perceptions of the women and girls in those spaces may be very different. What happens then to the right to privacy of those women and girls? What happens to their right to feel safe, away from men, if they have been hurt and abused?
These changes have already begun to happen, without a change in the law. For example, people who define as transwomen are already held in women's prisons, without the need for any medical transition to have taken place. Topshop has already changed its changing room policy so that to access the women's changing rooms one simple to state that one is a woman. These changes may enhance the rights of some trans people, but in my view they undermine the rights of women and girls.

Trans women are women. Mentally, they have never been men. They are feminine in outlook and psychology. They do not belong in male toilets and changing rooms and they are sometimes at real risk from trans phobic men, who have, on occasion, violently assaulted and even killed trans women. Can you imagine what might happen if they were forced to serve sentences in male prisons?

 The comments about domestic abuse and rape crisis centres seems particularly callous to me, as these women are at equal risk of family and partner violence and sexual abuse and yet Helen seems to believe trans women who have been assaulted are a terrible danger and should be abandoned. Does she intend to stand on the steps of a rape crisis centre demanding all women seeking refuge undergo chromosome analysis to determine if they “deserve” sanctuary?

They are no more risk to other women than natal women, and for them these female only spaces are also safe and valued; they want to pass as women, they want to live as peacefully as any other woman would. To exclude them from women’s public amenities because they have male sex chromosomes is bizarre. It is surely cruel to force them to use male “spaces” and therefore “out” themselves every time they need to use the facilities.

 It is probably much more dangerous to trans women to be excluded than the imagined horror of a possibly “male bodied person” being allowed to register as a woman. Imagined horrors are the stock and trade of these arguments. The proposition is to force these women to “out” themselves as trans every time they use a bathroom or changing room because of hypothetical stories driven by the idea that the physical traits you are born with will drive one to become a sexual criminal.

The stories of what can happen to some of these women when they are “found out” in public and alone, are not hypothetical, the risks to their mental and physical health are very real. And if they chose not to take that risk, they will be forced to live their lives in the closet, which we now know has devastating effects to mental health. How can you live as yourself in public if you cannot even use a bathroom safely?

If a man truly wanted to assault a woman he doesn’t need to go through months of therapy, hormone treatments, surgery, name and legal gender changing to do so. In fact under Helen’s proposals he could simply claim to be a trans man, a group Helen seems to have forgotten, and who, after a period of hormone therapy generally are, I assure you, completely socially indistinguishable from natal men. She's also not clear about which toilets non-binary transgender individuals should use. 
It seems unlikely that anybody would go through the often harrowing experience of coming out to their families, possibly being disowned by their loved ones, being disrespected in the media and on the streets, living in fear of being found out, applying for legal changes and undergoing long hormone treatments and serious surgery, just for the chance to leer at women in a bathroom.

Punishing trans women as a group for imagined crimes will not protect natal women any more than they are now, but it may throw trans women to the wolves. This proposition of segregation is hurtful even if in practice it is impossible to "police".

I am not comfortable doing this to my fellow women, trans or otherwise. Helen’s argument hinges on the idea that trans women are inherently, from birth, a threat, no matter what the personality and morals of each individual woman may be. That seems to me a very unfair and cruel judgement, and it is on this basis that in her own words she believes their rights should be curtailed. I simply disagree.

 I see other women still suffering indignities and humiliation simply for who they are. As a feminist I believe in offering solidarity to all women who need it. Surely trans women are our sisters, who equally share our marginalised position in society and deserve solidarity from feminists, not hostility? 

 Siân Caiach

Tuesday 10 April 2018

Future Wales - Population Shift - Older and wiser?

We are living longer. In Wales not quite as long as our neighbours in England but now longer. on average, than our parents or grandparents. Statistics show the trend clearly {ref my last blog Future Wales-How Long Shall We live?} Add to this a low birthrate and the result is a growing  proportion of the elderly. By 2030 most people in Wales , it is projected, will be over 50 years old and in many communities outside of our cities, the majority of adults may well be even older.

What are the likely consequences of this population shift?

