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Ano ang mga kahihinatnan sa mga problemang ito at paano maapektuhan ang demographic dito?

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Ano-ano ang mga ideya, tradisyon, sistema, o iba pang aspeto ng lipunan na nagpapatuloy sa problema?

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Diskriminasyon laban sa mga babae at miyembro na kasali sa komunidad sa LGBTQ+

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Diskriminasyon laban sa mga babae at miyembro na kasali sa komunidad sa LGBTQ+

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is prejudice based on a personal belief that lesbian, gay and bisexual people are sinful, immoral, sick, inferior to heterosexuals, or incomplete women and men.
- is primarily caused by misinformation. As with racism and sexism, people are taught to be homophobic.

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is individual behavior based on personal homophobia. This hatred or dislike may be expressed by name‐calling, telling "jokes,” verbal and physical harassment, and other individual acts of discrimination.
- (harassment and individual discrimination) can be explained by considering psychological factors in conjunction with prejudice.

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refers to the many ways in which government, businesses, churches, and other institutions and organizations discriminate against people on the basis of sexual orientation. Institutional homophobia is also called heterosexism.
- is caused in part by competition for power. Societies such as our create scapegoats to maintain the status quo and the positions of those in power

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is largely caused by social norms which dictate "correct" sexuality.

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(CNN) - LGBQ teens are more vulnerable to planning or attempting suicide, according to a research letter published Tuesday in the journal JAMA.

Looking at answers in the 2015 National Youth Risk Behavior Survey in the U.S., researchers found that 40% of high school students who are considered sexual minorities - who identify as gay, lesbian or bisexual or questioning, meaning they are unsure of their orientation - were seriously considering suicide.

Transgender teens were not included in the U.S. government's survey, but research has shown that transgender youth may face a similarly high, if not higher, suicide risk.

The survey, conducted by the Centers for Disease Control and Prevention, looked at a nationally representative sample of 15,624 students across the country in that were in grades 9 through 12 (typically 14 to 18 years old).

Of the sexual minorities in the study, 34.9% were planning suicide and 24.9% had attempted suicide in the previous year. Compared with heterosexual teens, those numbers are exceptionally high: Of the straight teens in the study, 14.8% had seriously considered suicide, 11.9% had been planning suicide, and 6.3% had made an attempt in the past year.

The children who were bisexual faced the greatest suicide risk; 46% had considered suicide in the past year. Bisexual girls were the most vulnerable, with nearly 48% saying they had considered taking their own lives.

Girls who identify as lesbian also had higher rates. More than 40% said they seriously considered suicide in the past year; in comparison, 19.6% of girls who considered themselves heterosexual said they had seriously considered suicide in the past year. Of boys who identify as gay, 25.5% had.

Past research has noted the higher suicide risks for these groups, but much of that work comes from regional surveys, or teens who were surveyed were not from a general sample of the population.

This research is one of the first nationally available estimates representing the general population, and it documents how LGBQ teens' experience with suicide is different from that of other youth.

"We want this to be a wake-up call and a call to action, so that this will become a part of the national agenda to address this very real public health crisis," said research co-author John W. Ayers, a computational epidemiologist who works as an adjunct associate professor at San Diego State University.

He hopes the numbers will prompt a "comprehensive reaction" from policy-makers, clinicians and parents and teachers. "While this may be a small subset of our teens, this burden is tremendous."

Jason Cianciotto, executive director of the Tyler Clementi Foundation, agreed.

"The question is, how many times are we going to reveal the same horrific information about young people in the US before we do something about this?" asked Cianciotto, who was not involved in the new study. The Clementi family created the anti-bullying foundation after Tyler, who had been bullied for being gay, died in 2010 having jumped off a bridge.

When Cianciotto was co-authoring the book "LGBT Youth in America's Schools," he came across similar startling suicide statistics that go back as far as the late 1980s.

What's driving them, he said, is that not all teens live in a supportive culture, even with the advances in same-sex marriage, inclusive anti-bullying programs and non-discrimination protection. Many evangelical Christians, for instance, still preach that LGBTQ kids are going to hell, he said.

"There are still too many LGBTQ young people growing up in harmful environments where they are rejected at home or at church or school; they face pervasive bullying; they lack access to safe or supportive spaces and don't have supportive physical or mental health care, and all those comorbidities pile up and increase the suicide risk," Cianciotto said.

Research has shown that lesbian, gay and bisexual students had fewer suicidal thoughts and attempts when schools had gay-straight alliances and had long-term policies prohibiting expression of homophobia. Yet not all schools have these programs, although national groups like the Trevor Project offer 24/7 crisis lines to help young LGBTQ people.

In a separate study on suicide issues concerning LGBTQ teens, also published Tuesday, researchers saw a heightened risk for suicide and found that these teens were more likely than their straight peers to have experienced some form of adverse childhood experience such as abuse. The authors of this study also say there is evidence that suicide rates are going up for this age group.

"Too little is changing, and for too long, our society has put Band-Aids on this problem," Cianciotto said. "While Band-Aids are good, we need to help by better addressing the root causes of these problems."
This story was first published on CNN.com, "LGBQ teens face serious suicide risk, research finds."

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LGBQ teens face serious suicide risk, research finds

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(CNN) - LGBQ teens are more vulnerable to planning or attempting suicide, according to a research letter published Tuesday in the journal JAMA. Looking at answers in the 2015 National Youth Risk Behavior Survey in the U.S., researchers found that 40% of high school students who are considered sexual minorities - who identify as gay, lesbian or bisexual or questioning, meaning they are unsure of their orientation - were seriously considering suicide.

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Sexism begins with prejudices. A prejudice is a bias against a person or group of people. It is often based on myths, stereotypes, and generalizations that a person learns from others.

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Sexism is prejudice or discrimination based on sex or gender. It affects every level of society, from institutions and governments to personal relationships. Sexism affects women and other marginalized genders most severely. Indirectly, it also harms men.

Sexism creates inequity between different sexes and genders. It also fuels gender-based violence and hate crime. Worldwide, the economic cost of institutional gender discrimination is $12 trillion, or 16% of the world's total income.

This article looks at what sexism is, what causes it, types and examples of sexism, and its impact.

Sexism is prejudice and discrimination against people based on their sex or gender.

A person's sex is assigned at birth based on biological traits, such as genitalia and chromosomes. Gender involves how a person feels and self-identifies. Gender also exists as a social construct. This consists of societal and cultural roles and norms considered appropriate for various genders.

Any action, speech, law, practice, or media representation that places a higher value on one gender or sex over another is sexist. This applies whether the person or institution meant to cause harm or not.

Worldwide, sexism affects women and girls most often. This is because in most cultures, being male or masculine is more highly valued than being female or feminine.

Sexism also affects people who were not assigned female at birth but who express themselves in a way that people perceive as feminine. This includes trans and gender-expansive individuals.

It is possible to be sexist toward men. However, because men possess more power and status in most countries, the harm that they experience is usually an indirect result of sexism toward women.

For example, if a person believes that women are weaker than men, they may feel that they have to be strong or tough at all times - even if this means risking their health or participating in violence.

Sexism begins with prejudices. A prejudice is a bias against a person or group of people. It is often based on myths, stereotypes, and generalizations that a person learns from others.

Biases about sex and gender can be explicit, something that a person is aware that they have. And they can be implicit, in which case, a person is not consciously aware of their biases.

A common prejudice about gender is called "gender determinism." This refers to the idea that men and women are fundamentally different in ways that cannot change and that these differences determine their personalities, behaviors, and abilities.

This includes the stereotype that women are naturally better at looking after children than men - or that men are naturally better at math or science.

Gender determinism also causes prejudice against transgender people. This is because people who believe that gender is determined solely by biology may not understand how being transgender is possible or refuse to accept that it is. This is known as cissexism.
Learn more about cissexism and transphobia.
Prejudice based on sex or gender can have different forms. Some are more obvious and easier to identify, while others are more subtle. Types of sexism include:

Hostile sexism: This involves any overtly hostile attitudes about women, such as the belief that women are manipulative, sinful, weak, or resentful, or that they owe men sex. Hostile sexism is dangerous and fuels gender-based violence.

Benevolent sexism: This is based on the idea that women are naturally kind, pure, and innocent. These may not seem like negative qualities, but they stem from the opinion that women are weaker than men. This is what makes benevolent sexism harmful.

Ambivalent sexism: Ambivalent sexism is a combination of benevolent and hostile sexism, which often work together as part of a system. For example, a person might have benevolent sexist views about mothers, such as that they always put their children first. If a mother enters the workforce, though, the person might display hostile sexism by openly judging or punishing that person for having a job.

Sexism can also occur alongside other forms of oppression, such as racism or ableism, affecting people who belong to more than one marginalized group.
Learn more about the types of sexism, with examples, here.
Sexist beliefs can lead to discrimination. Discrimination is prejudice in action, and it occurs whenever a person or group treats others unfairly based on an aspect of their identity.

Gender discrimination can manifest itself at any level of society, including the:

Institutional level: Institutional sexism occurs when sexism affects the practices of a whole institution or system, such as a university, healthcare system, or legal system.

Interpersonal level: Interpersonal sexism occurs within personal relationships and social interactions. Examples include catcalling, verbal insults, and abuse.

Individual level: People can have internalized sexism, which refers to sexist beliefs about a person's own sex or gender. This may cause them to discriminate against others who belong to the same group.

Discrimination does not have to be obvious or intentional to be damaging. Smaller acts of discrimination can have a cumulative effect on mental and physical health. These acts are known as microaggressions.

Some examples of gender-based microaggressions include:

interrupting or talking over someone

questioning someone's competence because of their gender

denying that sexism exists

using sexist language or making sexist jokes

One location where gender discrimination occurs is the workplace. A 2017 survey by the Pew Research Center, in the United States, found that 42% of women have experienced gender discrimination at work, such as:

being paid less than a man for doing the same job

being denied a promotion because of their gender

being treated as less competent because of their gender

receiving less support from management than a man doing the same job

Gender discrimination also occurs in healthcare. In a 2021 study, more women doctors than men said that their gender had negatively affected their careers, limiting the level of respect that they felt they received.

Almost 100% of the women in the study had been mistaken for patients or support staff, compared with 29% of the men.
Learn about the effects of gender discrimination on health.
Sexual harassment is sexualized mistreatment. It includes any unwanted sexual comments about a person's appearance or sexuality. Often, these comments are tinged with aggression.

Sexual harassment can take place anywhere, including workplaces, public restrooms, and between friends and family members.

Unlike flattery or flirting, which happens between consenting adults, sexual harassment is often one-sided, and it exploits an uneven power dynamic. This is what makes it threatening.

A 2018 online survey found that sexual harassment is an extremely common experience among women, with 81% saying that they had experienced some form of street harassment.

Sexual harassment is also common in workplaces, particularly among women who work for tips, who work in male-dominated fields, or who do not have permanent legal immigration status.

Examples of sexual harassment include:

someone making a remark about a person's body from a moving car or on the street, then using a gendered slur when the person does not respond

an employer making inappropriate comments about a female employee's appearance

unsolicited online comments about a person's body or sexual activities

Sexual harassment can make people feel uncomfortable, scared, and even traumatized. Even if a person does not feel physically threatened at the time, it may cause or reinforce a fear of walking alone, wearing certain clothes, or being sexually assaulted.

Common examples of gender-based violence include:

Intimate partner abuse

This type of violence occurs in intimate relationships. It is also known as domestic abuse. Anyone can experience intimate partner abuse (IPA), but it disproportionately affects women. Gender inequity, sexist beliefs, and cultural practices that devalue women all increase the risk of IPA.

According to the World Health Organization (WHO), around of women worldwide have been physically or sexually assaulted by an intimate partner, and 38% of all murders of women are committed by their partners.

Female genital mutilation

This harmful practice involves removing parts of the female genitals, such as the clitoris and labia. People usually perform female genital mutilation (FGM) against the person's will and in unsterile conditions. Often, this happens before the person has reached the .

FGM causes significant mental and physical trauma. It also carries a risk of infection, sexual health problems, and fertility problems, as well as birth complications if a person becomes pregnant. The WHO estimates that more than 200 million females alive today have undergone FGM.

Sexual assault

Sexual assault includes any unwanted, coerced, or forced sexual contact. Anyone can experience or commit sexual assault, but most survivors are female.

According to the Centers for Disease Control and Prevention (CDC), 1 in 5 women and 1 in 38 men experience attempted or completed rape during their lifetimes. Among trans people, the rate is just under 1 in 2.

The long-term impact of widespread sexism is gender inequity. This refers to unfair and preventable differences between genders. Most research on this focuses on the inequities between men and women.

Gender inequity is present in:

The household

A 2018 study from Spain found that women in heterosexual relationships were involved in more than double the household chores that their male partners were. This is due to traditional gender roles and expectations.

When heterosexual couples freely choose these roles, it may not cause problems. However, the study found that women who did more household labor reported higher levels of family conflict.

The uneven distribution of household labor also contributes to economic inequity. A 2017 report states that one-fifth of women who live in poverty in Europe are not employed, due to their domestic and caregiving responsibilities.

Health and healthcare

Sexism negatively affects health and the healthcare system. Exposure to prejudice, discrimination, and higher levels of unpaid work can cause chronic stress, which contributes to mental and physical health conditions.

Lower wages also make it more difficult to access quality healthcare. And even when a person can access healthcare, sexism affects how doctors treat people.

For example, a notes that doctors regularly deny female patients birth control in order to coerce them into getting pap smears every year. This prevents females from making decisions about and having control over their own bodies.
Learn more about gender bias in medical diagnosis.
The economy

The cumulative impact of sexism on the worldwide economy is huge. According to the Organisation for Economic Co-operation and Development, gender inequity is associated with:

lower national incomes

lower levels of productivity

lower levels of education

an artificially reduced talent pool

Gender equity would result in a better quality of life for women and other marginalized genders, as well as economic gains that benefit everyone.

Sexism is prejudice or discrimination based on sex or gender. It is widespread globally, and it can affect every aspect of a person's life, including their relationships, mental and physical health, life expectancy, and income.

Dismantling sexist institutions, laws, and practices is important for the health and empowerment of everyone, regardless of their sex or gender.

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What is sexism? Types, examples, and their impact

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Sexism is prejudice or discrimination based on sex or gender. It affects every level of society, from institutions and governments to personal relationships. Sexism affects women and other marginalized genders most severely. Indirectly, it also harms men. Sexism creates inequity between different sexes and genders. It also fuels gender-based violence and hate crime.

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Kate Manne's Down Girl () offers an 'ameliorative' account, in Sally Haslanger's sense of the term, 1 of misogyny, sexism, patriarchy, and the relations between them. Manne argues that women's essential role within patriarchy is to offer various social goods and support such as recognition, sexual attention, and emotional labor to men. Misogyny enforces patriarchy by keeping women in their proper place, as suppliers of these services, through an elaborate and interlocking set of social images, disciplinary practices, normalizing techniques and bodily habituation, and so forth. Misogyny is a self-correcting system that penalizes and disciplines women who violate the patriarchal order and step out of their proper place, 2 while promoting special sympathy for men who do not receive the support and recognition from women that they are 'owed.'

One of the compelling dimensions of Manne's account is her reading of misogyny as a structural social system enforcing patriarchy, rather than a set of mental attitudes that men have about women. Misogyny, for her, is a set of practices that put and keep women in their place. Anyone can participate in these practices whether or not we mean to, and whether or not we feel hatred for women. In order to spot misogyny, Manne argues, we should look at what a practice does to women, rather than by trying to scrutinize the true inner life of the doers. As she puts it, "Rather than conceptualizing misogyny from the point of view of the accused, at least implicitly, we might move to think of it instead from the point of view of its targets or victims. In other words, when it comes to misogyny, we can focus on the hostility women face in navigating the social world, rather than the hostility men (in the first instance) may or may not feel in their encounters with certain women" (59). 3 And again, "So, as compared with the naïve conception, my account holds that misogyny primarily targets women because they are women in a man's world (i.e., a historically patriarchal one, among other things), rather than because they are women in a man's mind where that man is a misogynist" (64).

I strongly support Manne's attempt to offer an effect-centered, systems-oriented account of misogyny, for at least three reasons. First, it is more interesting and more politically important to identify systems and structures that hold patriarchy in place than it is to identify individual bad apples. Second, it is epistemically more promising: We never really know what is going on in someone else's inner, private feelspace, and indeed, much psychological research shows that we don't even know what's going on in our own. 4 So if we understand misogyny as a kind of attitude or emotion, that won't help us much in identifying it. Third (and growing out of the above two), a focus on individual attitudes almost inevitably leads to politically fruitless arguments about blame and intentions. Arguments over what someone was actually feeling or intending are rarely resolvable or useful as political interventions. People accused of having misogynist attitudes are likely to be unproductively offended, and also likely to protest the purity of their intentions or the innocence of their emotions. Such arguments turn the focus to the perpetrators and away from the victims, and in an especially unhelpful way.

I would argue that many of the misogynist structures that enforce patriarchy are not only structural but indeed built directly into our material environment, completely apart from how we feel about that environment or whether we approve of it. Consider traditional suburban homes, with their fairly formulaic divisions into rooms, their separation from workspaces, and their privatization of leisure space. These homes materially embed all sorts of gender norms, and undergird and propagate patriarchy merely through what is involved in living in them. Similarly, gated communities that fracture and disunify urban space while creating territorial boundaries embed racist and classist ideologies, regardless of the conscious beliefs and attitudes of their inhabitants. All of us are often stuck living in spaces that reproduce problematic ideologies whether we want to be in them or not. Once we do, our daily activities embody and perpetrate these ideologies just in virtue of needing to negotiate these spaces, regardless of our individual mental attitudes or emotions.

Manne takes misogyny to be the 'enforcement' arm of patriarchy, and sexism to be its 'justification' arm: "I propose taking sexism to be the branch of patriarchal ideology that justifies and rationalizes a patriarchal social order, and misogyny as the system that polices and enforces its governing norms and expectations. So sexism is scientific; misogyny is moralistic" (20). One reading of Manne's distinction is that misogyny is a set of prescriptions that uphold patriarchy, while sexism is a set of descriptive empirical claims that justify these norms. This is suggested by her talk of morals versus science. On this reading, for example, the prescriptive norm that women should take their husbands' last name when they get married (thereby indicating that their identity is tethered to and less solid than their husbands') would be a piece of misogyny, whereas the empirical claim that women are biologically more care-oriented than men would be a piece of sexism.

But in the domain of ideology, I am not convinced that there are clean distinctions between enforcement and justification. Indeed, it strikes me as one of the characteristic hallmarks and part of the power of ideology that it operates in ways that confound just this distinction. For instance, Manne writes, "As a substantive matter of fact, sexism often works by naturalizing sex differences, in order to justify patriarchal social arrangements, by making them seem inevitable, or portraying people trying to resist them as fighting a losing battle." (79) I agree, and have argued elsewhere (Kukla , , and ) that this naturalizing move is actually the signal mechanism of ideology. But naturalization doesn't just justify - it also enforces. Claims such as "women are naturally more caring" are shot through with normative meaning, which is exactly why they support norms. A term like 'naturally' masquerades as a purely scientific, descriptive term, but it only does ideological work because it is in fact functioning as a normative term, meaning something like "properly" or "when things are working as they are meant to." By treating something as natural we treat it as ahistorical and given, in a way that makes it wrong to contravene or question it. Claims of naturalness - of breastfeeding or heterosexual sex, for instance, or of the sexual binary - are routinely used directly to police and punish those who behave "unnaturally," and to shut down critical inquiry into the "natural" way of doing things. Justification and enforcement are not detachable functions in such cases.

Another challenge for separating justification from enforcement in the domain of ideology is that many of our ideologically potent beliefs do not take the form of occurrent mental states, but instead are embedded into our practices. In particular, sexist beliefs, such as that girls are more caring and worse at math, for instance, are often embodied and revealed in the subtleties of how people act. Teachers assign girls helping and caring roles in the classroom and underestimate their mathematical abilities; parents buy their daughters books about the caring professions or expect more caring behavior from them than from their brothers, and so forth. These practices manifest beliefs, even if the people enacting them would disavow these beliefs. The various enforcement activities that uphold patriarchy are often, in effect, justificatory practices. Conversely, much of what enforces and upholds patriarchy is people's induction into various scientific research paradigms and the like, that are also tools of justification.

None of this is to reject Manne's basic distinction as unhelpful. My point is only that when we dig into its metaphysics and its political functioning, it becomes murky and complex rather than clean. There is more philosophical work to do in teasing out the justificatory and enforcement functions of patriarchal ideology and understanding their interdependence.

Strikingly, Manne strongly resists the common idea that misogyny involves dehumanization. As I read her, she takes this resistance as required for coherence with other essential parts of her account. Women's role under patriarchy is to provide certain goods to men. These goods include recognition, emotional support and validation, sexual appreciation, and so forth. Such goods can only be offered by persons; objects cannot provide them. If misogyny dehumanized women, Manne reasons, then there would be no way of using it to keep women in their place, giving men the goods that patriarchy demands they give - indeed it would render them unable to occupy this place at all. Women are relationally defined under patriarchy, but as persons in relation: Patriarchy makes a woman "somebody's mother, sister, daughter, grandmother: always somebody's someone, and seldom her own person. But this is not because she's not held to be a person at all, but rather because her personhood is held to be owed to others, in the form of service labor, love, and loyalty" (173).

Prima facie, it certainly seems like there is a lot of dehumanization of women going on around us, so Manne faces a high bar in making her case. The commodification of women's bodies, sexuality, and appearance; the silencing and invisibility of our epistemic perspectives; the use of our bodies as adornment and stage-setting in many contexts; the broad cultural skepticism concerning our ability to choose, use rationality, or have comprehensible preferences; the assumption that we are governed by arational hormones rather than reason - all these things certainly seem like examples of our dehumanization. On the face of it, it seems that if Manne can make room for dehumanization in her account, then she should. It is true that if dehumanization literally involved taking people as pure objects, then dehumanizing women would be incompatible with using us for the functions that she argues we perform under patriarchy. But while I understand Manne's reasoning, I think that she relies on an unnecessarily simplified and absolutist conception of dehumanization in order to make her case. Furthermore, dehumanization doesn't need to be complete or constant to be real. Men may dehumanize women in some contexts but not others, or they may treat us as having reduced rather than nonexistent humanity and agency

Notice that Manne's argument against misogyny involving dehumanization is in effect a riff on a classic Hegelian point: In the master/slave dialectic (Hegel ), the master needs the slave to provide him with recognition, which is something that only a subject rather than a mere tool can offer. According to Hegel, this is exactly why the position of the master is tension-ridden and ultimately self-undermining. In dehumanizing and objectifying the slave, the master thereby undermines the possibility of extracting from him what he needs most. But Hegel's most important lesson is that ideology and ideologically structured practices and norms are by no means internally consistent. The master can objectify and dehumanize the slave and simultaneously need him to be human, and men can do the same to women. Like many ideological practices, this is indeed incoherent. Plausibly, the incoherence of misogynistic logic is precisely why women can't win at its game. Overly obedient, conformist, pliable women are punished for being too object-like, while women who make their independent humanity and agency clear are punished for stepping out of place. Some of men's anger at women can be read as rooted in the fact they have objectified us so much that they cannot extract from us the validation they need.

Manne claims that the fact that women can practice misogyny means that these practices are not dehumanizing, because surely we don't dehumanize ourselves (146). It's not obvious to me that people never dehumanize themselves at the level of experience and attitudes. Certain kinds of depression might well go along with experiencing oneself as thing-like, for instance. Moreover, it is all too easy for people to fail to empathize with or respect others who are nominally or demographically "like them." That is, a woman might in fact have misogynist, dehumanizing attitudes towards other women, while thinking of herself as an exception, or simply while not feeling any strong sense of identity with other women qua women. But let's assume for purposes of argument that it is unusual or difficult for someone to experience members of a group to which they belong as dehumanized objects. Remember that according to Manne, misogyny is not reducible to a set of mental states or attitudes, but rather consists of systems of social norms and practices. Given this, I don't see why women wouldn't be able to participate in and enforce misogynist norms, including dehumanizing norms perhaps, without any particular felt attitudes towards ourselves or other women.

