Category: LGBTQ+

Student Submission: The Education and Health Impact of Restricting Diversity, Education, and Inclusion Programming in Alabama

April 12, 2024
Raimi Liebel | UAB Graduate Student, Magic City Acceptance Center Intern

LHC is proud to feature student work on relevant policy issues such as this one. If you are a UAB student interested in contributing to Policy Watch publications, please email lhc@uab.edu.

The concept of DEI (diversity, equity, and inclusion) has become a political hot-button in recent years. DEI in higher education refers to programs, training, events, organizations, and spaces that are centered around historically marginalized identities. Higher education institutions have been incorporating DEI measures since the 1960s following the civil rights movement. DEI is not a new concept and has been integrated into universities and colleges across the country. Historic legislation such as Title IX, the Americans with Disabilities Act (ADA), and Deferred Action for Childhood Arrivals (DACA) have contributed to the increase in DEI offices, services, and organizations at higher education institutions across the US over the past 60 years.

Since 2022, more than 40 anti-DEI bills have been proposed in the US. Texas, Florida, North Dakota, South Dakota, Texas, Utah, and now Alabama have all signed bills into law limiting or banning DEI offices at higher education institutions. Representative Will Barefoot introduced SB 129 to the Alabama Senate on February 20th, which restricts state-funds from being used for DEI offices and sponsored DEI programming, potentially including student organizations such as USGA and SJAC. The University of Alabama at Birmingham alone has 12 DEI offices and more than 150 student organizations that could face state funding loss. SB 129 moved from its first reading to being passed in the Senate within three legislative days before was signed into law by Governor Kay Ivey on March 19th.

According to a 2023 mixed methods analysis, “Students of color thrive and achieve more at higher educational institutions where there are deliberate efforts made to provide diversity, equity, and inclusion activities.” The link between student success, belonging, and graduation rates and DEI programming has been demonstrated in several studies. Academic communities fear that legislation of this kind may prevent students from enrolling in higher education institutions where DEI restrictions are present. Reduced staff and student enrollment or retention can result in economic effects on institutions across the state, especially those that use diversity as an incentive to drive recruitment. DEI efforts at higher education institutions help facilitate students’ learning from a variety of thoughts and perspectives, which has proven to increase cognitive development and cross-cultural empathy.

DEI has been attributed to improved student enrollment, retention, and graduation rates. A 2023 mixed methods study identified significant positive correlations between perceived campus climate, diversity in staff/faculty, curricular diversity, and interactional diversity and college student re-enrollment. Also, explicit DEI policies in workplaces led to more diversity in employment, accounting for 46% of the variance reported in the study. Higher education institutions and workplaces benefit from recruiting and retaining diverse staff.

Attainment of a college degree is positively correlated with improved health outcomes and behaviors. Those who attain a bachelor’s degree or higher earn $1.2 million more than their high school-educated peers over their lifetime, and college degree holders are almost twice as likely to have employer-sponsored health insurance (ESI). ESI covers approximately 60.4% of the US population and is often the most affordable and comprehensive option for workers.

Degree attainment and long-term health are correlated, and historical trends showcase certain populations have lower enrollment and retention rates. The U.S. Department of Education notes that the “participation of underrepresented students of color remains a problem at multiple points across the higher education pipeline including at application, admission, enrollment, persistence, and completion.” DEI bans compounded with lower college enrollment could lead to increased health disparities for marginalized communities. Decreasing diversity in classrooms, workplaces, and communities decreases collaboration, cultural exposure, and productivity.

Other facts of note:

Click here to view this brief in PDF format.

Policy Works: State Department Announces Non-Binary Option on U.S. Passport

March 31, 2022 | Kimberly Randall, Lister Hill Center for Health Policy

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Image courtesy of Getty Images

Background: 

Since their inception, United States government documents have only allowed two options for gender selection: male or female. The modern understanding of gender identity has shifted to view gender as a spectrum, rather than a dichotomy. Research has differentiated between biological sex and gender identity, which has opened up conversations regarding gender-inclusive language on a variety of platforms in recent years. 