The Health Service is most energised by the demographic predictions from the current data. The number of people aged over 75 years is expected to double in the next 10 years.  At a recent conference leading GP Dr Clare Gerada  asserted that over 65's will, in the near future, be the largest population group in the UK.

Currently more and more of the medical care of the elderly is being provided by general practitioners. As this age group visits a GP for a consultation 12-14 times on average the GPs are concerned whether they can cope. There is little sign of a sufficient  increase of GPs and old age specialist doctors in the pipeline to cover this expanding need but there has been a shift to offer more services in the community.  Many common,chronic conditions are already monitored by nurses and other allied medical staff, rather than doctors. Despite long waits, occasional failures and regional inequality, the NHS is, though imperfect. still the best overall health service in the World. 

The increase in lifespan is, for most people, likely to be an experience of better health in middle and later life, so the actual amount of and length of disability and ill health in individual lives may  not increase in direct proportion to  our longer lifespans. 

It is the increase in the numbers of  elderly people in our populations which has to be planned for. Increasing pension age and so keeping the fit elderly working, makes them economically active for longer. but also occupying jobs which would have been vacated in favour of younger workers in the past

As in many things, Wales has less primary health care provision per head of population. According to  BMA figures the number of GP's per head in Wales is low.

GP numbers in the UK :

England 7,613

Scotland 958
Northern Ireland 349
Wales    454

How will the elderly vote and what for?

World Economic Forum Report 2015

An old saying goes, “If you’re not a liberal when you’re young, then you don’t have a heart – but if you haven’t become a conservative when you’re old, then you don’t have a brain.”

In the UK home ownership is said to shift your views to the right and certainly older voters are thought to be less radical. 

 By 2030 the majority of voters in most European Countries will be over 50.

This is part of the conclusion of the World Economic Forum report in 2015. After noting that the elderly are currently politically more likely to support pensions, healthcare and even crime fighting over provision of jobs and housing there is uncertainty as to which way this growing group will act politically.. 

"However, our results also suggest that we should be cautious when projecting age patterns, since they are far from deterministic. In other words, some young liberals may become old conservatives, but it also depends on the economic circumstances and events through which they live".


There is little doubt that there is a significant  growing  expansion of the elderly populations of the developed world. Whatever their  personal politics, in democracies the issues which effect and influence our older citizens are likely to become more and more important as their numbers grow.

Democracy will ensure that the elderly have a bigger voice in the future here in Wales. Already older people vote more often than younger ones, but their growing numbers should significantly affect the political outlook. A 60 year old in wales today can expect, on average, to live a further 25 years. Life expectancy is still increasing, although the rate is slowing, so it could be even more.

In later life will people still follow the tribal politics of their youth or will they mobilise to form powerful groups to represent their own interests? 
Probably a bit of both, but to win power, no party can ignore them. In fact, as the majority of voters will be elderly, every political organisation will be tailoring their message to the mature voter. 

The elderly used to be a relatively easy for governments to ignore. A nod to social conservatism or community policing was all that was needed.

 Closing care homes, reducing social care support , giving the elderly free bus passes while reducing bus services, reorganising health services for the convenience of Health Boards, not patients, planning new home builds for the maximum profit of the developers. not the needs of residents, the elderly have seen these things played out all over Wales. They may decide to use their electoral power to knock some sense into the shallow politicians whose lies have usually gone unchallenged. Many criticise politicians as untrustworthy, self interested and having poor memory of their electoral promises. Now those with the most experience of successful and failed political delivery have the most power to chose their elected representatives. 

Importantly, the older citizen is not only more likely to vote but also more likely to be geographically settled and have more concern for their homes, community and environment. Many financially and practically support younger family members. They will have developed an overview of their local areas and economies based on their personal observations and experiences. 

I doubt the older voters will continue to tolerate the politics of spin, the endless manifesto promises which were never going to be delivered and the same old "jam tomorrow" story of a better, fairer society which has failed to materialise over their long lives. It would be good to see more honesty and candour in politics, with an electorate who, in large part, really have heard it all before! 