In what I found the most disturbing and surprising moment in Down Girl, Manne writes, "If the perpetrators of mass atrocities often dehumanize their victims, then why do the perpetrators so frequently rape the female ones? It is not just that sex between human beings and nonhuman animals is generally taboo, and relatively unusual, presumably partly because of this it is also that the spirit in which mass rapes tend to be committed is typically vindictive, punitive, triumphalist, and domineering. These acts hence bear all of the hallmarks of interpersonal violence" (165). I certainly don't think of the act of rape as particularly reflecting or recognizing the humanity of the victim. But more specifically, it seems much more plausible to read rapes that are acts of war or terror as designed to target the owners of the women - their husbands and fathers. Wartime rape treats women as men's property, and desecrates that property. This is why it so often goes along with more general looting and pillaging. It is also why wartime rapists generally have no trouble raping even those women who they mark as "disgusting" because of their race, age, anatomy, or whatever. I cannot see why we should think that the vindictiveness, punitiveness, or triumphalism Manne mentions are aimed at the victims themselves. These rapes are strategies for harming and humiliating men by desecrating their property and "ruining" their women. Such rapes turn women into the spoils of war. Indeed, wartime rape is often used as a tool of ethnic cleansing, by making women "unfuckable" because they have been "used" by another man. 5 None of this requires understanding the rapes as interpersonal exchanges between the victims and the rapists. Indeed, wartime rape strikes me as one of our most powerful examples of dehumanization.

I have different intuitions than Manne does about when language is dehumanizing. She supports her claim that misogyny is not dehumanizing with an analogy with race: "Think of the terms 'thug', 'welfare queen', 'urban youth', or even 'looter', as they figure in current political discourse in the United States. These are all primarily terms used by whites to refer disparagingly to black Americans. ... Yet none of the concepts these terms express seem, on the face of it, well described as dehumanizing" (152). On the contrary, I think that 'thug' in particular is a deeply dehumanizing term. The point of the insult is to portray someone as governed by purely animalistic impulses towards violence and destruction, as beyond reason, as needing to be constrained by force rather than persuaded by argument. 6 The ideological function of the insult is to justify the use of force, in virtue of the beast-like character of the target.

If neither wartime rape nor conceiving of people as "thugs" counts as an example of dehumanization for Manne, I think she has defined the concept too stringently for the purposes of her ameliorative project. It is probably extremely rare for someone to literally and completely take another person as not a person at all, as a mere object. But the logic of dehumanization - the reduction of the agency and perspective of others and the objectification of their bodies and impulses - can still be an important part of many ideological practices. This can include practices where this logic is directly in tension with competing logics, as is arguably so in the case of misogyny.

Down Girl has had a profound effect on me, as on many others. It has shaped the lens through which I see much of the culture around me. For instance, while I was reading the book, I went to see I, Tonya, a movie that purports to be a "dark comedy" chronicling the rise and fall of ice skater Tonya Harding. To my surprise, the movie contained a relentless series of scenes of horrific and graphic abuse of Harding at the hands of both her mother and her husband, played for laughs. Tonya Harding was a woman who challenged the proper gender (and class) order by being strong, aggressive, and assertive - she was not in her proper place. Thus, Manne's account helps us see, the performance of her brutalization is a way of reaffirming this proper order. Why is this a comedy, though? Harding was - and was presented in the film as being - strong and savvy, as well as aggressive. Thus the idea that she could be a target of abuse is inherently "hilarious." This is underscored by several scenes in which she hits back after being attacked (also played for laughs), conveying that she is not a victim but a full participant in a dysfunctional dynamic. The superimposed text in the movie's epilogue tells us that her terrifyingly abusive husband (Jeff Gillooly) is "happily remarried." The word 'happily' here, surely undersupported by any possible evidence that the filmmakers could have had access to, denies the deep pattern of abusers continuing to abuse regardless of the behavior of their victims, and implicates that Gillooly was a decent guy who was just hapless enough to end up with an unmanageable, abuse-inducing woman. In our contemporary social climate, it is not socially acceptable to make a movie openly claiming that a woman deserves brutalization. But by portraying Harding's strength and assertiveness as funny, and using it to imply that she is un-abusable, the movie powerfully reinscribes misogynist norms and puts Tonya in her place, without needing explicit bigotry to do it. We could call this the "Taming of the Shrew" trope. This was just one example of how I found Manne's account of misogyny powerfully illuminating of the logic of the culture around me.

Down Girl is a difficult read indeed. I had to take numerous breaks from reading it, and numerous breaks from writing this response. The story it tells is both brutal and completely fundamental to understanding how the social world works, at least in late-capitalist post-industrialized nations. I have raised some philosophical questions and worries about the details of its story, and there are places where my intuitions or understanding of the facts depart from Manne's, as I have discussed. But the existence of this book is vital, and reading it and wrestling with it was as illuminating and empowering as it was emotionally exhausting. 7

Kate Manne's Down Girl () offers an 'ameliorative' account, in Sally Haslanger's sense of the term, 1 of misogyny, sexism, patriarchy, and the relations between them. Manne argues that women's essential role within patriarchy is to offer various social goods and support such as recognition, sexual attention, and emotional labor to men. Misogyny enforces patriarchy by keeping women in their proper place, as suppliers of these services, through an elaborate and interlocking set of social images, disciplinary practices, normalizing techniques and bodily habituation, and so forth. Misogyny is a self-correcting system that penalizes and disciplines women who violate the patriarchal order and step out of their proper place, 2 while promoting special sympathy for men who do not receive the support and recognition from women that they are 'owed.'

One of the compelling dimensions of Manne's account is her reading of misogyny as a structural social system enforcing patriarchy, rather than a set of mental attitudes that men have about women. Misogyny, for her, is a set of practices that put and keep women in their place. Anyone can participate in these practices whether or not we mean to, and whether or not we feel hatred for women. In order to spot misogyny, Manne argues, we should look at what a practice does to women, rather than by trying to scrutinize the true inner life of the doers. As she puts it, "Rather than conceptualizing misogyny from the point of view of the accused, at least implicitly, we might move to think of it instead from the point of view of its targets or victims. In other words, when it comes to misogyny, we can focus on the hostility women face in navigating the social world, rather than the hostility men (in the first instance) may or may not feel in their encounters with certain women" (59). 3 And again, "So, as compared with the naïve conception, my account holds that misogyny primarily targets women because they are women in a man's world (i.e., a historically patriarchal one, among other things), rather than because they are women in a man's mind where that man is a misogynist" (64).

I strongly support Manne's attempt to offer an effect-centered, systems-oriented account of misogyny, for at least three reasons. First, it is more interesting and more politically important to identify systems and structures that hold patriarchy in place than it is to identify individual bad apples. Second, it is epistemically more promising: We never really know what is going on in someone else's inner, private feelspace, and indeed, much psychological research shows that we don't even know what's going on in our own. 4 So if we understand misogyny as a kind of attitude or emotion, that won't help us much in identifying it. Third (and growing out of the above two), a focus on individual attitudes almost inevitably leads to politically fruitless arguments about blame and intentions. Arguments over what someone was actually feeling or intending are rarely resolvable or useful as political interventions. People accused of having misogynist attitudes are likely to be unproductively offended, and also likely to protest the purity of their intentions or the innocence of their emotions. Such arguments turn the focus to the perpetrators and away from the victims, and in an especially unhelpful way.

I would argue that many of the misogynist structures that enforce patriarchy are not only structural but indeed built directly into our material environment, completely apart from how we feel about that environment or whether we approve of it. Consider traditional suburban homes, with their fairly formulaic divisions into rooms, their separation from workspaces, and their privatization of leisure space. These homes materially embed all sorts of gender norms, and undergird and propagate patriarchy merely through what is involved in living in them. Similarly, gated communities that fracture and disunify urban space while creating territorial boundaries embed racist and classist ideologies, regardless of the conscious beliefs and attitudes of their inhabitants. All of us are often stuck living in spaces that reproduce problematic ideologies whether we want to be in them or not. Once we do, our daily activities embody and perpetrate these ideologies just in virtue of needing to negotiate these spaces, regardless of our individual mental attitudes or emotions.

Manne takes misogyny to be the 'enforcement' arm of patriarchy, and sexism to be its 'justification' arm: "I propose taking sexism to be the branch of patriarchal ideology that justifies and rationalizes a patriarchal social order, and misogyny as the system that polices and enforces its governing norms and expectations. So sexism is scientific; misogyny is moralistic" (20). One reading of Manne's distinction is that misogyny is a set of prescriptions that uphold patriarchy, while sexism is a set of descriptive empirical claims that justify these norms. This is suggested by her talk of morals versus science. On this reading, for example, the prescriptive norm that women should take their husbands' last name when they get married (thereby indicating that their identity is tethered to and less solid than their husbands') would be a piece of misogyny, whereas the empirical claim that women are biologically more care-oriented than men would be a piece of sexism.

But in the domain of ideology, I am not convinced that there are clean distinctions between enforcement and justification. Indeed, it strikes me as one of the characteristic hallmarks and part of the power of ideology that it operates in ways that confound just this distinction. For instance, Manne writes, "As a substantive matter of fact, sexism often works by naturalizing sex differences, in order to justify patriarchal social arrangements, by making them seem inevitable, or portraying people trying to resist them as fighting a losing battle." (79) I agree, and have argued elsewhere (Kukla , , and ) that this naturalizing move is actually the signal mechanism of ideology. But naturalization doesn't just justify - it also enforces. Claims such as "women are naturally more caring" are shot through with normative meaning, which is exactly why they support norms. A term like 'naturally' masquerades as a purely scientific, descriptive term, but it only does ideological work because it is in fact functioning as a normative term, meaning something like "properly" or "when things are working as they are meant to." By treating something as natural we treat it as ahistorical and given, in a way that makes it wrong to contravene or question it. Claims of naturalness - of breastfeeding or heterosexual sex, for instance, or of the sexual binary - are routinely used directly to police and punish those who behave "unnaturally," and to shut down critical inquiry into the "natural" way of doing things. Justification and enforcement are not detachable functions in such cases.

Another challenge for separating justification from enforcement in the domain of ideology is that many of our ideologically potent beliefs do not take the form of occurrent mental states, but instead are embedded into our practices. In particular, sexist beliefs, such as that girls are more caring and worse at math, for instance, are often embodied and revealed in the subtleties of how people act. Teachers assign girls helping and caring roles in the classroom and underestimate their mathematical abilities; parents buy their daughters books about the caring professions or expect more caring behavior from them than from their brothers, and so forth. These practices manifest beliefs, even if the people enacting them would disavow these beliefs. The various enforcement activities that uphold patriarchy are often, in effect, justificatory practices. Conversely, much of what enforces and upholds patriarchy is people's induction into various scientific research paradigms and the like, that are also tools of justification.

None of this is to reject Manne's basic distinction as unhelpful. My point is only that when we dig into its metaphysics and its political functioning, it becomes murky and complex rather than clean. There is more philosophical work to do in teasing out the justificatory and enforcement functions of patriarchal ideology and understanding their interdependence.

Strikingly, Manne strongly resists the common idea that misogyny involves dehumanization. As I read her, she takes this resistance as required for coherence with other essential parts of her account. Women's role under patriarchy is to provide certain goods to men. These goods include recognition, emotional support and validation, sexual appreciation, and so forth. Such goods can only be offered by persons; objects cannot provide them. If misogyny dehumanized women, Manne reasons, then there would be no way of using it to keep women in their place, giving men the goods that patriarchy demands they give - indeed it would render them unable to occupy this place at all. Women are relationally defined under patriarchy, but as persons in relation: Patriarchy makes a woman "somebody's mother, sister, daughter, grandmother: always somebody's someone, and seldom her own person. But this is not because she's not held to be a person at all, but rather because her personhood is held to be owed to others, in the form of service labor, love, and loyalty" (173).

Prima facie, it certainly seems like there is a lot of dehumanization of women going on around us, so Manne faces a high bar in making her case. The commodification of women's bodies, sexuality, and appearance; the silencing and invisibility of our epistemic perspectives; the use of our bodies as adornment and stage-setting in many contexts; the broad cultural skepticism concerning our ability to choose, use rationality, or have comprehensible preferences; the assumption that we are governed by arational hormones rather than reason - all these things certainly seem like examples of our dehumanization. On the face of it, it seems that if Manne can make room for dehumanization in her account, then she should. It is true that if dehumanization literally involved taking people as pure objects, then dehumanizing women would be incompatible with using us for the functions that she argues we perform under patriarchy. But while I understand Manne's reasoning, I think that she relies on an unnecessarily simplified and absolutist conception of dehumanization in order to make her case. Furthermore, dehumanization doesn't need to be complete or constant to be real. Men may dehumanize women in some contexts but not others, or they may treat us as having reduced rather than nonexistent humanity and agency

Notice that Manne's argument against misogyny involving dehumanization is in effect a riff on a classic Hegelian point: In the master/slave dialectic (Hegel ), the master needs the slave to provide him with recognition, which is something that only a subject rather than a mere tool can offer. According to Hegel, this is exactly why the position of the master is tension-ridden and ultimately self-undermining. In dehumanizing and objectifying the slave, the master thereby undermines the possibility of extracting from him what he needs most. But Hegel's most important lesson is that ideology and ideologically structured practices and norms are by no means internally consistent. The master can objectify and dehumanize the slave and simultaneously need him to be human, and men can do the same to women. Like many ideological practices, this is indeed incoherent. Plausibly, the incoherence of misogynistic logic is precisely why women can't win at its game. Overly obedient, conformist, pliable women are punished for being too object-like, while women who make their independent humanity and agency clear are punished for stepping out of place. Some of men's anger at women can be read as rooted in the fact they have objectified us so much that they cannot extract from us the validation they need.

Manne claims that the fact that women can practice misogyny means that these practices are not dehumanizing, because surely we don't dehumanize ourselves (146). It's not obvious to me that people never dehumanize themselves at the level of experience and attitudes. Certain kinds of depression might well go along with experiencing oneself as thing-like, for instance. Moreover, it is all too easy for people to fail to empathize with or respect others who are nominally or demographically "like them." That is, a woman might in fact have misogynist, dehumanizing attitudes towards other women, while thinking of herself as an exception, or simply while not feeling any strong sense of identity with other women qua women. But let's assume for purposes of argument that it is unusual or difficult for someone to experience members of a group to which they belong as dehumanized objects. Remember that according to Manne, misogyny is not reducible to a set of mental states or attitudes, but rather consists of systems of social norms and practices. Given this, I don't see why women wouldn't be able to participate in and enforce misogynist norms, including dehumanizing norms perhaps, without any particular felt attitudes towards ourselves or other women.

In what I found the most disturbing and surprising moment in Down Girl, Manne writes, "If the perpetrators of mass atrocities often dehumanize their victims, then why do the perpetrators so frequently rape the female ones? It is not just that sex between human beings and nonhuman animals is generally taboo, and relatively unusual, presumably partly because of this it is also that the spirit in which mass rapes tend to be committed is typically vindictive, punitive, triumphalist, and domineering. These acts hence bear all of the hallmarks of interpersonal violence" (165). I certainly don't think of the act of rape as particularly reflecting or recognizing the humanity of the victim. But more specifically, it seems much more plausible to read rapes that are acts of war or terror as designed to target the owners of the women - their husbands and fathers. Wartime rape treats women as men's property, and desecrates that property. This is why it so often goes along with more general looting and pillaging. It is also why wartime rapists generally have no trouble raping even those women who they mark as "disgusting" because of their race, age, anatomy, or whatever. I cannot see why we should think that the vindictiveness, punitiveness, or triumphalism Manne mentions are aimed at the victims themselves. These rapes are strategies for harming and humiliating men by desecrating their property and "ruining" their women. Such rapes turn women into the spoils of war. Indeed, wartime rape is often used as a tool of ethnic cleansing, by making women "unfuckable" because they have been "used" by another man. 5 None of this requires understanding the rapes as interpersonal exchanges between the victims and the rapists. Indeed, wartime rape strikes me as one of our most powerful examples of dehumanization.

I have different intuitions than Manne does about when language is dehumanizing. She supports her claim that misogyny is not dehumanizing with an analogy with race: "Think of the terms 'thug', 'welfare queen', 'urban youth', or even 'looter', as they figure in current political discourse in the United States. These are all primarily terms used by whites to refer disparagingly to black Americans. ... Yet none of the concepts these terms express seem, on the face of it, well described as dehumanizing" (152). On the contrary, I think that 'thug' in particular is a deeply dehumanizing term. The point of the insult is to portray someone as governed by purely animalistic impulses towards violence and destruction, as beyond reason, as needing to be constrained by force rather than persuaded by argument. 6 The ideological function of the insult is to justify the use of force, in virtue of the beast-like character of the target.

If neither wartime rape nor conceiving of people as "thugs" counts as an example of dehumanization for Manne, I think she has defined the concept too stringently for the purposes of her ameliorative project. It is probably extremely rare for someone to literally and completely take another person as not a person at all, as a mere object. But the logic of dehumanization - the reduction of the agency and perspective of others and the objectification of their bodies and impulses - can still be an important part of many ideological practices. This can include practices where this logic is directly in tension with competing logics, as is arguably so in the case of misogyny.

Down Girl has had a profound effect on me, as on many others. It has shaped the lens through which I see much of the culture around me. For instance, while I was reading the book, I went to see I, Tonya, a movie that purports to be a "dark comedy" chronicling the rise and fall of ice skater Tonya Harding. To my surprise, the movie contained a relentless series of scenes of horrific and graphic abuse of Harding at the hands of both her mother and her husband, played for laughs. Tonya Harding was a woman who challenged the proper gender (and class) order by being strong, aggressive, and assertive - she was not in her proper place. Thus, Manne's account helps us see, the performance of her brutalization is a way of reaffirming this proper order. Why is this a comedy, though? Harding was - and was presented in the film as being - strong and savvy, as well as aggressive. Thus the idea that she could be a target of abuse is inherently "hilarious." This is underscored by several scenes in which she hits back after being attacked (also played for laughs), conveying that she is not a victim but a full participant in a dysfunctional dynamic. The superimposed text in the movie's epilogue tells us that her terrifyingly abusive husband (Jeff Gillooly) is "happily remarried." The word 'happily' here, surely undersupported by any possible evidence that the filmmakers could have had access to, denies the deep pattern of abusers continuing to abuse regardless of the behavior of their victims, and implicates that Gillooly was a decent guy who was just hapless enough to end up with an unmanageable, abuse-inducing woman. In our contemporary social climate, it is not socially acceptable to make a movie openly claiming that a woman deserves brutalization. But by portraying Harding's strength and assertiveness as funny, and using it to imply that she is un-abusable, the movie powerfully reinscribes misogynist norms and puts Tonya in her place, without needing explicit bigotry to do it. We could call this the "Taming of the Shrew" trope. This was just one example of how I found Manne's account of misogyny powerfully illuminating of the logic of the culture around me.

Down Girl is a difficult read indeed. I had to take numerous breaks from reading it, and numerous breaks from writing this response. The story it tells is both brutal and completely fundamental to understanding how the social world works, at least in late-capitalist post-industrialized nations. I have raised some philosophical questions and worries about the details of its story, and there are places where my intuitions or understanding of the facts depart from Manne's, as I have discussed. But the existence of this book is vital, and reading it and wrestling with it was as illuminating and empowering as it was emotionally exhausting. 7

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Kate Manne's Down Girl () offers an 'ameliorative' account, in Sally Haslanger's sense of the term, 1 of misogyny, sexism, patriarchy, and the relations between them. Manne argues that women's essential role within patriarchy is to offer various social goods and support such as recognition, sexual attention, and emotional labor to men.

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Women in a man's world:Understanding the logic of misogyny

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Women in a man's world:Understanding the logic of misogyny

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Discrimination because of sexual orientation

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Discrimination because of sexual orientation

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What is discrimination because of sexual orientation

Discrimination because of sexual orientation is when you are treated unfairly because of your sexual orientation. S exual orientation is also know as sexuality.

Your sexual orientation depends on whether you are sexually attracted towards:

your own sex. This means gay and lesbian people

the opposite sex. This means heterosexual people

the same and the opposite sex. This means bisexual people.

If sexual orientation discrimination takes place in any of the following situations it is illegal and you may be able to take action about it.

Discrimination because of sexual orientation can be direct or indirect. It can also take the form of victimisation or harassment.

It's also illegal to discriminate against you because:

of the sexual orientation of someone you know, such as family or friends, rather than because of your own sexual orientation. This is known as discrimination by association

you are believed to be of a particular sexual orientation, even, when you are not

of gender reassignment.

For more information about discrimination because of gender reassignment, see Gender reassignment discrimination.

Direct discrimination because of sexual orientation

It is direct discrimination to treat you less favourably because of your sexual orientation than someone of a different sexual orientation would be treated in the same circumstances.

It is also direct discrimination to treat you less favourably because of the sexual orientation of someone you know, such as a family member or friend (discrimination by association).

To prove direct discrimination, it will help if you can give an example of someone from a different sexual orientation who, in similar circumstances, has been, or would have been, treated more favourably than you.

Abuse and harassment because of sexual orientation are forms of direct discrimination.

If someone has been violent or hostile towards you because of your sexual orientation, you can also report this to the police as a hate incident or hate crime.

For more information on hate crime see Hate crime

Here are some possible examples of direct discrimination because of sexual orientation:

an insurance company insists that a man applying for life insurance takes an HIV test before they will give him life insurance. His application form shows he is gay by referring to his male partner

a landlord asks a letting agent to say that their flat to let has been taken if a lesbian or gay couple ask about renting it. If the letting agent agrees, both the landlord and the letting agent would be guilty of direct discrimination because of sexual orientation.

a shop assistant bars someone they know to be gay from the shop where they work because they are prejudiced against gay people. Both the shop assistant and the person or company that owns the shop would be guilty of direct discrimination because of sexual orientation.

For more information about direct discrimination, see Direct discrimination.

Indirect discrimination because of sexual orientation

It is indirect sexual orientation discrimination to have a rule, policy or practice which someone of a particular sexual orientation is less likely to be able to meet, and this places them at a disadvantage to people of a different sexual orientation.

An example of indirect discrimination because of sexual orientation is where a club has a policy of offering free membership to all husbands and wives of its members, but not to civil partners.

If you think that indirect sexual orientation discrimination might have occurred, you may be able to make a complaint about it. However, if the person or organisation you are complaining about can show that there are genuine reasons for the rule, policy or practice and that it has nothing to do with sexual orientation, this won't count as discrimination.

For more information about indirect discrimination, see Indirect discrimination.

Victimisation

If you complain about sexual orientation discrimination, you shouldn't be victimised because you complained. This means that you shouldn't be treated unfairly just because you've made a complaint.

Making a complaint includes taking a case to court, going to an employment tribunal or standing up for your rights in some other way.

You can get protection if you are victimised because you've made a complaint about sexual orientation discrimination. You can also get protection from discrimination for helping someone else to make a complaint about sexual orientation discrimination, for example, by giving evidence as a witness in court.

An example of victimisation would be where a lesbian tenant had previously made a claim of discrimination against the manager of the property management company. The company refuses to allow the tenant to use facilities which are available to other tenants. This is victimisation and you can take action about it.

For more information about victimisation, see Victimisation.

Sexual orientation discrimination in employment and training

It is illegal for an employer to discriminate against you because of your sexual orientation. This includes all employers, no matter how few people they employ. Most workers, including employees, agency workers, trainees and those who are self-employed have protection from sexual orientation discrimination at work. This includes:

recruitment and selection

promotion

training, pay and benefits

redundancy and dismissal

terms and conditions of work.

Here is an example of sexual orientation discrimination:
An employer allows a man whose female partner is pregnant to take annual leave so that he can go to ante-natal appointments with her.
The employer refuses a similar request from a woman whose female partner is pregnant. This is likely to be direct discrimination because of sexual orientation.

There are some circumstances where an employer is allowed to treat you unfavorably because of your sexual orientation. If an employer can show that you need to be of a particular sexual orientation in order to do a certain job, they can insist on employing someone of that sexual orientation. This is known as an occupational requirement and does not count as discrimination.