The idea of including a third gender option on government identification has already been taken up by several state agencies. According to the National Center for Transgender Equality, 22 US states currently allow for a third gender option on a driver’s license or state-issued photo identification, while 16 states allow for the option on a birth certificate. In almost all cases, the third-gender option is marked with an X. 

In 2020, legislation was filed in the US House of Representatives calling for a third-gender option on passports, and the following year, the first passport with an X gender marker was printed. However, its recipient, Dana Zzyym, underwent extensive legal and medical scrutiny to demonstrate that they were neither male or female but intersex, and represented themselves as non-binary. The process for obtaining a third-gender passport in the US was seen as expensive and lengthy, requiring extensive documentation, prior to recent changes.

Denmark became the first nation to allow for a third-gender option on official documentation in 2014, with Malta following suit in 2016. To date, fifteen countries officially allow for third-gender options on government documents. 

Policy: 

Announced via Twitter on Transgender Day of Visibility, US Secretary of State Anthony Blinken stated “we recognize the achievements and resilience of transgender, nonbinary, and gender non-conforming persons worldwide. … U.S. Citizens will be able to select X as their gender marker on their U.S. passport book starting April 11.” 

The official State Department website was updated to reflect the announcement, detailing the process for how citizens can apply for or update their passport under the new guidelines: 

“You can select the gender marker you would like printed on your U.S. passport. The gender you select does not need to match the gender on your supporting documentation such as a birth certificate, previous passport, or state ID. We no longer require medical documentation to change the gender marker on your U.S. passport.

Beginning April 11, 2022, you can select male (M), female (F), or unspecified or another gender identity (X) as your gender marker if you are applying for a U.S. passport book and selecting routine service. Beginning in late 2023, you will be able to select X as a marker if you are seeking a passport card or selecting expedited service.” 

The policy with initially apply to traditional passport applications utilizing Form DS-11, however the State Department has stated that additional documents including passport cards, emergency passports printed at embassies and consulates, expedited and emergency passports issued at passport agencies, and Consular Reports of Birth Abroad will have the option by late 2023. 

Impact: 

Recent population studies have shown that up to 4.6% of individuals currently identify as nonbinary or gender nonconforming, while as many as two million US citizens identify as transgender. A study in the Journal of Adolescent Health found a positive correlation to overall mental wellbeing with higher rates of gender affirmation through medical care, educational experiences, and social interactions. Gender-affirming government documents are anticipated to have similar positive impacts on mental health. 

The addition of a third-gender option enables individuals to feel gender congruence, or “the feeling of harmony with one’s gender.” Being noted as a gender nonconforming person could help aid in how individuals are seen and recognized in an official capacity. Increased gender congruency has been shown to increase positive outlook regarding one’s identity and overall life satisfaction. In addition, gender-affirming recognition and language are linked to lower rates of anxiety, depression, and suicide in non-binary persons. According to the ILGA, “​​the X marker could provide relief to non-binary person, persons not identifying with any gender at all and persons currently transitioning.”

While activists have advocated for a third-gender option on official documentation as early as 2000, there are some fears that it could increase discrimination for visa applications and border crossings. Australia, an X-gender issuing nation, has warned that travelers utilizing the third-gender option could face difficulties when entering certain countries. Additionally, logistical issues such as checking in for an airline flight where there is no third gender option may impact travelers as well. It is expected that following the updated passport policy, federal regulations regarding this will change in the coming months. 

Next Steps: 

The policy for U.S. passports will go into effect on April 11th and the move has received support from President Biden. However, legislation has been passed in the Alabama Senate and is now in debate in the House of Representatives that would restrict access to gender-affirming medical care for citizens under the age of 18. SB184 would prohibit medical procedures or prescriptions intended to alter the physical appearance or hormonal balance of individuals undergoing transition. If you want to make your voice heard on this or future legislation, click here to identify your elected officials. 

Don’t know what to say? Check out this guide from the American Civil Liberties Union on drafting a letter to your government officials. 

Learn More: 

Want to learn more about LGBTQ+ policy initiatives? Check out these resources. 