Siân Caiach 

Monday 2 April 2018

Future Wales: Reading the Tombstones - How long shall we live?

As in Education, Wales was devolved a health system which was not quite up to the average standard of facilities throughout the UK. To this add a "sicker" population. We also took over a depressed economy and many areas with inadequate housing and infrastructure. Poorer people tend to have less healthy lifestyles, less adequate housing, and less money to pay for the "extras" available to enhance health, from private services to helpful aids and home modifications. 

Since devolution we do live longer, but there is still a significant gap between Wales and England. However, the overall figures show even within Wales there is great variation. Life expectancy is something easy to quantify as births and deaths are registered.  Why life expectancy is improving is less clear.  Wales is following the trend, but not catching up. Wales may not feel like a rich country but compared with all the world's nations it is one, as it has generally good nutrition and healthcare. However, we should look to improving the standards at least up to the UK average.

Most deaths occur in the elderly and the big killers in 2016 were cancer, 28.5% circulatory illness [heart attack, stroke etc] 25.5% and Alzheimer/other dementia 15.6%. Over 75's are showing a small decrease in mortality.

Prince Phillip Hospital, Llanelli. 


Last year's [2017] data from IDS Scotland indicates a 1 year lag in the average life expectancy of Welsh men – who live to an average 78.4 years from birth- compared to their English equivalents, with Welsh women trailing behind by 0.8 years in living to an average age of 82.3.

In the field of  gross life expectancy the gap between England and Wales is obvious, with the sexes showing similar widening between English and Welsh men and women. The life expectancy increases in both populations but more in England than Wales.

Figure 1: Life expectancy for babies at birth by sex and country - ONS

England and Wales, 1991-1993 to 2012-2014
Male - England
Female - England
Male - Wales
Female - Wales
 Male - England: 74.18
 Female - England: 79.44
 Male - Wales: 73.42
 Female - Wales: 78.99
Source: Office for National Statistics
  1. Figures are based on deaths registered and mid-year population estimates, aggregated over 3 consecutive years.
  2. Figures for each country exclude deaths of non-residents.
  3. Newborn life expectancy has steadily increased in England and Wales since 1991-93. Life expectancy is higher in England then in Wales, while the gap between both countries has widened over the last 2 decades.
  4. The gap between male and female life expectancy at birth has also narrowed in both countries

Looking at the UK as a whole there is notable variation where, as a rule, poorer areas have poorer health.

Figure 3: Life expectancy (LE) at birth for males and females, by local area, UK, 2013 to 2015

  1. Local areas include lower tier local authorities (LTLAs) in England, unitary authorities in Wales, council areas in Scotland and local government districts in Northern Ireland.
  2. Isles of Scilly and City of London have been excluded from the map because of insufficient population counts

Poor health does not necessarily mean hospitals or community health resources are lacking. Nutrition, housing, geographical access, education and lifestyle issues are all factors and these figures above are indications only of how long people currently live. In all the UK countries there are sharp differences between the best and worst areas.


Life expectancy at age 65 differs by up to 5.6 years within U.K. countries

The opposite can be seen for females where the majority of highest and lowest life expectancies are different for each country. The only figure that was the same at birth and at age 65 was the lowest life expectancy in Northern Ireland, which was in Belfast.

In Wales we can be proud that people are living longer and larger portions of our lives are spent in reasonable health. This is common amongst developed countries throughout the world and thought to be due to a combination of healthier living and improved routine successful  treatment of many medical conditions and prevention of others through vaccination and education.

 In Wales the question is always "why the gap?".  We know the gap was there before devolution, and this gap remains despite general  progress in health and longevity.

How long we live is not only a function of formal healthcare but a range of nutritional, social and environmental factors which affect our health. The current movements to reorganise formal hospital based healthcare in Wales seem to be more related to the needs and difficulties of the health care providers than easy access to provision of  healthcare and adequate social care, which is arguably the more pressing concern of the population. 

Although most of us now can look forward to living longer, why are we not be living as long as our neighbours? 

  Siân Caiach