An example of an occupational requirement is where the employers of a religious Minister insist that they can't employ a transsexual person or a gay man in order to avoid offending the religious convictions of the religion's followers.

Sexual orientation when providing goods, facilities and services

Someone who provides goods, facilities and services would be discriminating against you if, because of your sexual orientation, they:

refused to sell you something

did not allow you to use a service

provided you with worse or more expensive goods or services than someone with a different sexual orientation

behaved in a rude or hostile way.

Examples of organisations which provide goods or services include:

pubs, restaurants and hotels

shops

entertainment facilities such as cinemas, theatres, amusement parks, ice-skating rinks and race tracks

hospitals and clinics

estate agents, private landlords and local authority housing departments

banks, building societies, insurance companies and finance companies

railway stations, bus stations and airports

churches and other places of worship

charities and voluntary organisations

schools and colleges

welfare services such as housing advice, day-care or community care

people who provide trade or personal services. This includes builders and people who provide complementary therapies such as acupuncture or reflexology

residential care homes

courts, prisons and the police.

For more examples of organisations which provide goods and services, see the Equality and Human Rights Commission website at: www.equalityhumanrights.com.

An example of discrimination in goods, facilities and services is where a hotel, guesthouse or B&B refuses a booking from a same-sex couple, or stops them from booking a double room.

It is illegal to discriminate against someone because of their sexual orientation, regardless of how the goods and services are provided or whether you have to pay for them or not.

It is not discrimination for a business to provide goods, facilities or services which are aimed especially at the gay community. They don't have to start providing similar goods, facilities or services aimed at heterosexuals. However, the business is not allowed to turn away any heterosexual customers. For example, a lesbian and gay bookshop doesn't have to stock books aimed at heterosexual readers, but can't turn away heterosexual customers who want to buy its books.

If you're in a civil partnership, someone who provides goods, facilities or services is not allowed to treat you differently to how they would treat a married couple. Goods, facilities and services available to unmarried opposite-sex couples must be available to same-sex couples not in a civil partnership.

Pubs, bars, restaurants and nightclubs

You can't be turned away from pubs, bars, restaurants or nightclubs because of your sexual orientation. This applies if you're gay, lesbian, bisexual or heterosexual. So, for example, you can't be asked to leave a bar just because you're gay or lesbian. And a gay bar can't turn you away simply because you're heterosexual. However, they can turn you away if you make nasty comments about gay people or don't respect the fact that you're in a gay space.

Private members' clubs and associations

Private members' clubs and associations with more than 25 members are not allowed to discriminate against you because of your sexual orientation. However, it doesn't count as discrimination if the main purpose of the club or association is to provide benefits to lesbians, gay men or bisexuals. This applies particularly if their purpose is to offer privacy or a safe, supportive environment. For example, if the main purpose of a gay football club is not to compete in tournaments but to provide a safe social space for gay men, it could refuse to allow heterosexual men to join if that would change the whole nature of the club.

Financial services

Banks, building societies and other financial service providers are not allowed to refuse you a loan, grant, credit or other financial services because of your sexual orientation.

Insurers aren't allowed to use your sexual orientation as a condition on its own for not offering you insurance.

Tour operators and transport or travel companies

Travel companies can't refuse to sell you a holiday because of your sexual orientation. For example, if a holiday is offered as couples only, it must be offered to both heterosexual and same-sex couples.

Charities

Charities aren't allowed to exclude people because of their sexual orientation. However, they can provide services for people of a particular sexual orientation if their purpose is to help that group. For example, a charity might exist to support homeless gay men or give counselling to young lesbians with mental health issues.

Religious organisations

Religious organisations can refuse to provide services to you under certain circumstances. For example, a religious retreat may be allowed to turn you away because you're lesbian, gay or bisexual, or a church may be allowed to refuse to allow a gay group to hold meetings on its premises.

Public authorities

It's illegal for a public authority to discriminate against you because of your sexual orientation while carrying out any of it's functions. Public authorities includes government departments, local authorities, NHS trusts, courts and tribunals, police officers and prisons.

On top of this, public authorities have a legal duty to take action against discrimination and to actively promote equality.

Advertising

It's illegal to publish or broadcast an advert which discriminates because of sexual orientation, or which advertises discriminatory services.

This means that a business is not allowed to advertise goods, facilities or services which are only available to heterosexuals.

In the same way, a gay business is not allowed to advertise that heterosexual people are excluded from its' facilities. However, it is allowed to say that it's a 'gay-friendly' business.

You won't be able to take action about advertising which discriminates. Action about advertising which discriminates must be taken by the Equality and Human Rights Commission (EHRC).

Adoption and fostering agencies

An adoption or fostering agency is not allowed to refuse to place children with you just because you're lesbian, gay or bisexual.

This applies to all adoption and fostering agencies.

Sexual orientation discrimination in education and training

Educational establishments such as schools, colleges and universities are not allowed to treat you differently because of your sexual orientation. They are not allowed to treat you differently if your parents are lesbian, gay or bisexual.

This applies to both state and private schools and colleges.

A school or college must not discriminate in any of its policies and practices. This includes its:

admissions policies

treatment of students

exclusions

decisions about a pupil's special educational needs.

Teachers must recognise your needs and tackle homophobic bullying, that is, bullying because of your sexual orientation.

Faith schools can still teach that their religion sees being lesbian, gay or bisexual as wrong. However, they must not do this in a way that puts you at a disadvantage compared with other pupils.

What can you do about sexual orientation discrimination in education?

You can make a complaint about discrimination by a school, college, university or Local Education Authority in your local county court (sheriff court in Scotland).

If your complaint is about a school, you should first try to resolve your complaint by talking to the school's headteacher. If you are still unhappy, you can then take your complaint to the school's governing body.

For more information about how to complain about a school, see Sorting out school problems.

If your complaint is about a college or university, you should first use the institution's own complaints procedure. If you are complaining about a further education college funded by the Education and Skills Funding Agency, you could also complain to the agency.

If your complaint is about a university in England or Wales, you could take your complaint to the Office of the Independent Adjudicator (the OIA).The OIA can be contacted at:

Third Floor
Kings Reach
38-50 King's Road
Reading
RG1 3AA
Tel: 0118 959 9813
Website: www.oiahe.org.uk.

If you have a complaint about a university in Scotland, you should complain to the Scottish Public Services Ombudsman at: www.spso.org.uk.

For more information about how to use an ombudsman in Scotland and when to use one, see How to use an ombudsman or commissioner in Scotland.

If you are thinking about taking court action about discrimination, you should get advice from an experienced adviser, for example, at a Citizens Advice local office. You can search for your nearest Citizens Advice.

Sexual orientation discrimination in housing

For more information about discrimination in housing, see Discrimination in housing.

What can you do about sexual orientation discrimination

If you think you've suffered discrimination because of your sexual orientation, there are a number of things you may be able to do. These include:

getting advice from Citizens Advice, a law centre or gay rights organisation

talking to the person or organisation that discriminated against you

making a written complaint to the company or organisation involved

following the company's written complaints procedure

complaining to the relevant Ombudsman. All public bodies such as local authorities, government departments, health authorities and social landlords have an Ombudsman, as well as financial institutions such as banks and building societies

using a grievance procedure or making a claim to an employment tribunal if it is an employment problem

publicising your case through the media

taking legal action through the courts

giving details of the problem to an advice agency who may be able to refer it to the Equality and Human Rights Commission if you believe the problem is widespread

Taking legal action about sexual orientation discrimination

If you want to make a claim in the county court (or sheriff court in Scotland), there is a time limit of six months from the date that the discrimination took place.

There is also a formal procedure for gathering evidence. You need to send a standard form, containing questions you want to ask, to the company, organisation or person you are complaining about. The court can award compensation, but if you lose you can be ordered to pay the other side's legal costs, so make sure you understand all the procedures and the risks involved.

Taking legal action about discrimination is likely to be complicated. If you are thinking about taking court action, you should get advice from an experienced adviser, for example, at a Citizens Advice local office. You can search for your nearest Citizens Advice.

Other types of discrimination

As well as discrimination because of your sexual orientation, you could be treated unfairly for other reasons, for example, because of your race, disability or because you're a woman.

For more information about discrimination, see our discrimination pages.

Further help

Stonewall

Stonewall is a campaigning and lobbying organisation working on issues of relevance to lesbians, gay men and bi-sexuals. In England, they have information about discrimination on their website at: www.stonewall.org.uk. They also run a free information helpline on: 08000 50 20 20. The line is open Monday to Friday, 9.30am to 5.30pm. Or you can email them for information on: info@stonewall.org.uk.

In Wales, the website for Stonewall Cymru is: www.stonewallcymru.org.uk.

In Scotland, the contact details are:

9 Howe Street
Edinburgh
EH3 6TE

Tel: 0131 557 3679
Email: info@stonewallscotland.org.uk
Website: www.stonewallscotland.org.uk

Stonewall cannot give you legal advice or help you pursue a case or complaint but they can refer you to specialists who can.

Equality Advisory Support Service (EASS)

If you have experienced discrimination, you can get help from the EASS discrimination helpline.
More about the EASS helpline
Equality and Human Rights Commission (EHRC)

You can find useful information about discrimination on the EHRC website at www.equalityhumanrights.com.

Law centres

A law centre can offer free legal advice if you want to take a case for sexual orientation discrimination. If a solicitor from a law centre represents you, you may be entitled to legal aid. In England and Wales, details of the nearest law centre are available from the Law Centres Network, and in Scotland from the Scottish Association of Law Centres.

England and Wales

Law Centres Network
Floor 1, Tavis House
1-6 Tavistock Square
London
WC1H 9NA

Tel: 020 3637 1330 (admin only)
Email: contact form available on the website
Website: www.lawcentres.org.uk

Scotland

Scottish Association of Law Centres
c/o Govan Law Centre
47 Burleight Street
Govan
Glasgow G51 3LB
Tel: 0141 440 2503
Email: m@govanlc.com
Website: www.govanlc.com/salc

Free Representation Unit (England)

The Free Representation Unit (FRU) can provide representation for people on a low income and living in the London area.

However, the FRU is a voluntary organisation and representation in cases cannot be guaranteed. If you want help from the FRU, you must be referred in writing by an advice agency once the date of a hearing has been set.

The agency must be an FRU subscriber. Some Citizens Advice local offices in London area are subscribers. You can search for your nearest Citizens Advice local office.

The FRU can be contacted at:

6th Floor
289 - 293 High Holborn
London
WC1V 7HZ

Tel: 020 7611 9555
Fax: 020 7611 9551
Email: available through a form on the website
Website: www.thefru.org.uk

Free Representation (Scotland)

There is some free representation available in Scotland for tribunals and courts. It is only available for certain cases and for people on a low income. It is only available through Citizens Advice. You can search for your nearest Citizens Advice.

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Discrimination because of sexual orientation

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Discrimination because of sexual orientation is when you are treated unfairly because of your sexual orientation. S exual orientation is also know as sexuality. Your sexual orientation depends on whether you are sexually attracted towards: your own sex. This means gay and lesbian people the opposite sex.

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Many lesbian, gay, bi, trans and intersex (LGBTI) people report to dealing surprisingly well with systemic discrimination, and most do not experience depression or any other mental health condition. However, experiences with discrimination and stigmatisation can lead to a higher likelihood of emotional distress, depression and anxiety.

People can often feel pressured to fit in with society's conventional ideas of being male or female. Those who don't fit the mould can be subjected to ridicule, intimidation and even physical abuse.

Even though there is an increasing acceptance of LGBTI people in society and greater visibility in the media and public life, many LGBTI people still experience discrimination, harassment and violence at work, school and in social situations.

Discrimination can take the form of:

obvious acts of prejudice and discrimination (e.g. someone who is open about being transgender being refused employment or promotion)

more subtle, but no less harmful, discrimination that reinforces negative stereotypes and feelings of difference (e.g. use of the word 'gay' as a derogatory term).

Stop. Think. Respect.

Because of the things people say and do, LGBTI people are far more likely to experience depression and anxiety. beyondblue is committed to raising awareness about these issues and helping to reduce the discrimination faced by LGBTI communities.

beyondblue, in collaboration with LGBTI communities and the Movember Foundation, has produced a national campaign aimed at improving the Australian community's understanding of discriminatory behaviour and the impact it can have on the mental health of LGBTI communities.

The campaign, including the Left hand cinema commercial and real life stories, works predominantly with the broader Australian community, and young people in particular. It has been designed to prompt people to stop the discrimination, think about how comments you make could cause real distress and harm, and respect people who are different from you.

Real life stories

Annaliese, Gina, Marlee, Rob, Sally and Shane share their stories of being treated differently and how they have overcome depression and/or anxiety. You can watch their stories at the top of this page, or visit our Stop. Think. Respect. page to find out more about our campaign.

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Many LGBTI people report to dealing surprisingly well with systemic discrimination, and most do not experience depression or any other mental health condition. However, experiences with discrimination and stigmatisation can lead to a higher likelihood of emotional distress, depression and anxiety.

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All anybody is trying to do is live their lives and be given the service, be treated with respect as anyone else is treated. All we want is equality.
-Petra E., Biloxi, MS, October 4, 2017

Over the past decade, lesbian, gay, bisexual, and transgender (LGBT) people have made significant legal and political gains in the United States, including the freedom to marry. Despite this progress, federal law does not expressly prohibit discrimination based on sexual orientation and gender identity in fields like employment, housing, and access to services, and fewer than half of the states offer explicit protections for LGBT people at the state level. Without these protections, LGBT people across the United States lack clear recourse and redress when they are fired, evicted, or refused service because of their sexual orientation or gender identity.

Against this backdrop of legal vulnerability, lawmakers who oppose marriage for same-sex couples and recent moves to advance transgender equality have led an anti-LGBT charge, pushing for, and often succeeding in getting, new laws that carve out religious exemptions for individuals who claim that compliance with particular laws interferes with their religious or moral beliefs. While LGBT equality is not the only area where exemptions have been debated-particularly as lawmakers have sought to substantially broaden exemptions related to sexual and reproductive healthcare-this report specifically examines a worrying wave of exemptions being introduced to blunt the recognition of LGBT rights across the United States.

The freedom of religion, as well as nondiscrimination, is a significant rights issue, and it is important that governments do not unnecessarily burden the exercise of religious conscience. This is especially important to minority religious groups, whose practices are all too easily trampled on by laws and policies enacted by majorities. But when exemptions to laws to accommodate religious beliefs or practices impinge on the rights of others or core societal values like nondiscrimination, lawmakers should proceed with caution.

Proponents of these laws argue that they properly balance religious freedom with the rights of LGBT individuals. In fact, with few exceptions, the laws as drafted create blanket exemptions for religious believers to discriminate with no consideration of or even mechanism for consideration of the harms and burdens on others. Because of their narrow focus on the objector, the laws provide little protection for the rights, well-being, or dignity of those who are turned away.

Statements made by legislative supporters of the laws, and in some cases the content of the laws themselves, moreover, make clear that they aim to push back against recent gains toward LGBT equality and to dilute the rights of LGBT people to secure protection from invidious discrimination.

They send a signal that the state governments enacting them accept and even embrace the dangerous and harmful notion that discrimination against LGBT people is a legitimate demand of both conscience and religion. Particularly in states that lack any underlying laws prohibiting discrimination against LGBT people, many of the laws are not "exemptions" so much as a license to discriminate.

In recent years and mostly since 2015, when the US Supreme Court ruled in favor of marriage equality, numerous states have considered and at least eight US states have enacted new laws that permit people to infringe on the rights of LGBT individuals and their families to the extent they believe that discriminating against them is necessary to uphold their own religious or moral beliefs. In 2018, lawmakers in at least six other states will consider similar legislation.

These laws and bills vary in scope. As has been widely publicized, some would permit people to refuse to participate in same-sex wedding ceremonies or to provide goods and services related to such weddings. Others, less widely publicized, would permit child welfare agencies, physical and mental health providers, businesses that serve the public, and other actors to refuse service to LGBT people and other groups. Such legislation immediately endangers LGBT rights. By allowing people to elevate their prejudices above fairness and equality, it also threatens the broader principle that people should not be refused goods and services solely because of who they are.

Together, the failure of most states to enact nondiscrimination protections and the growing number of religious exemption laws leave many LGBT people with little recourse when they encounter discrimination. While these exemptions are almost always couched in the language of religious freedom or religious liberty, they directly and indirectly harm LGBT people in a variety of ways.

Some laws enable and embolden businesses and service providers to refuse to serve LGBT people, compelling LGBT people to invest additional time, money, and energy to find willing providers; others simply give up on obtaining the goods or services they need. More insidiously, they give LGBT people reason to expect discrimination before it even occurs, and to take extra precautions or avoid scenarios where they might face hostility out of self-preservation.

Such laws also threaten the basic dignity of LGBT people, sending a clear message that their rights and well-being are not valued and are contingent on the goodwill of others. Our interviewees explained that, by enacting religious exemptions to blunt the advancement of LGBT equality, lawmakers sent a powerful signal that they were unequal or unvalued in their community.

Brandiilyne Mangum-Dear, a lesbian pastor in Mississippi, described that harm in these words: "We're not being melodramatic. You're being treated with disrespect, as a second-class citizen-not even a citizen, an outsider. And after a while, that begins to tear a person down, to hurt them emotionally and spiritually. Rejection is hard for everyone, and we get it over and over."

This report documents how religiously motivated discrimination against LGBT people can inflict real harm and why state endorsement of this discrimination is dangerous. From August 2017 to January 2018, researchers interviewed 112 LGBT people, service providers, and advocates, primarily in states that have enacted religious exemptions in recent years, about the discrimination that LGBT people have faced because of an absence of comprehensive nondiscrimination legislation and the passage of legislation that provides for exemptions based on religious or moral beliefs.

The results of this research indicate that the laws already enacted in eight states and the bills still under consideration in many more do not strike a proper balance between the freedom of religion and the equal rights of LGBT people under the law. And in fact, few if any of these laws even represent a serious attempt to do that. Lawmakers at the federal, state, and local level should work to ensure that LGBT people are protected from discrimination in employment, education, housing, healthcare, adoption and foster care, and public accommodations, and should repeal religious exemption laws that give government support to those who would discriminate based on their religious or moral beliefs.

Human Rights Watch conducted the research for this report between August 2017 and January 2018. To identify interviewees, researchers conducted outreach through national and state LGBT groups, legal advocates, and service providers who circulated information about the project to their networks. The outreach focused on eight states where statewide exemptions affecting LGBT people had been legislatively enacted at the time the research began: Alabama, Michigan, Mississippi, North Dakota, South Dakota, Tennessee, Texas, and Virginia. Researchers conducted a total of 112 interviews, including 30 individuals who were affected by discrimination and 82 advocates and providers working with affected individuals.

Interviews were primarily conducted by telephone due to the geographic dispersion of the interviewees for the project. Interviews were conducted in person in Mississippi in November 2017, Tennessee in December 2017, and Michigan, Mississippi, and Tennessee in January 2018. No compensation was paid to interviewees. Researchers obtained oral informed consent from interviewees, and notified interviewees why Human Rights Watch was conducting the research and how it would use their accounts, that they did not need to answer any questions, and that they could stop the interview at any time. Interviewees were given the option of using pseudonyms in published materials for the project; where pseudonyms are used in this report, that is reflected in the footnote citation.

On June 26, 2015, the US Supreme Court issued its decision in Obergefell v. Hodges, which invalidated bans on marriage for same-sex couples across the United States. As marriage equality became a reality, first in individual states and then nationally, lawmakers proposed allowing those with religious or moral objections to refuse or decline to provide a range of goods and services to same-sex couples.

When they are carefully designed, religious exemptions can play a valuable role in safeguarding the freedom of religious exercise and belief. The laws that states have introduced in response to recent advances towards LGBT equality, however, tend to tip the scales much too far in one direction, often with complete disregard for the very real harm they are likely to inflict. As this report describes, they are born of hostility to a marginalized group, and display little regard for the rights of those who are turned away. These laws undermine the central principle of nondiscrimination protections, deliberately embracing rather than pushing back against the denial of goods and services to individuals simply because of their identity or the services they need. In short, they give license to discriminate.

Addressing Discrimination on the Basis of Sexual Orientation and Gender Identity

Nonetheless, people in most US states lack these protections, as neither Congress nor most state legislatures have expressly prohibited discrimination against LGBT people. At the beginning of 2018, only 19 states and the District of Columbia had explicitly prohibited discrimination based on sexual orientation and gender identity in employment, housing, and public accommodations. In three other states, narrower protections exist. New Hampshire and Wisconsin prohibit discrimination in employment, housing, and publications based on sexual orientation, but do not prohibit discrimination based on gender identity. Utah prohibits discrimination on the basis of sexual orientation and gender identity in employment and housing, but not public accommodations.

With these laws, states have recognized that there is an urgent need to combat discrimination that denies people access to goods and services because of their sexual orientation or gender identity. The enactment of religious exemption laws bucks this trend, signaling a broad acceptance and even an encouragement of service providers who would discriminate against LGBT individuals.

Advances and Struggles in LGBT Equality

As public attitudes across the United States have become more favorable toward LGBT equality in recent years, LGBT people have won significant gains. The Supreme Court's decision in Obergefell, which recognized that same-sex couples have a constitutional right to marry, gave those who choose to marry and their families access to a range of economic and legal protections. The Obama Administration took steps to address discrimination against LGBT people, and particularly transgender people, in regulations around healthcare, housing, and education.

Religious Exemptions as a Backlash against LGBT Equality in the United States

In recent years-and particularly as marriage equality gained ground in state and federal courts-proponents of exemptions have drafted bills and filed lawsuits that would exempt people who say that their religious or moral convictions are irreconcilably at odds with what generally applicable anti-discrimination laws require of them in some circumstances. In many instances, lawmakers have proposed laws to prevent the government from denying funding, licenses, contracts, and other forms of support to service providers who discriminate based on religious or moral beliefs.

Religious Exemption Laws

Recent license-to-discriminate laws break from that tradition. They do not create a nondiscrimination rule; instead, they only create the exemption allowing discrimination to flourish. And rather than strike any kind of careful balance between assertions of religious liberty and LGBT equality or other rights and values that could be at stake, many grant a nearly unfettered license to discriminate while brushing aside the rights and freedoms of others. On both fronts, most of these laws bear no resemblance to religious exemptions that are motivated by a concern for human rights and are narrowly drawn to respect the rights of all involved.

A License to Discriminate Under State Law

The religious exemptions that have been considered or enacted by state legislatures take different forms. Some are comprehensive, providing blanket protection for entities that do not wish to provide various services to LGBT people because of their religious or moral beliefs. Others are more narrowly circumscribed, focusing particularly on adoption and foster care services and physical and mental healthcare services.

While these laws are typically characterized as exemptions, the term "exemption" is misleading. Few of the states that have enacted these laws have protections in place that prohibit discrimination based on sexual orientation and gender identity. In most cases, states are enacting "exceptions" allowing providers to discriminate based on religion without first prohibiting anti-LGBT discrimination more generally. In this context, these laws function first and foremost as a license to discriminate, signaling that discrimination against LGBT people is acceptable in the state.

Comprehensive Exemption Laws

The most sweeping exemption law enacted to date is Mississippi's HB 1523, enacted in the first legislative session after the Supreme Court's ruling in Obergefell v. Hodges. The law specifies three protected "religious beliefs or moral convictions": "(a) [m]arriage is or should be recognized as the union of one man and one woman; (b) [s]exual relations are properly reserved to such a marriage; and (c) [m]ale (man) or female (woman) refer to an individual's immutable biological sex as objectively determined by anatomy and genetics at time of birth." It prevents the government from taking "any discriminatory action" against religious organizations or persons that discriminate in a variety of ways against LGBT individuals (and in some cases against unmarried heterosexual individuals) "consistent with a sincerely held religious belief or moral conviction." The bill explicitly protects an extraordinary range of discriminatory conduct, in spheres that range from the conduct of wedding ceremonies and the provision of wedding-related services to the hiring and firing of employees, the rental or sale of housing, child placement services, psychological counseling, fertility or transition-related healthcare, and the restriction of access to shared facilities. "Discriminatory action" is defined very broadly so as to preclude most of the avenues the government might use to sanction or withhold government support for such an organization or individual. The sponsor of the bill expressly cited the Supreme Court's decision in Obergefell and the desire to protect those who believe marriage is between one man and one woman as the motivation for the law.