International Lesbian, Gay, Bisexual, Trans, and Intersex Association 

Magic City Acceptance Center

Movement Advancement Project 

The Knights and Orchids Society Inc

The Trevor Project

Student Submission: Reflections on SB 10

As a part of a weeklong course for Health Equity Scholars in April 2021, students in the UAB School of Medicine researched current health issues around the world. The Lister Hill Center for Health Policy will be share these evaluations from different students over the next few weeks to shed light on various situations. This post was written by Jasper Kennedy before the end of Alabama’s 2021 Legislative Session. SB 10 passed the state senate this year but its counterpart in the state house of representatives (HB1) never came up for a vote. A similar bill may or may not be proposed next year.

 

I have lived in Alabama all my life. I was born, raised, and educated here, including my ongoing training as a medical student at the University of Alabama at Birmingham. I am also a transgender person surviving in this state, and I’m worried about what SB10, which would criminalize providing healthcare to trans youth, would mean for my trans community as well as my colleagues.

Transgender youth are an incredibly vulnerable population that is at a greater risk than their peers for violence from others as well as suicide1. We know that the risk of suicide for trans youth drops dramatically when their gender identity is affirmed by the people around them2,3. SB10 would do more than prevent trans youth from accessing affirming healthcare; it would also enlist teachers and school counselors in outing trans students to their parents. In a population that already experiences increased discrimination, harassment, and outright violence at school1, this removes any possibility of finding supportive adults in an educational environment. Trans young people can have healthy, happy lives when they are supported by their families and schools. This bill would disrupt the tenuous balance many trans youth in our state have found. Make no mistake, this legislation will cause suffering and harm to young Alabamians.

SB10 would not only endanger trans youth but also interfere with the provider-patient relationship and medical decision making. It would make it a felony to provide any kind of transition care, including puberty blocking medications. These therapies have been used safely for years in the treatment of a variety of conditions from early puberty in youth to prostate cancer in adults. Puberty blocking therapies allow time for trans youth to think about what they want for their future without the urgency of impending changes to their bodies. Even more compelling is the evidence on the mental health benefits of these medications– puberty blockers are associated with decreased lifetime suicidality in trans people who want access to them4. Under SB10, a physician who provides a patient with this lifesaving therapy would face up to a decade in prison.

Alabama has long struggled to keep enough primary care providers in its borders to provide for our population. At UAB and other medical schools across the state, students are familiar with entreaties to stay and practice in Alabama, particularly in our underserved rural communities. Like many of my classmates, I am excited to be part of the next generation of primary care physicians, but we have to weigh our desire to stay and help the community we love against the opportunity to get the medical training we need to be competent physicians. As someone who cares deeply about the wellbeing of all youth and particularly vulnerable populations like trans kids, I would not be able to learn about the full breadth of comprehensive pediatric care in Alabama if SB10 were made law. In a state with a shortage of primary care providers, it seems a particularly risky gamble to reduce the pool of thoughtful and compassionate trainees even further.

Within the trans community, we talk often about how our narratives are boiled down to trauma and fear without any room for nuance or joy. To be trans in this state is simultaneously a story of beauty, resilience, and sadness. It’s more than just trauma, but the risk of trauma looms large with the possibility of this legislation passing. SB10 represents a scramble by a select few in our state to deny the inevitable– trans children will continue to be trans regardless of what we do. The only thing we can influence is how many of them make it into adulthood.

 

1. Johns MM, Lowry R, Andrzejewski J, et al. Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students — 19 States and Large Urban School Districts, 2017. Morbidity and Mortality Weekly Report. 2019; 68: 67–71. DOI: http://dx.doi.org/10.15585/mmwr.mm6803a3.

2. Russel ST, Pollitt AM, Li G, Grossman AH. Chosen Name Use is Linked to Reduced Depressive Symptoms, Suicidal Ideation and Behavior among Transgender Youth. Journal of Adolescent Health. 2018 Oct; 63(4): 503–505. DOI: https://doi.org/10.1016/j.jadohealth.2018.02.003.

3. National Survey on LGBTQ Youth Mental Health. Trevor Project, 2020. Access at: https://www.thetrevorproject.org/survey-2020/.

4. Turban JL, King D, Carswell JM, et al. Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. Pediatrics. 2020; 145(2): e20191725. DOI: https://doi.org/10.1542/peds.2019-1725.