Adoption and Foster Care Services

In 2003, North Dakota enacted a law stating that "[a] child-placing agency is not required to perform, assist, counsel, recommend, facilitate, refer, or participate in a placement that violates the agency's written religious or moral convictions or policies." Under the law, the state's department of human services may not deny a child-placing agency a license, grant, or contract based on such an objection.

In 2012, Virginia enacted a law establishing that "no private child-placing agency shall be required to perform, assist, counsel, recommend, consent to, refer, or participate in any placement of a child for foster care or adoption when the proposed placement would violate the agency's written religious or moral convictions or policies." The law prevents the state from sanctioning or withholding licensing or support-including contractual relationships-from agencies that refuse to participate in a "placement that violates the agency's written religious or moral convictions or policies." At the time of its passage, Senator Adam Ebbin-who opposed the law-told press that his colleagues intended the bill to shield agencies from placing children with same-sex couples. On the day a Senate subcommittee approved the religious exemption, it rejected Ebbin's bill that would have prohibited discrimination on the basis of sexual orientation and gender identity in adoption and foster care placement.

In 2015, Michigan enacted a law stating that "a child placing agency shall not be required to provide any services if those services conflict with, or provide any services under circumstances that conflict with, the child placing agency's sincerely held religious beliefs contained in a written policy, statement of faith, or other document adhered to by the child placing agency." The law prohibits the state or local governments from taking "adverse action" against a child placing agency because of its refusal to provide services on the basis of those religious beliefs. In addition to requiring that the child placing agency set out its beliefs in writing, the law requires agencies that decline to provide services to refer the applicant to another agency or a list of agencies maintained by the state. As the bill was under consideration, Representative Jeff Irwin, who opposed the bill, stated that "[t]he whole goal of this package is to allow agencies to discriminate against same-sex couples." Representatives of the Michigan Catholic Conference and Michigan Family Forum, who supported the bill, justified it as a preemptive move to prevent adoption and foster-care agencies from having to comply with nondiscrimination laws requiring them to serve same-sex couples.

In 2017, South Dakota enacted a law barring the state from discriminating or taking adverse action against a child placement agency because it declines "to provide any service that conflicts with, or provide any service under circumstances that conflict with a sincerely-held religious belief or moral conviction of the child-placement agency." The committee debate on the bill focused primarily on religious objections to placing children with same-sex couples. Senator Alan Solano, who co-sponsored the bill, cited the Obergefell decision and the decision by Catholic Charities to withdraw from adoption and foster care services in Massachusetts, Illinois, California, and Washington, D.C. rather than comply with nondiscrimination laws that protect same-sex couples as the motivation for the law. Solano co-wrote the bill with Catholic Social Services, an agency which only places children with heterosexual couples. Governor Dennis Daugaard signed the bill into law, voicing a hope that it would prevent individuals in a protected class from suing child welfare agencies if they were denied placement.

In 2017, Alabama enacted a law that bars the state from discriminating or taking adverse action against a child placing agency "on the basis that the child placing agency declines to make, provide, facilitate, or refer for a placement in a manner that conflicts with, or under circumstances that conflict with, the sincerely held religious beliefs of the child placing agency." As the bill was debated, Representative Rich Wingo, who sponsored the bill, told press it was necessary to ensure that child welfare agencies are not compelled to place children with same-sex parents. Representative Patricia Todd, who opposed the bill, remarked that "[t]his bill obviously came about because same-sex marriage is approved."

In 2017, Texas enacted a law that broadly protects religious objections in child welfare services, defined to include not only child placement services but also services for abused or neglected children, counseling for children or parents, and family preservation and support services. It prevents the state from discriminating or taking adverse action against providers who decline to "provide, facilitate, or refer a person for child welfare services that conflict with, or under circumstances that conflict with, the provider's sincerely held religious beliefs" or provides the children in their care with a religious education. If a provider declines to provide a service because of religious objections, the government is supposed to ensure that an alternative provider is available in that area or a nearby area. The provider is supposed to refer the applicant to another service or the list of providers on the state's website. The law specifies that child welfare agencies may not deny placements based on race, ethnicity, or national origin; Representative Joe Moody introduced an amendment to include sex, religion, sexual orientation, gender identity, and disability as protected grounds, but the legislature rejected it.

Mental and Physical Health Care

In 2016, Tennessee enacted a law that states that "[n]o counselor or therapist providing counseling or therapy services shall be required to counsel or serve a client as to goals, outcomes, or behaviors that conflict with a sincerely held religious belief of the counselor or therapist." The law states that providers who refuse services should coordinate a referral to another provider who will see the client. According to the bill's sponsor, Senator Jack Johnson, the impetus for the bill was a change in the American Counseling Association's Code of Ethics which states that counselors should "refrain from referring prospective and current clients based solely on the counselor's personally held values, attitudes, beliefs, and behaviors." In committee, Senator Jeff Yarbro noted that the public debate on the bill "has been very much focused on issues of same-sex marriage," and Senator Rusty Crowe noted that although same-sex couples can now marry, the bill could exempt religious objectors from having to counsel them. Members of the Tennessee Association of Marriage and Family Therapists testified against the bill, stating that it was unnecessary in light of established referral mechanisms within the profession and would open the door to discrimination.

The framing and scope of these exemption laws differ in many respects, but are alike in several fundamental ways. First, they are motivated to a large degree by hostility to recent advances in LGBT equality; on their face they invoke only a concern for religious liberty but the public debate around and legislative history of many of these laws show quite clearly the animus and the discriminatory intent that underpin them. Second, they permit blatantly discriminatory practices without clear limitations or meaningful safeguards. They do not strike a careful balance-or even suggest that any serious attempt was made to do so-between religious exercise and the purposes of the underlying law from which the exemption is carved out, a feature of rights-respecting approaches to religious exemptions. Third, they often show no regard whatsoever for the harms that the discrimination they legitimize might inflict on those who are turned away from a range of important services and for the nondiscrimination principle itself.

These laws are directly harmful, and they take on added importance because of the larger message they send. By enacting these laws, states send a clear signal that discrimination against LGBT people is permissible-and that message has serious consequences at a time when discrimination against LGBT people remains all too common in the United States.

Proponents of exemptions that allow for anti-LGBT discrimination have framed them in terms of religious liberty, foregrounding how these laws might exempt businesses and service providers from laws and regulations that they find objectionable. The assumption seems to be that the resulting harms to LGBT individuals, or to the core value of equality, are insubstantial. As detailed below, however, the exemptions come at a high price.

To understand the harm, it is important to look at the larger context in which such laws are being considered, including pre-existing anti-LGBT discrimination and how exemption laws can encourage such discrimination, particularly in states without nondiscrimination protections. Anti-LGBT religious exemption laws are likely to exacerbate mistreatment because, both on their face and in the political discourse that surrounds them, they tend to legitimize and signal official acceptance of discrimination against LGBT people. And by restricting the state's ability to prohibit, sanction, or even discourage discrimination, the laws undermine the core principle of nondiscrimination law: that people should not face adverse treatment simply because of who they are.

Denying Goods and Services

Already, LGBT people often face discrimination by service providers who deny them goods and services. Where discrimination against LGBT people is permitted, because nondiscrimination laws do not exist, these problems tend to be worse. The following pages describe the tangible, human impact of such discrimination-which will likely worsen as a result of religious exemption laws-on the people who bear the brunt of it.

Incidents of Refusals

In states without nondiscrimination protections, individuals told Human Rights Watch that they had been denied access to goods and services because of a provider's religious beliefs. Leiana C., a 39-year-old lesbian woman in Mississippi, recalled an incident that occurred around 2012 when she and her wife were seeking a fertility doctor:

Tanya P., a 33-year-old woman in Tennessee, recalled the difficulties she faced obtaining affirming care for her transgender daughter in 2016. To obtain identity documents for her daughter that reflected her gender identity, Tanya needed to submit a note from her daughter's doctor affirming that she was undergoing appropriate clinical treatment. At the time, her daughter was already obtaining that treatment, had socially transitioned, and was seeing a therapist. Nonetheless, her pediatrician refused to provide a letter stating that information, citing his religious beliefs:

LGBT individuals have also experienced religious refusals in child welfare services. Recently, the American Civil Liberties Union of Michigan filed suit challenging the state's practice of granting contracts and funding to child welfare agencies that discriminate against same-sex couples. The suit was filed after two sets of prospective parents-Kristy and Dana Dumont and Erin and Rebecca Busk-Sutton-contacted religiously affiliated agencies in the state about adopting children from foster care and were informed the agencies did not work with same-sex couples. The Dumonts wanted to provide a foster home to an older child; they contacted the two agencies in their county that have older children eligible for foster placement and were told the agencies would not work with them as a same-sex couple. The Busk-Suttons were interested in adopting a child with special needs and were initially told by one agency that they would receive an information packet in the mail; when the packet did not arrive, they called to inquire and were told the agency does not specialize in same-sex couples. While the religiously affiliated agencies offered names of providers in neighboring counties, both couples expressed concern about traveling for the trainings and visits associated with becoming foster parents and potentially taking an older foster child or a child with special needs out of a county where they have family or are currently receiving services.

As Zawadski's case illustrates, refusals can occur in circumstances where LGBT people urgently need services and cannot readily access alternatives in the event that they are turned away.

Impacts of Refusals

When LGBT people are refused service, this discrimination has material and psychological consequences. Some individuals will obtain the good or service they sought, but will face additional costs: finding an alternative provider can require time, energy, and money, which can prove discouraging or even prohibitive.

Refusals create barriers to accessing mental and physical healthcare as well. Persephone Webb, an activist in Tennessee, noted:

Rhonda L., the mother of a transgender teenager in Tennessee, recalled how even available alternatives in the urban area could be prohibitively difficult:

Finally, even where LGBT people are ultimately able to obtain needed services elsewhere, incidents of discrimination can be psychologically traumatic and degrading. Rhonda L. said her transgender son had experienced hostility or overt religiosity from multiple healthcare professionals, including a pediatrician, dentist, gastrointestinal specialist, and pulmonologist. She described how these incidents affected him, making him unwilling to seek medical care even when it was urgently needed:

Added Harms of Religious Exemptions

As the incidents described above help illustrate, the absence of laws prohibiting discrimination based on sexual orientation and gender identity leaves LGBT people vulnerable to mistreatment, including mistreatment motivated by moral or religious convictions. Many of the incidents above occurred prior to the introduction of religious exemption laws, but were legally permissible because the state lacked any law providing protection from discriminatory treatment.

Second, as statutory provisions, religious exemption laws can override other protections that may exist for LGBT people. In Mississippi, for example, the cities of Jackson and Magnolia have nondiscrimination laws that protect sexual orientation and gender identity; the statewide imposition of HB 1523 allows religious objectors in those cities to cite the state law excusing them from compliance. As statutory provisions, these exemptions can also override administrative policies and practices that departments of health or child welfare have adopted to combat discrimination.

Finally, interviewees emphasized that the scope of religious exemptions is poorly understood, and many people perceive these exemptions as blanket permission to discriminate based on religious beliefs. Chris Sanders, the Executive Director of the Tennessee Equality Project, suggested:

David Dinelli, an attorney with the Southern Poverty Law Center, echoed this assessment. "My observation from being in the Deep South is that it almost doesn't matter what the law says. This narrative has taken hold, and now people are doing things that in no way would be authorized by the law itself."

Discouraging Access to Services

As noted above, most states in the US do not specifically prohibit discrimination on the basis of sexual orientation and gender identity, and discrimination against LGBT people remains widespread. Religious exemptions not only license the kinds of refusals discussed above, but encourage people to expect and fear discrimination and adapt accordingly.

It is important to note that, while these initiatives can alleviate gaps in service, they are not a sufficient substitute for full equality under the law. Many LGBT organizations do not have the resources to compile and maintain lists of affirming providers. Where they are developed, such lists tend to be ad hoc and non-exhaustive, as they rely on providers who are known to advocates to be reliably LGBT inclusive. A provider with competency with one population-for example, adult gay men-may not be similarly equipped to serve the needs of another-for example, transgender youth. The approach is particularly limited insofar as known providers are often concentrated in urban areas, with the result that LGBT people who live in rural areas may have to travel hundreds of miles to reach a provider who they know will serve them. And because these lists typically list only a fraction of the providers in a given state, the roster of providers can be quickly overwhelmed by demand.

In Tennessee, where state law allows counselors to decline to see LGBT patients based on their religious beliefs, researchers at the University of Tennessee have studied how these refusal laws impact self-concealment and psychological distress. One researcher on the project noted:

Healthcare providers expressed concern about how fears of discrimination were affecting the mental and physical health of LGBT populations in their states. One pediatrician in Alabama observed:

Kelley Blair, who runs the Diversity Center in Oklahoma City, OK, noted a similar phenomenon for adults at her practice, which specifically caters to the LGBT community:

Harms to Dignity

The harms of religious exemptions are not limited to outright refusals or deterring LGBT people from seeking goods and services. Interviewees in states with LGBT-targeted religious exemption laws in place also emphasized the harms to dignity and stigma that the laws impose on LGBT individuals and families.

While this message could be received from those who discriminated based on their faith generally, some interviewees indicated it was particularly injurious when it was endorsed by the state:

Proponents of sweeping religious exemptions have typically couched their claims in the language of religious freedom or religious liberty. International human rights law recognizes the importance of those rights, but also elaborates their limits, particularly where their exercise threatens to negatively impact the fundamental rights of others. Not only does the United States carry obligations under international law to respect these limits and safeguards, but more broadly the jurisprudence developed under international human rights law offers sound guidance to legislators seeking to strike a careful balance between rights that seem to stand in tension with one another.

Harmonizing Equality and the Freedom of Thought, Conscience and Religion

The United States is party to the International Covenant on Civil and Political Rights (ICCPR), which guarantees equal protection under the law as well as the freedom of thought, conscience, and religion.

Other Rights at Risk from Religious Exemptions

The religious exemptions being introduced to license discrimination in child welfare services, physical and mental healthcare, and public accommodations not only impinge upon the rights of LGBT individuals to equal treatment, they also jeopardize the enjoyment of several other rights as well.

Nondiscrimination More Broadly

While the religious exemption laws examined in this report were introduced as a result of gains that LGBT people have made in attaining nondiscrimination protections and the ability to adopt, marry, and form families under state and federal law, many of the exemptions being introduced at the state level are not limited to religious objections related to sexual orientation and gender identity. As critics have pointed out, many bills would broadly preclude states from taking action against religious objectors who operate according to their religious principles to the detriment of other groups as well, and potentially authorize forms of discrimination based on race, ethnicity, sex, religion, nationality, disability, veteran status, HIV status, and other classifications. States that enact these laws relinquish their ability to ensure that state funding and contracts support services available to all qualified recipients, and give a free pass to potentially sweeping discrimination under the color of state authority.

Right to Health

Children's Rights

To the US Congress

Enact the Equality Act or other legislation which would prohibit discrimination based on sexual orientation and gender identity in employment, education, healthcare, housing, and public accommodations.

Enact the Do No Harm Act, which would not allow the Religious Freedom Restoration Act to be used to carve out exemptions from federal laws and protections regarding nondiscrimination, labor, children's rights, and healthcare.

Enact the Every Child Deserves a Family Act, which would prohibit child welfare agencies that receive federal financial assistance from discriminating against foster parents based on sexual orientation, gender identity, and marital status.

Reject the First Amendment Defense Act, the Child Welfare Provider Inclusion Act, and other legislation that permits discrimination against LGBT people based on a provider's asserted religious beliefs.

To the US Department of Justice

Ensure that existing conscience protections are not misused to excuse or justify discrimination on the basis of race, sex, religion, sexual orientation, gender identity, and other classifications.

To State Legislatures

Enact legislation prohibiting discrimination based on sexual orientation and gender identity in employment, education, healthcare, housing, adoption and foster care, and public accommodations.

Repeal religious exemptions that require the state to continue licensing, funding, or otherwise supporting providers who discriminate against others according to their beliefs.

To State Human Rights Commissions

Affirm that discrimination based on sexual orientation and gender identity is unacceptable and investigate incidents of discrimination based on those grounds.

Ensure that existing conscience protections are not misused to excuse or justify discrimination on the basis of race, sex, religion, sexual orientation, gender identity, and other classifications.

Ryan Thoreson, a researcher in the LGBT Rights Program, wrote this report based on research that he undertook from August 2017 to January 2018.

The report was reviewed by Graeme Reid, director of the LGBT Rights Program; Grace Meng, senior researcher in the US Program; Amanda Klasing, senior researcher in the Women's Rights Division; Megan McLemore, senior researcher in the Health and Human Rights Division, Chris Albin-Lackey, senior legal advisor; and Joseph Saunders, deputy program director. Production assistance was provided by MJ Movahedi, LGBT Rights Program associate, Rebecca Rom-Frank, Photo & Publications coordinator; Fitzroy Hepkins, administrative manager; and Jose Martinez, senior coordinator.

Human Rights Watch would like to thank the experts and organizations that provided information for the report, especially the American Civil Liberties Union, the Movement Advancement Project, the ACLU of Michigan, Equality Michigan, the Tennessee Equality Project, the Tennessee Transgender Political Coalition, Voices for Trans Youth, the ACLU of Mississippi, and Lighthouse Community Church.

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This report documents how recent laws carve out space to discriminate against LGBT people in adoption and foster care, health care, and access to some goods and services. These laws fail to balance moral and religious objections to LGBT relationships and identities with the rights of LGBT people themselves, Human Rights Watch found.

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Texas's legal landscape and social climate put LGBT residents at risk of discrimination and harassment. The social, economic and health effects of stigma and discrimination against LGBT people negatively impact Texas's economy by tens of millions of dollars each year.

Texas's non-discrimination laws do not expressly include sexual orientation or gender identity as protected characteristics.

Discrimination against LGBT people in Texas has been documented in surveys, court cases, adminstrative complaints, and the media.

A more supportive legal landscape and social climate for LGBT people in Texas would likely reduce the economic instability and health disparities they face.

LGBT adults live in Texas

of Texas residents think LGBT people experience discrimination in the state

of LGBT adults in Texas reported not having enough money for food in the prior year

of non-LGBT adults reported not having enough money for food

of LGBT adults in Texas have been diagnosed with a depressive disorder

of non-LGBT adults have been diagnosed with a depressive disorder

annual benefit to Texas's economy if the LGBT disparity in major depresive disorder were reduced by one-third

Executive Summary

Texas is home to over 770,000 LGBT adults and 158,500 LGBT youth. LGBT people in Texas lack important legal protections and face a less supportive social climate than LGBT people in many other states. For example, statewide laws in Texas offer no protections from discrimination based on sexual orientation or gender identity in areas such as employment, housing, and public accommodations. Texas also has an anti-LGB curriculum law, requiring that teachers provide anti-LGB instruction during sex education lessons, and state law fails to adequately protect LGBT students from bullying. In terms of social climate, Texas ranks 39th in the nation on public support for LGBT rights and acceptance of LGBT people. However, a growing number of businesses in Texas have adopted LGBT-inclusive non-discrimination policies, and social attitudes toward LGBT people are becoming more positive over time.

The legal landscape and social climate for LGBT people in Texas likely contributes to an environment in which LGBT people experience stigma and discrimination. Stigma and discrimination can take many forms, including discrimination and harassment in employment and other settings; bullying and family rejection of LGBT youth; overrepresentation in the criminal justice system; and violence. Research has linked stigma and discrimination against LGBT people to negative effects on individuals, businesses, and the economy.

In this study, we provide data and research documenting the prevalence of several forms of stigma and discrimination against LGBT adults and youth in Texas, including discrimination and harassment in employment, housing, and public accommodations; bullying and harassment in schools; and family rejection of LGBT youth. We discuss the implications of such stigma and discrimination on LGBT individuals, in terms of health and economic security; on employers, in terms of employee productivity, recruitment, and retention; and on the economy, in terms of health care costs and reduced productivity.

To the extent that Texas were able to move toward creating more supportive environment for LGBT people, it would likely reduce economic instability and health disparities experienced by LGBT individuals, which, in turn, would benefit the state, employers, and the economy.

Key Findings

Prevalence of Stigma and Discrimination against LGBT People in Texas

LGBT People in Texas Experience Discrimination in Employment, Housing, and Public Accommodations

The 2015 U.S. Transgender Survey report, based on the largest survey of transgender and gender non-conforming people in the U.S. to date, found of respondents from Texas, 27%reported being fired, denied a promotion, or not being hired for a job they applied for in the year prior to the survey because of their gender identity, and 13% reported being verbally harassed at work in the year prior to the survey because of their gender identity. In addition, 22% of transgender respondents from Texas reported that they had experienced housing discrimination because of their gender identity within the past year, and 12% reported that they had experienced homelessness because of their gender identity within the past year.

Public opinion polling indicates that 79% of Texas residents, non-LGBT and LGBT, believe that LGBT people experience discrimination in the state.

Discrimination against LGBT people in Texas has also been documented in a number of court cases and the media. Instances of employment discrimination documented in these sources involve private and public sector workers in a range of occupations including, for example, teachers, a police detective, a bank employee, and a hospital architect. Examples of discrimination in housing and public accommodations have also been documented in these sources.

LGBT Youth in Texas Experience Bullying and Harassment at School

The 2015 Youth Risk Behavior Survey from Houston and Fort Worth, Texas, found that LGB students were more likely to report being bullied at school (Houston: 22.1% v. 11.0%; Fort Worth: 28.5% v. 11.5%) and electronically bullied (Houston: 22.1% v. 8.8%; Fort Worth: 23.3% v. 7.5%) in the 12 months prior to the survey than non-LGB students.

In addition, LGB students in Houston and Fort Worth were more likely than non-LGB students to report missing school because they felt unsafe at least once in the month prior to the survey (Houston: 17.7% v. 8.3%; Fort Worth: 16.4% v. 6.0%).

The 2015 U.S. Transgender Discrimination Survey report found that 73% of respondents who were perceived to be transgender while in grades K-12 experienced verbal, physical, or sexual harassment at school.

A 2012 campus climate report based on a survey of graduate students at Texas A&M University found that 14% of all students reported observing inappropriate behaviors (such as hostile comments and discriminatory treatment) based on sexual orientation and 10% of all students reported observing inappropriate behaviors based on gender identity or expression.

The University of Texas at Austin received 63 complaints of sexual orientation bias, 51 complaints of gender expression bias, and 47 complaints of gender identity bias
over a three-year period from 2012 to 2015.

Impact of Stigma and Discrimination on LGBT Individuals

LGBT People in Texas Experience Economic Instability

Stigma and discrimination against LGBT workers can lead to economic instability, including lower wages and higher rates of poverty.

Gallup polling data from 2012-2014 indicate that 30% percent of Texas LGBT adults and 26% of non-LGBT adults reported having a household income below $24,000.

Gallup data also indicate that about one-quarter of LGBT adults (26%) in Texas reported that they do not have enough money for food compared about one-fifth of non-LGBT adults (19%). Similar proportions of LGBT and non-LGBT people reported that they do not have enough money to meet their health care needs.

The 2015 U.S. Transgender Survey report found that 17% of respondents in Texas were unemployed, and 34% were living in poverty.

LGBT Adults and Youth in Texas Experience Health Disparities

Research indicates that stigma and discrimination contribute to adverse health outcomes for LGBT people such as major depressive disorder, binge drinking, substance use, and suicidality. Similarly, bullying and family rejection, as well as social stigma more broadly, have been linked to the increased likelihood of school dropout, suicide, and substance use among LGBT youth.

LGBT adults in Texas who completed the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey were significantly more likely to have been diagnosed with a depressive disorder by a health care professional than non-LGB adults who completed the survey (29.8% v. 16.8%). In addition, LGBT adults were significantly more likely to report binge drinking than non-LGBT adults (25.5% v. 14.3%).

The 2015 Youth Risk Behavior Survey from Houston and Fort Worth found that LGB students were much more likely to have seriously considered suicide in the year prior to the survey compared to non-LGB students (Houston: 34.5% v. 11.6%; Fort Worth: 40.7% v. 11.3%).

LGB students in Houston and Fort Worth were also more likely than non-LGB students to report smoking cigarettes (Houston: 30.5% v. 14.7%; Fort Worth: 20.0% v. 12.5%), drinking (Houston: 36.7% v. 24.9%; Fort Worth: 38.3% v. 28.2%), and using marijuana (Houston: 26.6% v. 18.0%; Fort Worth: 35.2% v. 18.3%) in the month prior to the survey.

Economic Impacts of Stigma and Discrimination

Discrimination against LGBT People in Employment and Other Settings Has Economic Consequences for Employers and the State Government

Productivity. Unsupportive work environments can mean that LGBT employees are less likely to be open about their sexual orientation or gender identity at work, and more likely to be distracted, disengaged, or absent, and to be less productive. These outcomes could lead to economic losses for state and local governments, as employers, and private businesses in the state. Given that over 520,000 workers in Texas identify as LGBT, the loss in productivity from a discriminatory environment could be significant.

Retention. LGBT employees in less supportive work environments feel less loyal to their employers, and are more likely to plan to leave their jobs. Given the average replacement costs of an employee, public and private employers risk losing $9,300, on average, for each employee that leaves the state or changes jobs because of an unsupportive policy or social environment in Texas.

Recruitment. Many LGBT and non-LGBT workers, in particular those who are younger and more highly educated, prefer to work for companies with more LGBT-supportive policies, and in states with more supportive laws. To the extent that workers from other states perceive Texas to be unsupportive of LGBT people, it may be difficult for public and private employers in the state to recruit talented employees from other places.

Public Benefits Expenditures. Discrimination in employment and housing can lead to hardships for individuals including lower earnings, underemployment or unemployment, and loss of housing, which in turn can lead to increased reliance on public benefits. As an illustration of how the state is impacted by the economic instability of LGBT residents, we estimate that discrimination in the workplace and in housing against transgender people annually costs Texas approximately $1,253,000 in state Medicaid expenditures and $372,000 in homeless shelter expenditures.

Bullying and Family Rejection of LGBT Youth Negatively Impact the Economy

Bullying and family rejection of LGBT youth can cause them to miss or drop out of school, become homeless, or unemployed or underemployed.

In response to the 2015 U.S. Transgender Survey report, of those respondents from Texas who said they had been harassed in school, 14% reported that the harassment was so severe that they had to drop out.

School drop-out and homelessness that arise due to bullying and family rejection are harmful not only to individual LGBT youth, but also have societal consequences in that they reduce the capacity of these youth to contribute to the economy as adults.

In addition, school-based harassment and family rejection can increase costs to the state via Medicaid expenditures, incarceration, and lost wages. The Jim Casey Foundation has estimated that homelessness, juvenile justice involvement, and poor educational and employment outcomes cost nearly $8 billion per cohort that ages out of foster care each year in the U.S. The best available data suggest that LGBT youth make up one-fifth, if not more, of each annual aging out cohort.

Health Disparities for LGBT People Negatively Impact the Economy

A more supportive legal landscape and social climate for LGBT people in Texas is likely to reduce health disparities between LGBT and non-LGBT people which would increase worker productivity and reduce health care costs.

We estimate that reducing the disparity in major depressive disorder between LGBT and non-LGBT people in Texas by 25% to 33.3% could benefit the state's economy by $289.9 million to $385.3 million, and reducing the disparity in binge drinking by the same proportion could benefit the state's economy by $118.3 million to $157.2 million in increased productivity and reduced health care costs each year. To the extent that a more supportive legal landscape and social climate would reduce other health disparities, the state's economy would benefit even more.

The Impact of Stigma and Discrimination Against LGBT People in Texas

Overview

Highlights

Data Points

Report

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The Impact of Stigma and Discrimination Against LGBT People in Texas - Williams Institute

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Texas's legal landscape and social climate put LGBT residents at risk of discrimination and harassment. The social, economic and health effects of stigma and discrimination against LGBT people negatively impact Texas's economy by tens of millions of dollars each year. Texas's non-discrimination laws do not expressly include sexual orientation or gender identity as protected characteristics.

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Families are major source of abuse for gay women, trans people, report says

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Families are major source of abuse for gay women, trans people, report says

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LONDON (Thomson Reuters Foundation) - Family members are often the main perpetrators of abuse against lesbians, bisexual women and transgender people, according to a major global report published on Monday.

The study of 24 countries by Britain's leading LGBT+ rights organisation Stonewall found participants in Zimbabwe in particular were more likely to suffer violence from relatives than from strangers.

More than half of the people in the southern African nation who took part in the two-year "Out of the Margins" project said they had experienced physical abuse at the hands of family members.

In Venezuela, all of the trans men who were surveyed reported attacks by relatives. Mothers in Venezuelan families were cited as the main aggressors by 71% of bisexuals and 48% of lesbians.

Dima, a respondent to the report in Russia's Chechen Republic who did not give his surname, told the researchers that a lesbian friend of his was killed by her husband's relatives when they found out she was gay.

"Out of the Margins", which also conducted reports on nations including Trinidad and Tobago, Montenegro, Burundi and Peru, found "striking levels of discrimination and violence against trans children and young people in schools".

The report noted that many people in Burundi had been unable to complete their education after being thrown out of their homes because of their sexuality or gender identity.

One respondent from the African country told researchers she was forced "to quit school because I couldn't find money to pay my school fees" after her mother ordered her to leave home due to being involved in a same-sex relationship.

"Out of the Margins" examined the global situation across Sub-Saharan Africa, Europe and Central Asia, and Latin America and the Caribbean from the perspective of five of the 17 United Nations' Sustainable Development Goals.

Focusing on health, economic well-being, education, personal security and violence, and civic and political participation, the report uncovered significant issues, particularly in terms of economic inequality and access to healthcare and education.

Alexandra Hernandez, executive director of Peru-based LGBT+ rights group Mas Igualdad (More Equality), said trans and non-binary people - who do not define themselves as male or female - faced discrimination and violence in the Andean country and elsewhere in Latin America.

"For lesbians and bisexual women, (reports of) sexual violence were particularly high," Hernandez told the Thomson Reuters Foundation by phone last week.

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Families are major source of abuse for gay women, trans people, report says

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LONDON (Thomson Reuters Foundation) - Family members are often the main perpetrators of abuse against lesbians, bisexual women and transgender people, according to a major global report published on Monday. The study of 24 countries by Britain's leading LGBT+ rights organisation Stonewall found participants in Zimbabwe in particular were more likely to suffer violence from relatives than from strangers.

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Summary

In this article, we address theories of attachment and parental acceptance and rejection, and their implications for lesbian, gay, bisexual, and transgender (LGBT) youths' identity and health. We also provide two clinical cases to illustrate the process of family acceptance of a transgender youth and a gender nonconforming youth who was neither a sexual minority nor transgender. Clinical implications of family acceptance and rejection of LGBT youth are discussed.

Keywords: LGBT, youth, family, support, acceptance

Introduction

In this article, we discuss sexual minority, i.e., lesbian, gay, and bisexual (LGB) and transgender (LGBT) youth. Sexual orientation refers to the individual's object of sexual or romantic attraction or desire, whether of the same or other sex relative to the individual's sex, with sexual minority individuals having a sexual orientation that is partly or exclusively focused on the same sex. Transgender refers to individuals for whom current gender identity and sex assigned at birth are not concordant, whereas cisgender refers to individuals for whom current gender identity is congruent with sex assigned at birth. Sexual orientation and gender identity are distinct aspects of the self. Transgender individuals may or may not be sexual minorities, and vice versa. Little is known about transgender youth, although some of the psychosocial experiences of cisgender sexual minority youth may generalize to this population.

The Institute of Medicine recently concluded that LGBT youth are at elevated risk for poor mental and physical health compared with heterosexual and cisgender peers. Indeed, representative samples of youth have found disparities by sexual orientation in health-related risk behaviors, symptomatology, and diagnoses, with disparities persisting over time. Furthermore, sexual orientation disparities exist regardless how sexual orientation is defined, whether by sexual or romantic attractions; sexual behaviors; self-identification as heterosexual, bisexual, lesbian/gay or other identities; or, any combination thereof. Disparities by gender identity have also been found, with transgender youth experiencing poorer mental health than cisgender youth.

Attempts have been made to understand sexual orientation and gender identity-related health disparities among youth. It has been argued that sexual minority youth experience stress associated with society's stigmatization of homosexuality and of anyone perceived to be homosexual [see Ch. 5]. This "gay-related" or "minority" stress is experienced at the hands of others as victimization. It is also internalized, such that sexual minorities victimize the self by means, for example, of possessing negative attitudes toward homosexuality, known as internalized homonegativity or homophobia. In addition to interpersonal stigma and internalized stigma, the main focus of this article, structural stigma reflected in societal level norms, policies and laws also plays a significant role in sexual minority stress, and is discussed in Mark Hatzenbeuhler's article, "Clinical Implications of Stigma, Minority Stress, and Resilience as Predictors of Health and Mental Health Outcomes," in this issue. Meta-analytic reviews find that sexual minorities experience more stress relative to heterosexuals, as well as unique stressors. Research also indicates that transgender individuals experience substantial amounts of prejudice, discrimination, and victimization and are thought to experience a similar process of minority stress as experienced by sexual minorities, although minority stress for transgender individuals is based on stigma related to gender identity rather than stigma related to having a minority sexual orientation. Stigma related to gender expression affects those with gender non-conforming behavior, a group that includes both transgender and cisgender individuals. This includes many cisgender youth growing up with LGB orientations.

Actual or anticipated family acceptance or rejection of LGBT youth is important in understanding the youth's experience of minority stress, how the youth is likely to cope with the stress, and consequently, the impact of minority stress on the youth's health. This article addresses the role of family, in particular parental acceptance and rejection in LGBT youths' identity and health. Literature reviewed in this article focuses on the experiences of sexual minority cisgender youth due to a lack of research on transgender youth. However, we include findings and implications for transgender youth whenever possible.

Theories of Parental Acceptance and Rejection

The continued importance of parents in the lives of youth is indisputable: beginning at birth, extending through adolescence and even into emerging adulthood, affecting all relationships beyond those with the parents, and determining the individual's own sense of self-worth. Attachment accounts for this vast reach and influence of parents.

According to Bowlby, attachment to the primary caretaker guarantees survival because the attachment system is activated during stress and concerns the accessibility and responsiveness of the attachment figure to the child's distress and potential danger. The pattern or style of attachment that develops is based on repeated interactions or transactions with the primary caregiver during infancy and childhood. Those experiences, in interaction with constitutional factors like temperament, influence the internal working model (i.e., mental representations of emotion, behavior, and thought) of beliefs about and expectations concerning the accessibility and responsiveness of the attachment figure. In time, this internal working model influences perception of others, significantly influencing patterns in relationships over time and across settings. The beliefs and expectations concerning the attachment figure also affect the internal working model of the self, meaning the individual's sense of self-worth.

The three consistent patterns of attachment that arise in infancy and childhood are related to the internal working models of the self and other. The "secure" child has positive models of the self and other because the primary attachment figure has been accessible when needed and responsive in an attuned and sensitive manner to the child's needs and capabilities. Consequently, the securely attached child is able to regulate emotion, explore the environment, and become self-reliant in an age-appropriate manner. The "insecure" child has an inaccessible and unresponsive primary caregiver, who is intrusive, erratic or abusive. One of two insecure attachment patterns emerges. In the first pattern, the child dismisses or avoids the parent, becoming "compulsively" self-reliant and regulating emotion even when contraindicated. This child with "avoidant/dismissive" attachment depends on the self, possessing a positive internal working model of the self but a negative one of the other. In the second insecure attachment pattern, the child is anxiously preoccupied with the caregiver but in a resistant (i.e., distressed or aroused) manner. The individual with "anxious/preoccupied/resistant/ambivalent" attachment has a negative working model of the self, but a positive model of the other.

Attachment patterns in childhood are partly related to character traits in adulthood, and have implications for emotion regulation from the perspective of coping with stress, as detailed elsewhere. Based on positive working models of the self and other, the securely attached individual approaches a stressful situation in an adaptive manner that allows for a realistic appraisal of the situation and a selection of coping strategies most likely to reduce or eliminate the stressor or, at minimum, render the stressor tolerable. By comparison, insecurely attached individuals may distort reality because they may be more likely to appraise a situation as stressful even when it is not. They may also be maladaptive in their management of stress and use emotion-focused coping strategies, such as substance use, to improve mood and tolerate stress. These patterns of coping influenced by attachment are present by and common in adolescence. Coping is critical because sexual orientation and gender development are potentially stressful experiences for all youth, but especially for sexual and gender minorities, given the frequent stigmatization of homosexuality, gender non-conforming behavior, and gender-variant identities.

Implications for Parent-Child Attachment

The vast majority of sexual minority youth are born to heterosexual parents. Those parents may not uncommonly possess implicit or explicit negative attitudes toward homosexuality and expect their children to be heterosexual. Parents may not only be surprised that their child may be or is a sexual minority, but they may also respond negatively to the child. Similarly, the vast majority of transgender and/or gender nonconforming youth are born to cisgender and/or gender conforming parents, who often possess negative attitudes toward those who violate societal expectations for gender identity, expression, and roles, and expect their children to be cisgender and gender conforming. Negative responses from parents to LGBT youth may range from anxious concerns about the child's well-being and future to abuse and even banishment of the child from the home.

The range of possible parental responses to the child's sexual orientation, gender-related behavior or identity when these deviate from parental expectation is linked to the child's attachment. The securely attached youth has parents who have encouraged age-appropriate exploration and value the child as a unique individual. Such parents may be surprised and concerned by the child's sexual minority orientation, gender non-conformity, or transgender identity, but they are likely to work through their negative attitudes over time and continue to be accessible and responsive to their child. Thus, the attachment of the securely attached youth may be shaken when parents learn of these, but it is unlikely to be undone. This does not apply to insecurely attached youth, given their a priori inaccessible, unresponsive, and potentially abusive parents. Knowledge of these deviations from expectation, coupled with negative attitudes, may lead such parents to be less supportive of their child, or reject them. The latter may manifest in parental abuse of the youth, running away by the youth to escape maltreatment, or eviction of the youth from the home.

Representative samples of youth find that relative to heterosexual peers, sexual minorities report lower levels of parental closeness and elevated rates of parental abuse and homelessness. Transgender youth also report elevated rates of child abuse compared to cisgender peers. More specifically, sexual minority youth relative to heterosexual peers and siblings report less secure attachment to their mothers and their mothers report less affection for them. It has also been found that maternal attachment mediates sexual orientation disparities in depressive symptomatology and substance use. These disparities in sexual and gender minority youth from their and gender normative peers and siblings involving the degree of attachment underscore the importance of parental attitudes toward non-heterosexual orientations, gender non-conforming behavior, and gender identity variance for secure attachment in youth. Pediatric clinicians should assess these and the quality of the parent-child attachment.

These attachment implications and findings take on added meaning when considered along with youth's neurocognitive development and coping capabilities. It is known that development of the prefrontal cortex lags behind that of limbic regions during adolescence, ensuring less impulse control and greater risk taking. The findings extend to emotion regulation. Human imaging studies demonstrate that youth have a difficult time down-regulating amygdala activation. Therefore, coping in youth is circumscribed by limited ability to rationally or logically plan, execute, evaluate, and readjust a problem-focused strategy to eliminate or reduce stress, while simultaneously controlling emotional reactivity.

Consequently, youth greatly depend on adults, especially parents, both to assist them with meeting developmental demands and to guide their personal experiences in various domains (e.g., interpersonal, romantic) and settings (e.g., school, work). LGBT youth with insecure attachment may have a difficult time navigating and coping with such challenges if their parents are inaccessible and unresponsive.

Nevertheless, attachment may change over time. This may happen if the attachment figure becomes more or less accessible and responsive, or if one attachment figure (e.g., the mother) buffers the negative impact of another attachment figure (e.g., the father). A non-parental individual may provide support, but whether she or he could provide the deep sense of security and the safe haven of an attachment figure is uncertain, particularly if social structures and cultural traditions do not foster these.

Parental Reactions to Gender Nonconformity

Gender nonconformity, defined as having a gender expression that is perceived to be inconsistent with gender norms expected for an individual's sex, is not uncommon in children. A study of gender atypical behavior (one aspect of gender nonconformity) among elementary school children found that approximately 23% of boys and 39% of girls displayed multiple gender atypical behaviors. Gender nonconformity exists on a spectrum, with some children displaying less and some children displaying more gender nonconformity. This spectrum has implications for victimization, such that youth who are more gender nonconforming are at increased risk for abuse by caregivers, as well as peer victimization and bullying (see Mark Hatzenbeuhler's article, "Clinical Implications of Stigma, Minority Stress, and Resilience as Predictors of Health and Mental Health Outcomes," in this issue) and an increased risk of depressive symptoms. Although a link exists between childhood gender nonconformity and later sexual minority orientation and/or transgender identity, not all children who are gender nonconforming are LGB or transgender in later adolescence or adulthood.

As with stigma attached to sexual minorities and transgender individuals, gender nonconformity is also stigmatized in and of itself, particularly among boys. Connell's theory of hegemonic masculinity sheds light on this stigma, as it suggests that one form of masculinity, with features such as aggression, limited emotionality, and heterosexuality, is culturally exalted above others. For this reason, variation from this level of masculinity among boys can be stigmatized. Similar to stigma related to sexual minorities and transgender individuals, stigma related to gender nonconformity is often enacted through prejudice, discrimination, and victimization. A study of early adolescents found that gender nonconformity was associated with increased victimization by peers. Youth who are sexual minorities may be bullied for gender nonconformity before they are aware of their sexual orientation. A recent study found that sexual minority youth were bullied as early as fifth grade, which is before the majority of sexual minority youth are aware of their sexual orientation or disclose it to others. Although the study did not assess the reason for bullying, it is possible that these youth were bullied based on gender nonconformity.

Negative societal views may include adverse parental reactions to a child's gender nonconformity. A qualitative study found that parents welcomed gender nonconformity among their daughters, but had mixed reactions to their sons' gender nonconformity; they accepted some level of nonconformity in their sons (e.g., interest in cooking), but had negative reactions to higher levels of nonconformity (e.g., wearing dresses). In addition to increased risk for bullying victimization from peers, previous research has found that gender nonconforming children have a high prevalence of childhood sexual abuse, physical abuse, and psychological abuse by caregivers, which may be indicative of negative parental reactions to their child's gender nonconformity. Parents' initial reactions to gender nonconformity in their children may extend to reactions to youth's sexual orientation disclosure.

Parental Reactions to Youths' LGBT Disclosure

Disclosure of sexual orientation to family members is common among sexual minority youth. One study found that 79% of sexual minority youth had disclosed their sexual orientation to at least one parent, and two-thirds of youth had disclosed their orientation to at least one sibling and one extended family member. Another study of sexual minority emerging adults found that 46% of men and 44% of women had disclosed their sexual orientation to their parents. In this study, participants were more likely to disclose their sexual orientation to their mothers than to their fathers, and disclosures typically occurred around age 19 years in a face-to-face encounter.

A number of theories have been proposed to conceptualize the reactions of parents to their children's disclosure of sexual minority orientation, including mourning/loss paradigms based on Kubler-Ross's stage model of grief and family stress theory. Willoughby et al. applied family stress theory to parental reactions to their children's sexual orientation disclosure, proposing that reactions may depend on the availability of family-level resources (e.g., relational competencies) to manage stress, meanings that parents attributed to the stressful event (e.g., believing that sexual orientation is a choice), and co-occurring stressors (e.g., divorce, major illness). Although these theories are useful for understanding parents' reactions to their child's sexual orientation disclosure, some researchers have proposed that these models are limited in that they may not describe the reaction of all parents, account for developmental change in reactions over time, or consider the experiences of the child.

Parents may experience a number of different responses when faced with a disclosure of sexual minority orientation from their child, ranging from accepting to rejecting. Research in this area has yielded mixed results regarding the positivity and negativity of parental reactions. One study found that sexual minority youth who had disclosed their sexual orientation to family members reported more verbal and physical abuse by family members and more suicidality compared to youth who had not disclosed their orientation. However, this study was published in 1998 and much has changed since then regarding societal acceptance of sexual minorities. Another study found that among sexual minority youth who had disclosed their sexual orientation to their mother or father, the majority (89-97%) received a positive reaction. However, these findings may be misleading, given they do not consider how many youth have not disclosed to parents due to fear of negative reactions or rejection.

A review of the sexual minority literature finds that one-third of youth experience parental acceptance, another third experience parental rejection, and the remaining third do not disclose their sexual orientation even by their late teenage years and early twenties. The review also finds that regardless of initial reactions, parents generally become more accepting of their child over time. For instance, one study found that compared to sexual minority youth who had not disclosed their sexual orientation to parents, sexual minority youth who had disclosed their orientation reported more past sexual orientation-based verbal victimization from parents, but more current family support and less fear of future parental victimization, indicating greater acceptance over time. Whether such findings generalize to transgender youth is unknown. Our first case vignette at the end of this article illustrates areas needing more empirical research regarding transgender youth's disclosure of gender identity to parents.

The process of sexual orientation disclosure in families may be shaped by the values of the family system. In one study investigating traditional values and family acceptance of sexual minorities, families with a strong emphasis on traditional values (e.g., importance of religion, emphasis on marriage, emphasis on having children) were perceived as less accepting of sexual minority orientation than less traditional families. Parental responses to youth's disclosure of sexual minority orientation may also differ based on race/ethnicity or cultural levels of acceptance of sexual minority individuals (see Ch. 11, "Sociocultural Factors and LGBT Youth's Health-related behavior: The role of race/ethnicity, socioeconomic status, religion and culture"). However, only one study, as far as we know, has examined parental responses to youths' sexual orientation disclosure by race/ethnicity among young adult gay males of African-American, European-American, Mexican-American, and Vietnamese-American backgrounds. It found family responses to be similar across the four groups.

Additional research on levels of family support and rejection of sexual minority youth has found group differences by sexual orientation, race/ethnicity, and gender identity. A study of sexual orientation group differences in parental support of young adults found that lesbian and bisexual women reported lower levels of parental support than heterosexual women, and that gay men reported lower levels of parental support than bisexual or heterosexual men. These group differences may be related to general attitudes toward different sexual orientation groups, indicating that attitudes toward sexual minority individuals are more negative than attitudes toward heterosexual individuals. Some race/ethnicity differences in level of family support have also been found. In a study of White and Latino sexual minority young adults, Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence. However, another study found similar levels of parental support among White and racial/ethnic minority LGBT youth. More research is needed to obtain a clearer picture of how race/ethnicity may be related to parental responses to sexual orientation disclosure among youth, as well as parental support and rejection of LGBT youth (see Ch. 11 for more information). Although there is little research on family support and rejection of transgender youth, some research has indicated that these youth report more rejection than cisgender youth. Further empirical research is needed on family support and rejection among transgender youth, particularly compared to cisgender sexual minority youth.

Implications for LGBT Youth Identity and Health

Levels of family acceptance and rejection may have implications for sexual minority youth's identity development. A study of sexual minority adolescents and young adults examined associations between parental acceptance and identity profiles that were affirmed as opposed to being characterized by struggle. Results indicated that less parental rejection was associated with a greater likelihood of having an affirmed identity than struggling with one's identity, suggesting that the level of parental rejection may affect youths' ability to accept their own sexual minority identity. Similarly, youth whose parents knew about their sexual orientation reported less "internalized homophobia" (or self-stigma - see Ch. 5, "Clinical Implications of Stigma, Minority Stress, and Resilience as Predictors of Health and Mental Health Outcomes") compared both to youth whose parents did not know about their sexual orientation and youth who newly disclosed their orientation to their parents over the course of the study.

Pediatric care providers should be aware that family rejection may have serious consequences for LGBT youth's physical and mental health. Studies have found that parental rejection is associated with health risk behaviors and poor mental and physical health outcomes among LGBT individuals. Sexual minority emerging adults with higher levels of family rejection were more likely to report attempted suicide, high levels of depression, and illegal drug use, and engagement in unprotected sexual intercourse. Parental rejection negatively affects health among both transgender and cisgender adolescents. In the Thai study referenced earlier, family rejection predicted adolescents' level of depression, suicidal thinking, and sexual risk behaviors among both transgender and cisgender youth.

Conversely, family acceptance may be protective for LGBT youth's health. Among sexual minority youth, adolescents whose mothers responded positively to their sexual orientation disclosure were less likely to use substances compared to those who had not disclosed their orientation to their parents or whose mothers and fathers did not react positively. In addition, family support and acceptance is associated with greater self-esteem, social support, general health status, less depression, less substance abuse, and less suicidal ideation and behaviors among LGBT youth. Family support is also associated with less substance use among LGBT youth. Among transgender youth specifically, parental support is protective against depression and associated with having a higher quality of life.

Clinical Implications

The preceding information underscores why it is important for providers of pediatric care to know the effects of family non-acceptance and rejection on youth; to understand specific threats to family acceptance affecting LGBT youth like parental stigma against LGB orientation, gender non-conforming behavior and/or gender variant identities; to assess these in youth and families; and to intervene appropriately in case of family non-acceptance or risk for it. The following case vignettes illustrate these principles in clinical practice.

Case 1 ( Box 1) illustrates several complexities of coming out as transgender during the later adolescent period. The burden of unshared personal information and associated shame and fears of rejection, especially by one's closest supports, combined with the mental effort required to maintain an external identity at odds with the internal sense of true self all contributed significantly to this patient's depression. Improvement in depression was observed with disclosure to the mother, but depression recurred following subsequent negative or ambivalent parental responses. Acceptance was achieved within a broader social network, but peer and other community support could not replace the desired parental reaction. Without the support of the parents, the patient regressed and acquiesced to the sex assigned at birth, followed by depression that required pharmacological treatment. Although the pediatrician and psychotherapist were not able to effect parental acceptance, treatment was used to clarify its importance as a way to set the stage for further family work or adaptive separation, individuation, and coping with ongoing family non-acceptance.

Box 1

A 16 year-old natal male presented to the physician with his mother and father with a chief complaint of depression. He reported feelings of worthlessness, failure, unhappiness, becoming easily overwhelmed and emotionally numb when stressed. During that first meeting he made a point of reporting that he had grown to feel more distant from his mother and father.

A referral was made for individual psychotherapy. During subsequent follow-up appointments the depression symptoms remained unchanged. There was ongoing resistance to therapy but during the course of care a positive alliance was developed with the physician. It was noted later in the treatment that the physician's neutral, inquisitive style, appearance of non-judgment and of agency for the patient, signaling of a primary alliance with the patient rather than the parents (while maintaining respect for the parents' interests) all helped to establish a good clinical alliance with the patient.

Seven months into the treatment relationship, an appointment was scheduled with the physician at the patient's request. The stated goal for the meeting was to inform the physician, "I'm a girl. I don't feel like I'm a girl, I am a girl." The patient reported constant preoccupation with thoughts related to their current gender identity, efforts to cope with already developed secondary sex characteristics and how to achieve gender affirmation. The patient indicated a preference for the use of feminine gender pronouns. The patient also chose to come out to her mother in the office with the physician present. Her mother was able to express an interest in understanding what was being explained to her but anticipated a slow process. The patient left the office indicating that the mother's response was consistent with her expectations.

The next scheduled appointment occurred two weeks later. By that time the patient had told her father who did not attend the visit. Her father's response was experienced as reserved and without clear acceptance or rejection. The drive to come out seemed to have been amplified since the initial experience with her mother. Beginning with a trusted faculty counselor at school and then with teachers and finally peers, she had informed members of her school and social community about her gender identity. The patient experienced their responses as supportive. There were no reports of explicit or implicit mistreatment. Her parents remained avoidant, however.

The patient felt an urgent drive to take action in the period after gender identity disclosure. After informing her broader social community, the patient sought to formally change her name and remained focused on gender affirmation. The family rejected the psychotherapist's suggestion to consult with a gender management service, saying they would not agree to this "until [he's] 18."

The patient's symptoms of depression continued, despite apparent relief and transient mood improvement immediately following the initial gender identity disclosure. As depression returned following her mother's and then father's avoidant responses, the patient appeared driven to repeat the disclosure to an expanding set of her social community. Each supportive encounter resulted in another transient improvement in mood, but these were always followed by recurrence of depression. Observing and discussing that process with the patient led to a calming of the fervent drive to act, but the depression remained. The patient eventually abandoned efforts to obtain a supportive and accepting response from the parents, and elected to defer pursuing further gender affirmation until able to do so independently, including suspending social transition such as requesting to be addressed by feminine name and pronoun. The depression was ultimately treated with antidepressant medication.

In Case 2 ( Box 2), the child benefited from the protective effects of supportive parents to whom she appeared to have a secure attachment. Her masculine gender expression provoked mistreatment from peers. The stress of her exclusion began to affect her psychological health, but was modified by her ability to share her feelings and experiences at school with her parents and to rely on their ability to provide support and take appropriate protective action. A good relationship with the pediatrician extended the foundation of support. Together they were able to care for the child through an environmental action that may have prevented the need for mental health care. This case also underscores that gender nonconforming behavior may, but does not necessarily, mean that the youth will have a LGB orientation or be transgender later in adolescence or adulthood.

Box 2

The pediatrician had provided primary care for a girl since her birth. She experienced an unremarkable early development and had remained medically healthy. She was clearly "a tomboy" as her mom would note, but this garnered no concern as it might if instead of a masculine girl she were a feminine boy. There was no interest in dolls or princesses, no comfort in wearing a dress, and no affinity for pink or purple. She wore jeans and T-shirts, played football with the boys at recess, and was comfortable getting dirty.

During her fourth grade year, a Monday office visit was scheduled after an episode of emesis at school. Her mother explained that the previous week, her daughter had been complaining of stomachaches and headaches in the morning. She had stayed home from school on Friday, but seemed better by that afternoon and over the weekend. On Monday morning she had again complained of feeling sick. Her examination was unremarkable. Physically she was well. Reassurance was given along with written authorization to return to school the next day.

School avoidance continued. Given the doctor's findings, she was not kept home. She began to pick at her skin and appeared unhappy. Her parents had always been caring and attentive though not intrusive. They asked what had been happening at school. Their daughter explained that a bully had called her "gay" and said she was "a lesbian". In the absence of effective intervention for bullying by her school, her persistent masculine gender expression elicited name-calling by a bully, which led to a group dynamic of teasing by other children at school. This led to widespread peer rejection and shunning. Her parents listened and supported her. A meeting was arranged at the school where the teacher acknowledged awareness of recent shifts in friendships. Although he and school administration acknowledged the problem, they did not implement standard anti-bullying interventions (see Ch. 6, "LGBT Youth and Bullying"), expressing confidence that the peer ostracism would pass quickly without school intervention.

However, peer perceptions of her sexual orientation and associated social ostracism did not change. With her parents' support and encouragement, she was able to attend school. Her skin picking resolved, but she remained unhappy. After speaking with their daughter, the parents requested a school district transfer, but were opposed by school administration.

Parents sought help from the pediatrician, asking for a letter of medical necessity. The pediatrician readily provided one that included information about negative health effects of bullying, social isolation and alienation resulting from gender nonconformity and perceived sexual minority status. She included information about increased risk of depression and suicide. After receiving the letter, the school district approved a transfer.

Adjustment to the new school, which had an antibullying policy and curriculum that included non-tolerance of bullying on the basis of sexual orientation and gender, was positive. The patient's mood improved quickly after the transfer. She found friends who introduced her to a new hobby of freestyle skateboarding. Now a teenager, she has become quite accomplished. Both she and her current boyfriend participate in the same competitive skateboard circuit.

Summary

In this article, we have discussed theories of attachment, parental acceptance and rejection, and implications of each for LGBT youths' identity and health. We have provided two clinical cases to illustrate the impact of family acceptance and rejection of a transgender youth and a gender nonconforming youth who was neither a sexual minority nor transgender. It is clear from existing research that family acceptance and rejection is crucial to the health and well-being of LGBT youth. However, the majority of research conducted in this area has focused on sexual minority cisgender youth. More research is needed to understand how family acceptance and rejection affects the health of transgender youth. Health care providers working with LGBT youth should address issues of family acceptance and rejection during clinical visits to ensure that youth develop a healthy sense of self in terms of their sexual orientation and gender identity.

​

Footnotes

The authors have nothing to disclose.

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

References

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In this article, we address theories of attachment and parental acceptance and rejection, and their implications for lesbian, gay, bisexual, and transgender (LGBT) youths' identity and health. We also provide two clinical cases to illustrate the process of family acceptance of a transgender youth and a gender nonconforming youth who was neither a sexual minority nor transgender.

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Homelessness is a devastating experience that has a significant negative impact on an individual's physical and mental health, well-being, functioning, human development, and life trajectory-and LGBT runaway and homeless youth are at high risk for a number of negative experiences and outcomes. Recent studies, as well as anecdotal evidence from social service professionals, suggest that LGBT youth are significantly overrepresented in homeless populations compared with their proportion of the U.S. population. Analyses of available data have found that approximately 1.6 million (an estimated 1 in 7) U.S. youth ages 12 to 17 ran away from home and experienced at least one night of homelessness in 2002. Although research on the percentage of homeless youth who are LGBT varies, analyses suggest that approximately 20 percent to 40 percent of these youth identify as LGBT. Also, African American and Native American youth are disproportionately represented among LGBT homeless youth.

LGBT youth experience homelessness at higher rates than non-LGBT youth for a range of reasons. A recent study of more than 350 runaway and homeless providers throughout the United States identified four top causes for homelessness among LGBT youth: (1) family rejection resulting from sexual orientation or gender identity; (2) physical, emotional, or sexual abuse; (3) aging out of the foster care system; and (4) financial and emotional neglect.

Experiences of LGBT Homeless Youth

In shelters, while searching for housing, and on the streets, these youth may endure traumatic experiences, such as harassment, stigmatization, and abuse from peers and shelter staff as a result of their sexual orientation and/or gender expression. Youth may find it difficult to find housing and may be asked to leave shelters after revealing their sexual or gender identity. As a result of harassment and negative experiences in shelters, LGBT youth are more likely to live on the streets than their heterosexual peers and are especially vulnerable to physical and sexual exploitation. LGBT youth who are homeless also experience high rates of conduct disorder, post-traumatic stress, and suicidal behavior.

Supporting LGBT Homeless Youth

To address these challenges, LGBT youth who are homeless need access to safe, supportive housing. Street outreach, homeless shelters, transitional living programs, and other housing programs and services for youth should be free of bias and harassment and provide access to culturally competent services that affirms their identity and welcomes them. This requires strategies to improve the cultural competence of staff working in these programs and providing these services, including how staff are screened before being hired; professional development of current staff; and development of partnerships with the LGBT community to connect youth with adult LGBT role models. Runaway and homeless youth services should also follow positive youth development and trauma-informed approaches (PDF, 9 pages) in providing care and supports. Such an approach requires that system and program policies, practices, structures, and values are grounded in knowledge and understanding of trauma. Care that is not trauma informed risks inadvertent retraumatization of vulnerable youth. A trauma-informed approach focuses on physical, psychological, and emotional safety. Many youth who are homeless have experienced chaotic and violent environments. Youth can more easily heal when they feel safe. It is also important for runaway and homeless youth services to

promote positive youth development;

provide safe spaces for LGBT youth;

offer services and supports to reconnect youth with their families when it is safe to do so;

connect youth to community resources and services that are affirming and safe for LGBT young people; and

expand public awareness about LGBT youth issues and decrease stigma associated with LGBT identity.

Furthermore, it is worth noting that the U.S. Department of Housing and Urban Development has recently taken steps to provide equal access to housing for LGBT youth and adults, limit discrimination, and provide resources for reporting discrimination.

Visit the Families page for more information about the important role of families for LGBT youth, and view the Runaway and Homeless Youth Topic to learn more about runaway and homeless youth.

Resources

Framework to End Youth Homelessness: A Resource Text for Dialogue and Action (PDF, 19 pages)
The United States Interagency Council on Homelessness Framework to End Youth Homelessness (youth framework) provides clarity on how to address youth homelessness to help reach the federal goal of ending homelessness among children and youth by 2020.

A Guide for Understanding, Supporting, and Affirming LGBTQI2-S Children, Youth, and Families (PDF, 19 pages)
This guide, written by members of the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration's (SAMHSA) National Workgroup to Address the Needs of Children and Youth Who Are LGBTQI2-S and Their Families, provides information for service providers, educators, allies, and community members who seek to support the health and well-being of children and youth who are lesbian, gay, bisexual, transgender, questioning, intersex, or two-spirit (LGBTQI2-S) and their families. This guide can support efforts to promote full and affirming inclusion of LGBTQI2-S youth and families in communities and provider settings (e.g., child welfare, juvenile justice, mental health, schools). The guide's last page includes a place for organizations to add their endorsement electronically. Both the National Association of School Psychologists (NASP) and the National Association of Social Workers (NASW) have endorsed the guide.

training and technical assistance

publications and materials

online learning opportunities

networking and collaboration.

Identifying and Serving LGBTQ Youth: Case Studies of Runaway and Homeless Youth Program Grantees (PDF, 52 pages)
This report summarizes findings from four case studies of four ACF runaway and homeless youth (RHY) program grantees that serve LGBT and questioning youth. The report's findings address four topics: (1) agencies' collection and use of data on clients' sexual orientation and gender identity, (2) providers' assessment and perceptions of needs and capacities among LGBT and questioning RHY, (3) providers' approaches to serving LGBT and questioning RHY, and (4) providers' perceptions of research gaps and data needs related to services for LGBT and questioning RHY.

Learning from the Field: Expert Panel on Youth Who Are LGBTQI2-S and Homeless (Summary of Proceedings) (PDF, 50 pages)
This document highlights key issues, strategies, best practices, and next steps for collaboration between the Homelessness Resource Center and other stakeholders to address homelessness among LGBT youth.

¹ Poirier, Murphy, Shelton, & Costello, 2013
² Ray, 2006
³ Center for American Progress, 2010; Ray, 2006
⁴ Durso & Gates, 2012
⁵ Centrone, Kenney, & Shapiro, 2009
⁶ Durso & Gates, 2012
⁷ Homelessness Resources Center, n.d., 2010; Kenney, Fisher, Grandin, Hanson, & Winn, 2012; Ray 2006
⁸ Lambda Legal, National Alliance to End Homelessness, National Network for Youth, & National Center for Lesbian Rights, 2009
⁹ Ray, 2006
¹⁰ Poirier, Murphy, Shelton, & Costello, 2013; Poirier, Fisher, Hunt, & Bearse, 2014
¹¹ Kenney, Fisher, Grandin, Hanson, & Winn, 2012
¹² Guarino, Soares, Konnath, Clervil, & Bassuk, 2009
¹³ Guarino et al., 2009
¹⁴ Poirier, Murphy, Shelton, & Costello, 2013; Homeless Resource Center, 2010
¹⁵ Carroll, 2010

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Homelessness is a devastating experience that has a significant negative impact on an individual's physical and mental health, well-being, functioning, human development, and life trajectory-and LGBT runaway and homeless youth are at high risk for a number of negative experiences and outcomes.

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[Senator and boxing legend] Manny Pacquiao says we're not human. They should just let us be.

- Edgar T., an 18-year-old gay high school student in Manila, February 2017

Schools should be safe places for everyone. But in the Philippines, students who are lesbian, gay, bisexual, and transgender (LGBT) too often find that their schooling experience is marred by bullying, discrimination, lack of access to LGBT-related information, and in some cases, physical or sexual assault. These abuses can cause deep and lasting harm and curtail students' right to education, protected under Philippine and international law.

In recent years, lawmakers and school administrators in the Philippines have recognized that bullying of LGBT youth is a serious problem, and designed interventions to address it. In 2012, the Department of Education (DepEd), which oversees primary and secondary schools, enacted a Child Protection Policy designed to address bullying and discrimination in schools, including on the basis of sexual orientation and gender identity. The following year, Congress passed the Anti-Bullying Law of 2013, with implementing rules and regulations that enumerate sexual orientation and gender identity as prohibited grounds for bullying and harassment. The adoption of these policies sends a strong signal that bullying and discrimination are unacceptable and should not be tolerated in educational institutions.

But these policies, while strong on paper, have not been adequately enforced. In the absence of effective implementation and monitoring, many LGBT youth continue to experience bullying and harassment in school. The adverse treatment they experience from peers and teachers is compounded by discriminatory policies that stigmatize and disadvantage LGBT students and by the lack of information and resources about LGBT issues available in schools.

This report is based on interviews and group discussions conducted in 10 cities on the major Philippine islands of Luzon and the Visayas with 76 secondary school students or recent graduates who identified as LGBT or questioning, 22 students or recent graduates who did not identify as LGBT or questioning, and 46 parents, teachers, counselors, administrators, service providers, and experts on education. It examines three broad areas in which LGBT students encounter problems-bullying and harassment, discrimination on the basis of sexual orientation and gender identity, and a lack of information and resources-and recommends steps that lawmakers, DepEd, and school administrators should take to uphold LGBT students' right to a safe and affirming educational environment.

The incidents described in this report illustrate the vital importance of expanding and enforcing protections for LGBT youth in schools. Despite prohibitions on bullying, for example, students across the Philippines described patterns of bullying and mistreatment that went unchecked by school staff. Carlos M., a 19-year-old gay student from Olongapo City, said: "When I was in high school, they'd push me, punch me. When I'd get out of school, they'd follow me [and] push me, call me 'gay,' 'faggot,' things like that." While verbal bullying appeared to be the most prevalent problem that LGBT students faced, physical bullying and sexualized harassment were also worryingly common-and while students were most often the culprits, teachers ignored or participated in bullying as well. The effects of this bullying were devastating to the youth who were targeted. Benjie A., a 20-year-old gay man in Manila who was bullied throughout his education, said, "I was depressed, I was bullied, I didn't know my sexuality, I felt unloved, and I felt alone all the time. And I had friends, but I still felt so lonely. I was listing ways to die."

The mistreatment that students faced in schools was exacerbated by discriminatory policies and practices that excluded them from fully participating in the school environment. Schools impose rigid gender norms on students in a variety of ways-for example, through gendered uniforms or dress codes, restrictions on hair length, gendered restrooms, classes and activities that differ for boys and girls, and close scrutiny of same-sex friendships and relationships. For example, Marisol D., a 21-year-old transgender woman, said:

When I was in high school, there was a teacher who always went around and if you had long hair, she would call you up to the front of the class and cut your hair in front of the students. That happened to me many times. It made me feel terrible: I cried because I saw my classmates watching me getting my hair cut.

These policies are particularly difficult for transgender students, who are typically treated as their sex assigned at birth rather than their gender identity. But they can also be challenging for students who are gender non-conforming, and feel most comfortable expressing themselves or participating in activities that the school considers inappropriate for their sex.

Efforts to address discrimination against LGBT people have met with resistance, including by religious leaders. The Catholic Bishops' Conference of the Philippines (CBCP) has condemned violence and discrimination against LGBT people, but in practice, the Roman Catholic Church has resisted laws and policies that would protect LGBT rights. The CBCP has sought to weaken anti-discrimination legislation pending before Congress, for example, and has opposed implementation of comprehensive sexuality education in schools. Representatives of the Church warn that recognizing LGBT rights will open the door to same-sex marriage, and oppose legislation that might promote divorce, euthanasia, abortion, total population control, and homosexual marriage, which they group under the acronym "DEATH." In a country that is more than 80 percent Catholic, opposition from the Church influences how LGBT issues are addressed in families and schools, with many parents and teachers telling students that being LGBT is immoral or wrong.

One way that schools can address bullying and discrimination and ameliorate their effects is by providing educational resources to students, teachers, and staff to familiarize them with LGBT people and issues. Unfortunately, positive information and resources regarding sexual orientation and gender identity are exceedingly rare in secondary schools in the Philippines. When students do learn about LGBT people and issues in schools, the messages are typically negative, rejecting same-sex relationships and transgender identities as immoral or unnatural. Juan N., a 22-year-old transgender man who had attended high school in Manila, said, "There would be a lecture where they'd somehow pass by the topic of homosexuality and show you, try to illustrate that in the Bible, in Christian theology, homosexuality is a sin, and if you want to be a good Christian you shouldn't engage in those activities." Virtually all the students interviewed by Human Rights Watch said the limited sexuality education they received did not include information that was relevant to them as LGBT youth, and few reported having access to supportive guidance counselors or school personnel.

When students face these issues-whether in isolation or together-the school can become a difficult or hostile environment. In addition to physical and psychological injury, students described how bullying, discrimination, and exclusion caused them to lose concentration, skip class, or seek to transfer schools-all impairing their right to education. For the right to education to have meaning for all students-including LGBT students-teachers, administrators, and lawmakers need to work together with LGBT advocates to ensure that schools become safer and more inclusive places for LGBT children to learn.

To the Congress of the Philippines

Enact an anti-discrimination bill that prohibits discrimination on the basis of sexual orientation and gender identity, including in education, employment, health care, and public accommodations.

To the Department of Education

Create a system to gather and publish data about bullying on the basis of sexual orientation and gender identity in schools. Revise forms to more clearly differentiate and record incidents of gender-based bullying on the basis of sex, sexual orientation, and gender identity, and include these categories on all forms related to bullying, abuse, or violence against children.

Revise the standard sexuality education curriculum to ensure it aligns with UNESCO's guidelines for comprehensive sexuality education, is medically and scientifically accurate, is inclusive of LGBT youth, and covers same-sex activity on equal footing with other sexual activity.

Issue an order instructing schools to respect students' gender identity with regard to dress codes, access to facilities, and participation in curricular and extracurricular activities.

To Local Officials

Enact local ordinances to prohibit discrimination on the basis of sexual orientation and gender identity, particularly in education, employment, healthcare, and public accommodations.

To School Administrators

Adopt anti-bullying and anti-discrimination policies that are inclusive of sexual orientation and gender identity, inform students how they should report incidents of bullying, and specify consequences for bullying.

Human Rights Watch conducted the research for this report between September 2016 and February 2017 in 10 cities on the major islands of Luzon and the Visayas in the Philippines. To identify interviewees, we conducted outreach through LGBT student groups, particularly at the university level. Human Rights Watch interviewed members of those groups as well as students who were known to those groups, whether or not they had experienced discrimination in school. We sought interviews with students of diverse sexual orientations and gender identities, but gay boys and transgender girls were disproportionately represented among the students identified by LGBT groups and the students who attended the group discussions.

Human Rights Watch conducted a total of 144 interviews, including with 73 secondary school students or recent graduates who affirmatively identified as LGBT or questioning, 25 students or recent graduates who did not affirmatively identify as LGBT or questioning, and 46 parents, teachers, counselors, administrators, service providers, and experts on education. Of the LGBT students, 33 identified as gay, 12 identified as transgender girls, 10 identified as bisexual girls, 6 identified as lesbians, 4 identified only as "LGBT," 3 identified as transgender boys, 2 identified as bisexual boys, 2 identified as questioning, and 1 identified as a panromantic girl.

Interviews were conducted in English or in Tagalog or Visayan with the assistance of a translator. No compensation was paid to interviewees. Whenever possible, interviews were conducted one-on-one in a private setting. Researchers also spoke with interviewees in pairs, trios, or small groups when students asked to meet together or when time and space constraints required meeting with members of student organizations simultaneously. Researchers obtained oral informed consent from interviewees after explaining the purpose of the interviews, how the material would be used, that interviewees did not need to answer any questions, and that they could stop the interview at any time. When students were interviewed in groups, those who were present but did not actively volunteer information were not counted in our final pool of interviewees.

Human Rights Watch sent a copy of the findings in this report by email, fax, and post to DepEd on May 15, 2017 to obtain their input on the issues students identified. Human Rights Watch requested input from DepEd by June 2, 2017 to incorporate their views into this report, but did not receive a response.

In this report, pseudonyms are used for all interviewees who are students, teachers, or administrators in schools. Unless requested by interviewees, pseudonyms are not used for individuals and organizations who work in a public capacity on the issues discussed in this report.

Synonym in many parts of the world for homosexual; primarily used here to refer to the sexual orientation of a man whose primary sexual and romantic attraction is towards other men. In the Philippines, the term "gay" can also refer to a person who is assigned male at birth but expresses themselves in a feminine manner or identifies as a woman.

A descriptor for people who do not conform to stereotypical appearances, behaviors, or traits associated with their sex assigned at birth.

A sexual orientation in which a person's primary sexual and romantic attractions are toward people of the same sex.

The Philippines has a long history of robust LGBT advocacy. In 1996, LGBT individuals and groups held a solidarity march to commemorate Pride in Manila, which many activists describe as the first known Pride March in Asia. Lawmakers began introducing bills to advance the rights of LGBT people in the country in 1995, including variations of a comprehensive anti-discrimination bill that has been reintroduced periodically since 2000.

In the absence of federal legislation, local government units across the Philippines have begun to enact their own anti-discrimination ordinances that prohibit discrimination on the basis of sexual orientation and gender identity. As of June 2017, 15 municipalities and 5 provinces had ordinances prohibiting some forms of discrimination on the basis of sexual orientation or gender identity. Attitudes toward LGBT people are relatively open and tolerant; a survey conducted in 2013 found that 73 percent of Filipinos believe "society should accept homosexuality," up from 64 percent who believed the same in 2002. President Rodrigo Duterte has generally been supportive of LGBT rights as well. During his time as mayor, Davao City passed an LGBT-inclusive anti-discrimination ordinance, and on the campaign trail, he vocally condemned bullying and discrimination against LGBT people.

The anti-discrimination ordinances that have passed in the absence of federal legislation remain largely symbolic, as Quezon City is the only local government unit to follow the passage of its ordinance with implementing rules and regulations that are required to make such an ordinance enforceable. Even if fully enforced, these municipal and provincial ordinances would collectively cover only 15 percent of the population of the Philippines.

In spite of this opposition, activists' lengthy efforts to engage policymakers on LGBT issues have led to important protections for LGBT youth, as discussed below. But these protections have not been effectively implemented. They will need to be strengthened and expanded if they are to uphold the rights of LGBT youth in schools.

Existing Protections for LGBT Youth and Their Limitations

Child Protection Policy

In 2012, DepEd enacted a Child Protection Policy, which it describes as a "zero tolerance policy for any act of child abuse, exploitation, violence, discrimination, bullying and other forms of abuse." Among the acts prohibited by the policy are all forms of bullying and discrimination in schools, including on the basis of sexual orientation and gender identity.

The Anti-Bullying Law

Comprehensive Sexuality Education

Effects of Bullying and Discrimination

As DepEd and the Congress recognized with their initial efforts to address bullying in schools, exclusion and marginalization can exact a damaging toll on the rights and well-being of LGBT youth. In addition to the documentation contained in this report, data collected by the Philippine government, academics, and civil society organizations illustrate how bullying and harassment, discrimination, and a lack of access to information and resources are adversely affecting LGBT youth across the Philippines.

In the Philippines, as elsewhere, violence and discrimination place LGBT youth at heightened risk of adverse physical and mental health outcomes, including depression, anxiety, substance use, and suicide. As the Psychological Association of the Philippines has noted, "LGBT Filipinos often confront social pressures to hide, suppress or even attempt to change their identities and expressions as conditions for their social acceptance and enjoyment of rights. Although many LGBTs learn to cope with this social stigma, these experiences can cause serious psychological distress, including immediate consequences such as fear, sadness, alienation, anger and internalized stigma." This has been borne out in small-scale empirical studies on LGBT youth and mental health in schools. One such study found that LGBT high schoolers were preoccupied with stigma, violence, bullying, discrimination in school, and anxiety over their future career prospects. Nor do these problems end upon graduation from high school; another study determined that "LGBT college students exhibited extremely underdeveloped emotional and social capacity because they continue to experience stigma, prejudice and discrimination in the Philippine society that served as specific stressors that have an impact on their emotional and social intelligent behaviors."

On a broader scale, the increased risk of suicidal thoughts and attempts for LGBT youth is evident in nationally representative data. The results of the Young Adult Fertility and Sexuality Survey 3, for example, indicate that 16 percent of young gay and bisexual men in the Philippines had contemplated suicide, while only 8 percent of young heterosexual men had done so. Young gay and bisexual men were also more likely to attempt suicide, with 39 percent of those who had contemplated suicide actually attempting suicide, compared to 26 percent of their heterosexual peers. A similar trend was evident for young lesbian and bisexual women; 27 percent of young lesbian and bisexual women contemplated suicide compared to 18 percent of young heterosexual women, and of those who considered suicide, 6.6 percent of lesbian and bisexual women made suicide attempts compared to only 3.9 percent of their heterosexual peers. GALANG, a Philippine nongovernmental organization that works with lesbian and bisexual women and transgender people, found even higher rates among their constituencies. In a survey conducted in 2015, researchers from GALANG found that 18 percent of LBT respondents, who were almost all between the ages of 18 and 29, had attempted suicide.

Physical Bullying

As detailed below, very few of the students interviewed reported bullying to teachers, either because they felt that reporting would not resolve the bullying or because they feared that reporting would lead to retaliation by other students and make the situation worse. In some instances, teachers also participated in harassment. Such behavior is not only discriminatory toward students of different sexual orientations and gender identities, but deters students from turning to teachers and administrators for help when they are bullied or harassed by their peers.

Sexual Assault and Harassment

Verbal Harassment

The most common form of bullying that LGBT students reported in interviews with Human Rights Watch was verbal harassment. This included chants of " bakla, bakla," " bayot, bayot," "tomboy," or " tibo," using local terms for gay, lesbian, or transgender students in a mocking fashion.

Daniel R., an 18-year-old gay student in Bacacay, said "People will say gay-they'll say 'gay, gay,' repeating it, and insulting us." Ernesto N., a gay teacher in Cebu City, observed, "Here in the Philippines, being called bayot, it's discrimination. It's being told you're nothing, you're lower than dirt. That you're a sinner, that you should go to Hell."

Many students described being labeled as sinners or aberrations. Leon S., a 19-year-old gay student from Malolos, said that "[s]tudents would say that homosexuality is a sin." Marco L., a 17-year-old gay student in Bacacay, said that "[p]eople say ipako sa krus, that you should be crucified." Gabriel K., a 19-year-old gay student who attended high school in Manila, said people told gay students "that you have to be crucified because you're a sinner."

Others described how they were treated as though they were diseased or contagious. Felix P., a 22-year-old gay high school student in Legazpi, noted: "Here, they call us 'carriers'-there's a stereotype that gays are responsible for HIV." Benjie A., a 20-year-old gay man in Manila, recalled a classmate telling him "don't come near me because you'll make me gay."

Some students altered their behavior or personality in an attempt to avoid disapproval from classmates. Patrick G., a 19-year-old gay man who had attended high school in Cainta, said:

They were teasing me for being effeminate. I developed this concept of how a man should walk, how a man should talk. It became-maybe because of them calling me malamya [effeminate], I became the person that I'm not. I was forced to be masculine, just for them to stop teasing me.

In addition to verbal harassment by peers, many LGBT students described verbal harassment and slurs from teachers and administrators. Patrick G., a 19-year-old gay man, said that at his high school in Cainta, "[s]ometimes teachers would join in with ' bakla, bakla.'" Jerome B., a 19-year-old gay man from Cebu City, said that "it really feels bad, because the only figure you can count on is your teacher, and they're joining in the fun, so who should I tell about my problems?"

Cyberbullying

As students interact with their peers on social media and in other virtual spaces, cyberbullying has increasingly impacted LGBT youth in schools. LGBT students described anti-LGBT comments and slurs as well as rapidly spreading rumors facilitated by social media.

Leon S., a 19-year-old gay student from Malolos, said: "They would post things online, which is a far easier thing to do than say it personally.... I would post something, and they would comment about my sexual orientation. It was the usual, bakla, bading." Marisol D., a 21-year-old transgender woman, similarly noted, "Some of my friends would put comments like bakla, bakla on my posts. You just ignore it... [b]ecause if they see that you're being affected they'll bully you more." Carlos M., a 19-year-old gay student from Olongapo City, said, "My classmates would post stuff online-memes against LGBT, Satan saying 'I'm waiting for you here.'"

Cyberbullying also draws on stereotypes about LGBT students, and particularly transgender women and girls, with harsh disapprobation for those who were perceived to fall short of social expectations. Geoff Morgado, a social worker, observed that:

Intervention and Reporting

Human Rights Watch heard repeatedly that schools fail to instruct students about what bullying entails, how to report incidents when they occur, and what the repercussions will be. As a result, many schools convey tacit acceptance to perpetrators and leave victims unaware of whether or how they can seek help.

When students do not know how to report bullying and harassment or do not believe that reporting would be effective, they are unlikely to bring incidents to the attention of teachers and administrators. Jerome B., a 19-year-old gay man from Cebu City, said:

Interviews with LGBT students indicate that many teachers fail to intervene when they witness bullying or harassment occurring or it is brought to their attention, even since passage of the Anti-Bullying Law, which in turn discourages students from reporting cases of bullying. Analyn V., a 17-year-old bisexual girl in Mandaue City, said, "Teachers don't step in. They think it's a joke. But some jokes are below the belt. We conceal being hurt because maybe they think it's overreacting." "The teachers don't say anything or get mad -if they hear people saying bakla, they just smile or laugh," said Felix P., a 22-year-old gay high school student in Legazpi. "Teachers might ask the students to stop, but they don't punish them. And as soon as they leave, the bullying happens again."
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As a coalition of Philippine organizations has noted, in many instances, "[b]ullying and other forms of violence within the schools or education settings is steered by institutional policies," for example, "through gender-insensitive curricula, SOGI-insensitive school policies (e.g. required haircuts and dress codes), and [a] culture of bullying." As evidenced in the following sections, the many forms of exclusion and marginalization that LGBT youth experience in Philippine schools can reinforce one another. In schools where LGBT youth lack information and resources, for example, they may struggle more deeply with their sexual orientation or gender identity or be unsure where to turn for help. In schools where policies discriminate against LGBT youth, they may be placed in situations where bullying by peers is likely to occur and may feel administrators are unlikely to help them.

In addition to bullying and harassment, LGBT students encounter various forms of discrimination that make educational environments hostile or unwelcoming. To ensure that all youth feel safe and included in schools, school administrators should examine policies and practices that punish LGBT students for relationships that are considered acceptable for their heterosexual peers, restrict gender expression and access to facilities, and stereotype LGBT youth in a discriminatory manner.

School Enforcement of Stereotyped Gender Norms

Uniforms and Hair Length Restrictions

It is common practice for secondary schools in the Philippines to require students to wear uniforms. Under these policies, the attire is gender-specific and the two options, male or female, are typically imposed upon students according to the sex they were assigned at birth.

In addition to clothing, many secondary schools have strict hair-length restrictions for their students, particularly for boys. Almost all interviewees reported that boys could not grow out their hair past ear-length or dye their hair at their schools, and many also noted that girls were prohibited from wearing their hair shorter than a permissible length.

Students whose gender expression differed from the norms associated with their sex assigned at birth told Human Rights Watch how these restrictions impeded their education. Students reported that being forced to dress or present themselves in a manner that was inconsistent with their gender expression made them unhappy and uncomfortable, lessened their confidence, and impaired their concentration. As Del M., a 14-year-old lesbian student who was allowed to wear the boys' uniform, remarked, "It's easier for me to learn wearing the boys' uniform."

At many of these schools, students who did not conform to the uniform and hair-length requirements faced disciplinary action. Common punishments included being sent to the guidance or discipline offices and mandatory community service. Ella M., a 23-year-old transgender woman who had attended high school in Manila, described being punished solely on this basis of her general gender presentation. She said that her school's handbook punished an "act of effeminacy," not further defined, with "a conduct grade of 75, which basically means you did something really really bad. I might as well have cheated."

Marisol D., a 21-year-old transgender woman, said:

Other interviewees reported similar incidents in which teachers or prefects would publicly call out students in violation of the restrictions and forcibly cut their hair in front of the class.

Jerome B., a 19-year-old gay man, said that in his high school in Cebu City:

It applies for all boys. If [your hair] touches the ear and you don't cut it, the school will cut it for you, and they do it in front of your classmates. The Student Affairs Officer who enforces the rules, once a month he would go to each classroom and knock, and say, "All those with long hair go outside," and he would go one by one with these large, rusty scissors like the kind you see in horror movies, and they'd cut our hair in front of everybody....
I think on purpose, he'd cut it very badly.

In most cases, teachers and administrators provided little to no explanation for the hair-length requirements when students asked about the policies at their respective schools. Felix P., a 22-year-old gay high school student in Legazpi, told Human Rights Watch:

As Lyn C., a 19-year-old transgender woman in Manila, recounted, gendered clothing requirements also extended to school-sponsored events such as prom nights:

Even when students are formally permitted to wear the uniforms of their choice, however, school personnel at times harass or humiliate them in practice. Gabby W., a 16-year-old transgender girl in high school in Bayombong, told Human Rights Watch:

Uniform and Hair Length Restrictions in Universities

Although this report focuses on secondary schools, many interviewees said they had experienced similar issues with uniform and hair-length restrictions at the university level.

In some extreme cases, students who repeatedly "cross-dressed"-a term that schools and some students used to describe gay, lesbian, or transgender students expressing their gender in school-were suspended or even expelled. According to Danica J., a 19-year-old lesbian woman at a university in Manila, "people are punished if they violate the uniform policy. It's like a disciplinary action. They won't let you in if you're cross-dressing, and after a couple times, you can be suspended or expelled."

As one 19-year-old university student in Caloocan told Human Rights Watch,

In our school, there are policies that if you cross-dress you will be suspended for one day. Your freedom of expression is very limited. I know we had policies against LGBTQ. We had hair-length restrictions-for guys, the shaved hair has to be three inches on the side, four inches in the back. So every time, if the hair passes three to four inches, the faculty will cut our hair. And even here in the university, the handbook says male students must only have hair to their ears.

Even in universities without formal uniform or hair-length policies, however, transgender and gender-fluid students sometimes reported harassment or reprisals from teachers, classmates, and administrators when they expressed their gender. Patrick G., a 19-year-old gay man in Manila, said that despite a policy at his university guaranteeing students the freedom to dress based on their gender expression, he was aware of one case in which the Discipline Office (DO) summoned a transgender woman to interrogate her about her clothing: "She was within the scope of the policy, but the DO said, 'Are you not ashamed of what you're wearing? Are you not thinking of how others will think about how you dress?'"

Dalisay N., a 20-year-old panromantic woman at a university in Caloocan, said:

When I enrolled in college, I even talked to the head of the office for student affairs, and told her I'm not comfortable wearing a skirt. They allow us to wear

slacks, but it's different from the male uniform. And she said, "What are you, you're a female, right?" I was speechless.

The guards are also a headache. They'll ask, "Why are you wearing slacks? Why aren't you wearing women's shoes?" I tell them I'm not comfortable wearing that. And sometimes they'll even look me up and down from head to toe, which is really uncomfortable.

Carlos M., a 19-year-old gay student at the same university, said that university security guards forced transgender women to go home if they were wearing makeup or long hair.

According to Lyn C., a 19-year-old transgender woman at a university in Manila:

The first three years of my school days we were just hiding ourselves, because if the guards and administration know that we're transgender we'll be punished. When the guard knows you're transgender, you'll be sanctioned. They'd send you to the discipline office... you'd get community service or suspension. It was really difficult for us, to hide our very identities.

Lyn's university removed its uniform and hair-length restrictions in January 2017 after years of persistent advocacy from student groups. However, even after the changes, some students still faced discrimination from teachers.

Several interviewees also told Human Rights Watch that they or their classmates had dropped out of classes or transferred sections at their universities to avoid conflicts with professors who were hostile to transgender students.

Certain departments and colleges also tend to have more stringent uniform and hair-length restrictions than their affiliated universities, often forcing transgender students to conform in order to matriculate. Some students and professors identified colleges of hospitality, management, and education among those requiring gendered clothing, irrespective of the broader university's policies.

Access to Facilities

For students who are transgender or identify as a sex other than their sex assigned at birth, rigid gender restrictions can be stressful and make learning difficult. One of the areas where gender restrictions arose most often for LGBT interviewees was in access to toilet facilities, known in the Philippines as "comfort rooms" (CRs). Most interviewees said that their schools required students to use CRs that aligned with their sex assigned at birth, regardless of how they identified or where they were most comfortable. Some said that both female and male CRs posed safety risks or made them uncomfortable, but that all-gender restrooms were scarce.

Some schools punish students for using the CRs where they felt comfortable. Ruby S., a 16-year-old transgender girl who attended high school in Batangas, said:

I was called by the administration when I used the CR for the girls. They said you're not allowed to use it just because you feel like you're a girl. They used that as a black mark on my campaign for student council. They said, even though he wants to be student council president, he doesn't follow the rules.

Access to Facilities in Universities

Policies that prevent students from accessing restrooms consistent with their gender identity exist in post-secondary institutions as well.

Dalisay N., a 20-year-old panromantic woman at a university in Caloocan, said:

Some of the trans women in our support group, the guards would shout, "Why are you using that restroom? You're not allowed in there," which for me is disrespectful. Why do they care? They're just putting on makeup, and they just want to feel safe when they pee. Because there's a lot of teasing and bullying in the men's room.

Marisol D., a 21-year-old transgender woman, said that in her university, instructors reported transgender students to the discipline office for using the "wrong" restroom. Ace F., a 24-year-old gay man in Manila, noted that another member of his university's LGBT group "was apprehended by our school administration-she's a transgender woman and she used a girl's bathroom. The office of student behavior gave her a minor disciplinary offense."

As in secondary schools, university policies that prevent students from accessing facilities on the basis of their gender identity are discriminatory and function to undermine student safety, health, privacy, and the right to education.

Gender Classifications

Hostility Toward Same-Sex Relationships

Many schools in the Philippines have policies restricting public displays of affection among students, and outline those policies in student handbooks or codes of conduct. Yet LGBT students reported that their relationships were policed more carefully or punished more harshly than their non-LGBT peers. In particular, young lesbian and bisexual women and transgender men who attended exclusive schools-those that are only open to one sex-reported that their friendships and relationships were closely scrutinized and policed by school staff.

Juan N., a 22-year-old transgender man who had attended high school in Manila, said:

Angelica R., a 22-year-old bisexual woman who had attended high school in Manila, said that more masculine girls were especially targeted to keep them from becoming close with other girls:

Pressure to Conform to Stereotypes

LGBT youth also described the pressure that teachers and administrators imposed on them to act in a stereotypical fashion.

Many of the LGBT youth interviewed by Human Rights Watch emphasized that, to the extent they were respected in school, they had earned that respect by being better students than their peers. Often, this meant that LGBT students were tasked with more work or responsibilities than other students as part of the price they paid to be accepted and respected. Eric Manalastas, a psychology professor at the University of the Philippines who has conducted research on LGBT youth issues, found that:

Manalastas found that the demand to be "respectable" put a heavy burden on LGBT students who did not conform: "It may be that gay students are warmly received, generally speaking, but if you're characterized as one of the indecent ones-perceived as very sexual, very loud, very gender non-conforming or outré, it's different." He added that LGBT people from lower socioeconomic strata often face double discrimination, as exemplified by the common insult baklang kalye-"you're bakla and also you come from the streets, you don't have a proper house, you're poor."

Some students were keenly aware of these conditions and expressed frustration with them, voicing a desire to be treated with the same inherent respect as their non-LGBT classmates. Felix P., a 22-year-old gay high school student in Legazpi, said:

Jerome B., a 19-year-old gay man from Cebu City, described another stereotype that he found oppressive: the idea that gay males should be entertainers, jokers, and talented performers. He said classmates and teachers:

Young lesbian women encounter different stereotypes. Dalisay N., a 20-year-old panromantic woman who had attended high school in Manila, observed that lesbian girls were particularly disadvantaged by teachers because "the lesbian community, they don't see us like that, like the gays, the creative ones who do something artsy, that gay people are at the top of the list."Instead, according to Eric Manalastas, "the stereotype with lesbians is that they're dangerous, a danger to other female students. Not in terms of being violent, but maybe as predatory. Or generally a bad influence-not good for moral development-as though they aren't also adolescents themselves." In interviews with Human Rights Watch, young bisexual women recounted how teachers scrutinized girls they considered "butch" or masculine, and took steps to separate them from other girls to prevent them from becoming close.

For youth who are transgender, pressure to "pass" according to their gender identity and, for transgender girls, to achieve high standards of physical beauty, were a serious source of stress for those who felt they lacked the ability or resources to meet the expectations of others.

These stereotypes were among the most consistent themes in interviews with LGBT youth. They illustrate how attitudes and informal practices, even when well-intentioned, can place heavy expectations on LGBT youth and undermine the notion that all youth are deserving of respect and acceptance. They underscore the importance of anti-bullying efforts, information and resources, and antidiscrimination policies that emphasize that all students, regardless of sexual orientation or gender identity, have rights that must be respected in schools.

When LGBT students face hostility in their homes, communities, and peer groups, access to affirming information and resources is vitally important. In interviews, however, few LGBT students in the Philippines felt that their schools provided adequate access to information and resources about sexual orientation, gender identity, and being LGBT.

School Curricula

Very few of the LGBT students interviewed by Human Rights Watch said they encountered positive portrayals of LGBT people as part of the school curriculum.

In many cases, LGBT people were simply invisible, with no acknowledgment that people are LGBT or discussion of LGBT history, literature, or other issues. One study found that, in elementary school textbooks required by DepEd:

Comprehensive Sexuality Education

In order to understand their own sexuality and to make responsible choices, LGBT students, as well as other students, need access to information about sexuality that is non-judgmental and takes into account the whole range of human intimacy. In recent years, many countries have moved toward providing comprehensive sexuality education, which UNESCO describes as an "age-appropriate, culturally relevant approach to teaching about sex and relationships by providing scientifically accurate, realistic, non-judgmental information."

In interviews with Human Rights Watch, students who received sexuality education described receiving that education at various grade levels, with varying degrees of comprehensiveness. But across the board, they stated that their sexuality education classes either excluded any discussion of LGBT people or conveyed inaccurate and stigmatizing messages about same-sex conduct and the existence of transgender people.

In many instances, sexuality education conveyed misinformation or disapproval about LGBT identities and relationships. Gabby W., a 16-year-old transgender girl at a high school in Bayombong, said that teachers "always say that gay is a disease, that it's a contagious disease. Or say being gay is a sin." Bea R., a 22-year-old transgender woman at another school in the area, said that although science teachers do cover safer sex at her school, "They say that LGBT are the ones spreading HIV and chlamydia." Francis C., a 19-year-old gay student from Pulilan, was similarly told by teachers "that there were same-sex who were doing those activities, but they would say that if two males or two female did those activities, they would become sick or ill." Jonas E., a 17-year-old gay boy in high school in Mandaue City, noted: "I get really offended when they talk about HIV. They say that gays are the main focus of HIV... I'm a bit ashamed of that, because I was once in section where I'm the only gay, and they kept pointing at me."

Counseling and Support

In addition to formal curricula, schools provide a variety of resources to students. Support from teachers, guidance counselors, school psychologists, and other school personnel is a valuable asset, and should be available to guide LGBT youth as well as their non-LGBT peers. According to UNESCO, "support from teachers can have a particularly positive impact on LGBT and intersex students, improving their self-esteem and contributing to less absenteeism, greater feelings of safety and belonging and better academic achievement."

Although some counselors have created successful programs for LGBT students, such as support groups, such efforts need to have support from the school administration to ensure counselors are recognized as affirming, non-judgmental resources. As one study found, "it has been the experience of gay students (or perhaps students in general) that the guidance counselor is associated with delinquent and problem students. This image of the guidance counselor may contribute to the problematization of gay identity in school settings, that being gay is something that has to be 'dealt with' with and by these counselors."

Interviews with LGBT youth in the Philippines underscore the urgent need for resources and support. Jerome B., a 19-year-old gay man from Cebu City, recalled that in secondary school, "I was questioning for a long time-is there something wrong with me? Am I mentally ill? I planned to talk to a psychiatrist because I thought I had a mental illness.... We had a guidance counselor. But I wouldn't go to them, because I was too ashamed." For some students, bullying and a lack of resources led to depression and thoughts of suicide. Benjie A., a 20-year-old gay student from Manila, recounted struggling to make sense of his identity until "I thought about getting a gun from a policeman and shooting myself."

Other LGBT students described going to counselors and facing outright hostility or condemnation. Ace F., a 24-year-old gay man who had attended high school in Manila, said that his school counselor used decades-old psychological materials:

What they taught us was DSM-3 or DSM-2-where being gay is still classified as a mental disorder. That's what they taught us. I was pretty well informed because I was a debater, so I would question them about it: it's already outdated, it's not the standard, it's not considered a mental disease. But they would institutionally still say that it was a disease, a mental disorder, it's bad.

Student Organizations

Student Organizations in Universities

LGBT organizations are increasingly prevalent at the university level, but many groups encounter obstacles from administrators in post-secondary settings as well. In interviews with Human Rights Watch, some university students also described difficulties forming or operating LGBT groups. Students from one university in Manila told Human Rights Watch that, after creating an LGBT organization in 2012, they were instructed in 2016 to rename the organization and work on the broad topic of "gender sensitivity," as the university did not want a group overtly focused on LGBT issues. Rosamie T., an 18-year-old bisexual woman, noted the group had been active and "well-known as an LGBT organization, and they wanted us to rebrand because it's known for that." She said that, after losing a large number of members and becoming less active as a result of the reorganization, "It's like we're starting again from zero." Although this report focuses on secondary schools, universities should also recognize the importance of LGBT organizations and take steps to foster and sustain them.

In recent years, the Philippines has enacted important laws and regulations that affirm the rights of LGBT learners in schools. DepEd's Child Protection Policy, the Anti-Bullying Law, and the Reproductive Health Law-as well as anti-discrimination ordinances at the local level-reiterate the government's commitment to ensuring that all youth are safe, healthy, and able to learn in schools.

Right to Education

LGBT students are denied the right to education when bullying, exclusion, and discriminatory policies prevent them from participating in the classroom or attending school. LGBT students' right to education is also curtailed when teachers and curricula do not include information that is relevant to their development or are outwardly discriminatory toward LGBT people.

Violence and Bullying

The terms of the Anti-Bullying Law and Child Protection Policy echo the Philippines' obligations under international law. The ICCPR states that "[e]very child shall have... the right to such measures of protection as are required by his status as a minor, on the part of his family, society and the State," while the CRC requires governments to "protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation." The government of the Philippines signed UNESCO's Call for Action on Homophobic and Transphobic Violence, issued in November 2016, which commits it to monitoring the prevalence of homophobic and transphobic bullying in schools, providing students with information about harmful gender-based stereotypes, training school personnel, and taking steps to make schools safe for LGBT youth.

Children who are especially likely to face violence, including bullying, merit specific attention and protection from the state. As the Committee on the Rights of the Child, the UN body that monitors implementation of the CRC, has noted, "[g]roups of children which are likely to be exposed to violence include, but are not limited to, children ... who are lesbian, gay, transgender or transsexual." The committee has repeatedly described bullying, harassment, and violence against LGBT youth as violations of children's rights, and emphasized that "[a] school which allows bullying or other violent and exclusionary practices to occur is not one which meets the requirements of article 29(1)," the CRC provision specifying the aims of education.

The Committee on the Rights of the Child has identified steps that governments should take to protect children from bullying, harassment, and other forms of violence. These include challenging discriminatory attitudes that allow intolerance and violence to flourish, establishing reporting mechanisms, and providing guidance and training for teachers and administrators to know how to respond when they see or hear about incidents of violence. When taking these steps, the committee has stressed that children themselves should be involved "in the development of prevention strategies in general and in school, in particular in the elimination and prevention of bullying, and other forms of violence in school."

Right to Health

Freedom of Expression

The right to free expression is violated when schools limit displays of same-sex affection or gender expression solely for LGBT youth. Schools need to ensure that LGBT students are able to participate in the school environment on the same terms as other students, regardless of their sexual orientation or gender identity.

Freedom from Discrimination

Even as municipalities and provinces pass anti-discrimination ordinances to protect the rights of LGBT people, the Philippines has not passed comprehensive legislation prohibiting discrimination on the basis of sexual orientation and gender identity.

...freedom from discrimination is a fundamental obligation of States under international law, and requires States to prohibit and prevent discrimination in private and public spheres, and to diminish conditions and attitudes that cause or perpetuate such discrimination. To this end, States should enact comprehensive anti-discrimination legislation that includes sexual orientation and gender identity among protected grounds."

The Committee on the Rights of the Child has explained that discrimination in the school setting, "whether it is overt or hidden, offends the human dignity of the child and is capable of undermining or even destroying the capacity of the child to benefit from educational opportunities." Because of the dangers that discrimination poses to health and development, children at risk of discrimination are "entitled to special attention and protection from all segments of society." The committee has specifically expressed concern about discrimination against children on the basis of their sexual orientation and gender identity in its review of state policies.

To the President of the Philippines

Speak out, as you have done in the past, against bullying in schools, reiterating that bullying of LGBT youth is harmful and unacceptable.

Speak out in support of an anti-discrimination bill that prohibits discrimination on the basis of sexual orientation and gender identity, including in education, employment, health care, and public accommodations.

To the Congress of the Philippines

Enact an anti-discrimination bill that prohibits discrimination on the basis of sexual orientation and gender identity, including in education, employment, health care, and public accommodations.

Authorize funding for the implementation of the Reproductive Health Law and any necessary support for comprehensive sexuality education in schools.

To the Department of Education

Undertake a comprehensive review of school compliance with the provisions of the Child Protection Policy and the Anti-Bullying Law.

Collect and publish data on the number of schools nationally that address sexual orientation and gender identity in their Child Protection Policy and Anti-Bullying Law. Recommend that schools that do not address sexual orientation and gender identity revise their policies to do so.

Create a system to gather and publish data about bullying on the basis of sexual orientation and gender identity in schools. Revise forms to more clearly differentiate and record incidents of gender-based bullying on the basis of sex, sexual orientation, and gender identity, and include these categories on all forms related to bullying, abuse, or violence against children.

Immediately review all curricula, including textbooks and teaching materials, to ensure that LGBT issues are incorporated. Remove content that is inaccurate or derogatory toward LGBT people and include content that is relevant to LGBT youth and promotes respect for gender diversity.

Revise the standard sexuality education curriculum to ensure it aligns with UNESCO's guidelines for comprehensive sexuality education, is medically and scientifically accurate, is inclusive of LGBT youth, and covers same-sex activity on equal footing with other sexual activity.

Issue an order instructing schools to respect students' gender identity with regard to dress codes, access to facilities, and participation in curricular and extracurricular activities.

Conduct trainings, in collaboration with LGBT rights groups where possible, to familiarize DepEd personnel at the division and district levels with LGBT terminology and issues.

To Local Officials

Enact local ordinances to prohibit discrimination on the basis of sexual orientation and gender identity, including in education, employment, health care, and public accommodations.

Promulgate implementing rules and regulations to ensure that existing anti-discrimination ordinances are applied and enforced.

To School Administrators

Adopt anti-bullying and anti-discrimination policies that are inclusive of sexual orientation and gender identity, inform students how they should report incidents of bullying, and specify consequences for bullying.

Conduct trainings, in collaboration with LGBT civil society groups where possible, for child protection committees and school staff to ensure that they are sensitive to the needs and vulnerabilities of LGBT youth. The trainings should inform school staff about proper terminology, the forms of bullying and discrimination that LGBT youth face, the rights that LGBT youth enjoy under domestic and international law, and resources and services available for LGBT youth.

Conduct trainings, in collaboration with children's rights groups where possible, for child protection committees and school staff to ensure they are able to recognize and intervene in bullying and harassment when they witness it occurring or it is brought to their attention.

Promulgate guidelines instructing school staff to respect the gender identity of students with regard to dress codes, access to facilities, and participation in curricular and extracurricular activities.

Commemorate occasions like Human Rights Day and National Women's Month with programming that promotes human rights and respect for gender diversity in schools.

Ensure that the school has resources available for LGBT youth, for example, books and printed material, access to counselors or other supportive personnel, and curricular resources that are inclusive of LGBT youth.

Ryan Thoreson, a researcher in the LGBT Rights Program, wrote this report based on research that he undertook from September 2016 to February 2017. Daniel Lee, associate with the Asia division, conducted additional interviews and wrote a section of the report.

The report was reviewed by Neela Ghoshal, senior researcher in the LGBT Rights Program; Michael Bochenek, senior counsel in the Children's Rights Division; and Carlos Conde, Philippines researcher in the Asia Division. James Ross, legal and policy director, and Joe Saunders, deputy program director, provided legal and program review, respectively. Production assistance was provided by Olivia Hunter, publications associate; Fitzroy Hepkins, administrative manager; and Jose Martinez, senior coordinator.

Human Rights Watch would like to thank the experts and organizations that provided information for the report, including ASEAN SOGIE Caucus, Babaylanes, Inc., Bisdak Pride, Bulsu Bahaghari, ChildFund Philippines, the Children's Legal Rights and Development Center, GALANG, Gayon Albay, Happy Hearts, Lagablab, MCC Marikina, Side B, TransMan Pilipinas, and UP Babaylan. Particular thanks go to the many students who shared their experiences with us.

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This report documents the range of abuses against lesbian, gay, bisexual, and transgender (LGBT) students in secondary school. It details widespread bullying and harassment, discriminatory policies and practices, and an absence of supportive resources that undermine the right to education under international law and put LGBT youth at risk.

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Using the Bible against LGBTQ+ people is an abuse of scripture

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Using the Bible against LGBTQ+ people is an abuse of scripture

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Documents released by Church of England reinforce their teaching that 'homosexuality is incompatible with scripture'. kaninw/Shutterstock

The Church of England issued pastoral guidance from the House of Bishops to its clergy on January 23, following the legal introduction of heterosexual civil partnerships in 2019. While the guidance concerns heterosexual civil partners, the document has, controversially, been used by the church to reiterate its position on sexual relationships outside of heterosexual marriage. It states that "sexual relationships outside heterosexual marriage are regarded as falling short of God's purpose for human beings".

This is squarely in line with the church's official position on homosexuality, which is that it is " incompatible with scripture". We have seen recent attempts by liberal members to get the church to take a more inclusive approach towards gender and sexuality, but these have been rebuffed by conservatives. In October 2018, four bishops from the diocese of Oxford published guidance designed "to advise local clergy and congregations in order to support LGBTQ+ people and their families, and to learn from the insights of LGTBQ+ people about being church together".

Several months later, more than a hundred "concerned Anglicans" signed an open letter criticising the guidance. The letter claimed that the attempt at inclusivity by the Oxford bishops actually served to exclude those who "hold to the traditional reading of scripture". Their response stated:

We cannot see how it is right to accept as Christian leaders those who advocate lifestyles that are not consistent with New Testament teaching.

The letter writers may be referring to New Testament teaching from Paul's letters in 1 Corinthians 6:9-10 and Romans 1:26-27 which describe how those who are "sexually immoral" will not enter the kingdom of God.

This example is one of the many cases where conservative Christians deploy biblical verses to bolster arguments against same-sex marriage, transgender identities, adoption and parenting by LGBTQ+ people.

Rawpixel.com/Shutterstock

Within the Bible, there are a number of texts which have been used as a weapon against LGBTQ+ people, known as "clobber texts" or "texts of terror". But using biblical verses in this way is actually an abuse of scripture. It must stop, urgently. Many LGBTQ+ Christians struggle to reconcile their faith with their gender or sexual identities, which can lead to self-harm or suicide.

Not the Word of God

The Bible is often used as a source of authority, but it is misleading to call it "the word of God". In fact, Christianity teaches that the word of God is not scripture, it is Jesus Christ.

As such, Jesus said nothing explicit about same-sex relationships or transgender people. In the New Testament, it is Paul who teaches about sexual morality, not Jesus. In 1 Corinthians 6:9 - 10, he said:

Do not be deceived: neither the sexually immoral, nor idolaters, nor adulterers, nor men who practise homosexuality, nor thieves, nor the greedy, nor drunkards, nor revilers, nor swindlers will inherit the kingdom of God.

While statements like these are cited by conservative Christians to support arguments against the sexual activities and relationships of LGBTQ+ people, it is important to note how Paul himself warns that such use of the Bible is dangerous. In 2 Corinthians 3: 6 Paul writes "for the letter kills, but the Spirit gives life".

In his provocative book, The Savage Text: The Use and Abuse of the Bible, theologian Adrian Thatcher cautions that Christians who mobilise the Bible to argue against the inclusion of others actually commit "bibliolatry" - worshipping the Bible instead of God.

Pick 'n' mix Bible?

Conservative Christians adopt a pick 'n' mix approach to scripture, selecting what appeals to suit their prejudices while ignoring other texts. The excerpt from Corinthians, above, lists alongside homosexuals, adulterers, the greedy and drunkards to just name a few. Thankfully, these and other offerings on the biblical buffet, such as divorce, owning slaves, and the role of women in the Church have, to some extent, been sympathetically re-interpreted by the church.

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The Bible is complicated when it comes to the issue of homosexuality, as it is on many other issues. However, many other activities inconsistent with New Testament teaching don't share the same airtime in religious discussions. There is no longer much concern, for example, about dressing modestly and inexpensively or getting drunk on wine. Besides, there are many inclusive LGBTQ+ readings of the Bible and interpretations of Christianity that raise new questions and have particular relevance for readers interested in LGBTQ+ issues.

One of the yardsticks for measuring how in touch the Church of England is with contemporary life lies in ongoing discussions about the acceptance and inclusion of LGBTQ+ people in the Church. However, the current situation shows the diminishing authority of the Church and the Bible in everyday life in the UK.

The Church of England faces a generational crisis, with only 2% of young people identifying with it in the UK. The decline points to how the Church's current position is seemingly hostile and incompatible with socially liberal views, particularly those towards LGBTQ+ people.

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Using the Bible against LGBTQ+ people is an abuse of scripture

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The Church of England issued pastoral guidance from the House of Bishops to its clergy on January 23, following the legal introduction of heterosexual civil partnerships in 2019. While the guidance concerns heterosexual civil partners, the document has, controversially, been used by the church to reiterate its position on sexual relationships outside of heterosexual marriage.

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Gay rights activists say that discrimination on the basis of sexual orientation along with violence or "gay bashing" has reached gigantic proportions against the gay and lesbian community.

A lobbying pamphlet distributed by the Coalition for Lesbian and Gay Civil Rights quotes a March, 1987 Wall Street Journal survey which said 66 percent of U.S. chief executives would hesitate to promote a gay person to management-committee level.

The same pamphlet cites a 1987 National Institute of Justice report entitled, "The Response of the Criminal Justice System to Biased Crime." as saying. "Homosexuals are probably the most frequent victims of hate-motivated violence."

A 1984 survey by the National Gay and Lesbian Task Force of 2000 respondents found that 40 percent of gay and lesbian people had been threatened with violence and 90 percent had experienced some kind of victimization because of their sexual orientation. The task force's 1987 report found that the number of cases of violence and intimidation against gay people rose 300 percent since 1985.

Since crime reports are published in newspapers, many victims are afraid to do anything about gay bashing because they know there are no civil rights statutes to protect them against job or housing discrimination, says David M. Osborne, aide to State Sen. Michael J. Barrett '70 (D-Cambridge).

Osborne says that a 1985 report by the Massachusetts Commission Against Discrimination found that the Commission received 170 complaints of discrimination on the basis of sexual orientation in the first half of that year alone.

Kevin M. Cathcart, a Boston attorney and ex-director of the Gay and Lesbian Advocates and Defenders says. "We receive phone calls regularly from people who are exposed to some kind of discrimination at work."

"Unless they live in the city of Boston or Cambridge, both of which have local ordinances, there is no protection against discrimination," Cathcart adds. "If the bill passes and becomes law, then MCAD will have jurisdiction," he says.

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The Root Cause: Discrimination | News | The Harvard Crimson

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Gay rights activists say that discrimination on the basis of sexual orientation along with violence or "gay bashing" has reached gigantic proportions against the gay and lesbian community. A lobbying pamphlet distributed by the Coalition for Lesbian and Gay Civil Rights quotes a March, 1987 Wall Street Journal survey which said 66 percent of U.S.

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Discrimination against members of the lesbian, gay, bi, trans and intersex community doesn't just hurt people; it hurts families, companies and entire countries. The latest video from the...

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Discrimination impacts health of LGBT people, analysis finds

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Discrimination impacts health of LGBT people, analysis finds

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In a review of thousands of peer-reviewed studies, the What We Know Project, an initiative of Cornell's Center for the Study of Inequality, has found a strong link between anti-LGBT discrimination and harms to the health and well-being of LGBT people.

The results of the analysis, the largest-known literature review on the topic, indicates that 286 out of 300 studies, or 95%, found a link between anti-LGBT discrimination and LGBT health harms.

"The research we reviewed makes it crystal clear that discrimination has far-ranging effects on LGBT health," said Nathaniel Frank, director of the What We Know Project, an online research portal that aggregates existing peer-reviewed LGBT research. "And those consequences are compounded for especially vulnerable populations such as people of color, youth and adolescents, and transgender Americans."

The research team screened more than 11,000 titles and read more than 1,300 peer-reviewed studies in order to identify those that addressed the question, "What does the scholarly research say about the effects of discrimination on the health of LGBT people?" Among the key findings identified by the report:

Anti-LGBT discrimination increases the risks of poor mental and physical health for LGBT people, including depression, anxiety, suicidality, PTSD, substance use and cardiovascular disease.

Discrimination is linked to health harms even for those who are not directly exposed to it, because the presence of discrimination, stigma and prejudice creates a hostile social climate that taxes individuals' coping resources and contributes to minority stress.

Minority stress - including internalized stigma, low self-esteem, expectations of rejection and fear of discrimination - helps explain the health disparities seen in LGBT populations.

Discrimination on the basis of intersecting identities such as gender, race or socioeconomic status can exacerbate the harms of discrimination based on sexual orientation or gender identity.

Protective factors against the harms of discrimination include community and family support; access to affirming health care and social services; and the establishment of positive social climates, inclusive practices and anti-discrimination policies.

The report is relevant to debates currently unfolding nationally about whether to ban discrimination or, alternatively, allow a "license to discriminate" through religious exemptions from discrimination law, Frank said. The data also offer guidance on what policies and practices can help mitigate the consequences of anti-LGBT discrimination, prejudice and stigma, he said.

"Sometimes research really humanizes a policy debate, and this is one of those times," said Kellan Baker of the Johns Hopkins Bloomberg School of Public Health, co-lead of the study. "Whatever you think of what the law should say about anti-LGBT discrimination, this research makes indisputable that it inflicts great harm on the LGBT population, and gives policymakers and individuals tools to reduce those harms."

Focusing on public policy debates around inequality, the What We Know Project connects scholarship, public policy and new media technology.

"The goal is to bring together in one place scholarly evidence that informs LGBT debates, so that policymakers, journalists, researchers and the public can make truly informed decisions about what policies best serve the public interest," Frank said. "We don't call 'balls and strikes' in our analysis, but simply describe what conclusions the studies reach so visitors may evaluate the research themselves."

The full research analysis and methodology can be viewed on the project website.

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Discrimination impacts health of LGBT people, analysis finds | Cornell Chronicle

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In a review of thousands of peer-reviewed studies, the What We Know Project an initiative of Cornell's Center for the Study of Inequality, has found a strong link between anti-LGBT discrimination and harms to the health and well-being of LGBT people.

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Homophobia, stigma (negative and usually unfair beliefs), and discrimination (unfairly treating a person or group of people) against gay, bisexual, and other men who have sex with men still exist in the United States and can negatively affect the health and well-being of this community.

These negative beliefs and actions can affect the physical and mental health of gay, bisexual, and other men who have sex with men, whether they seek and are able to get health services, and the quality of the services they may receive. Such barriers to health must be addressed at different levels of society, such as health care settings, work places, and schools to improve the health of gay and bisexual men throughout their lives.

The Effects of Negative Attitudes on Gay, Bisexual, and Other Men Who Have Sex with Men

Some people may have negative attitudes toward gay, bisexual, and other men who have sex with men. These attitudes can lead to rejection by friends and family, discriminatory acts and violence, and laws and policies with negative consequences. If you are gay, bisexual, or a man who has sex with other men, homophobia, stigma, and discrimination can:

Affect your income, whether you can get or keep a job, and your ability to get and keep health insurance.

Limit your access to high quality health care that is responsive to your health issues.

Add to poor mental health and poor coping skills, such as substance abuse, risky sexual behaviors, and suicide attempts.

Affect your ability to have and maintain long-term same-sex relationships that lower your chances of getting HIV & STDs.

Make it harder for you to be open about your sexual orientation, which can increase stress, limit social support, and negatively affect your health.

Homophobia, stigma, and discrimination can be especially hard for young men who are gay, bisexual, and other men who have sex with men. These negative attitudes increase their chance of experiencing violence, especially compared with other students in their schools. Violence can include behaviors such as bullying, teasing, harassment, physical assault, and suicide-related behaviors.

Gay and bisexual youth and other sexual minorities are more likely to be rejected by their families. This increases the possibility of them becoming homeless. Around 40% of homeless youth are LGBT. A study published in 2009 compared gay, lesbian, and bisexual young adults who experienced strong rejection from their families with their peers who had more supportive families. The researchers found that those who experienced stronger rejection were about:

8 times more likely to have tried to commit suicide

6 times more likely to report high levels of depression

3 times more likely to use illegal drugs

3 times more likely to have risky sex

Reducing the Effects of Stigma and Discrimination

Gay and bisexual men and their family and friends can take steps to lessen the effects of homophobia, stigma, and discrimination and protect their physical and mental health. One way to handle the stress from stigma and discrimination is by having social support. Studies show that gay men who have good social support-from family, friends, and the wider gay community-have:

higher self-esteem,

a more positive group identity, and

more positive mental health.

What Can Parents and Guardians Do?

Parents of a gay or bisexual teen can have an important impact on their child's current and future mental and physical well-being. Parents should talk openly with their teen about any problems or concerns and watch for behaviors that might show their child is being bullied or is experiencing violence. If bullying, violence, or depression is suspected, parents should take immediate action working with school staff and other adults in the community.

In addition, parents who talk with and listen to their teens in a way that invites open discussion about sexual orientation can help their teens feel loved and supported. Parents should have honest conversations with their teens about safer sex, STDS, and HIV prevention. Parents should also talk with their teens about how to avoid risky behavior and unsafe or high-risk situations.

Parents also should develop common goals with their teens, such as being healthy and doing well in school. Many organizations and online information resources exist to help parents learn more about how they can support their gay and bisexual teen, other family members, and their teens' friends.

Read more about Positive Parenting Practices.

What Can Schools Do?

Schools can also help reduce stigma and discrimination for young gay, bisexual, and other men who have sex with men. A positive school environment is associated with less depression, fewer suicidal feelings, lower substance use, and fewer unexcused school absences among LGBT students. Schools can help create safer and more supportive environments by preventing bullying and harassment, promoting school connectedness, and promoting parent engagement. This can be done through the following policies and practices:

Encourage respect for all students and not allow bullying, harassment, or violence against any students.

Identify "safe spaces," such as counselors' offices, designated classrooms, or student organizations, where gay and bisexual youth can get support from administrator, teacher, or other school staff.

Encourage student-led and student-organized school clubs that promote a safe, welcoming, and accepting school environment (such as gay-straight alliances, which are school clubs open to youth of all sexual orientations).

Make sure that health classes or educational materials include HIV and STD information that is relevant to gay and bisexual youth too, making sure that the information uses inclusive words or terms.

Encourage school district and school staff to create and publicize trainings on how to create safe and supportive school environments for all students, regardless of sexual orientation or gender identity and encourage staff to attend these trainings.

Make it easier for students to have access to community-based providers who have experience providing health services, including HIV/STD testing and counseling, and social and psychological services to gay and bisexual youth.

You can also help by reporting discrimination, especially while seeking and receiving healthcare services. This could also have a positive impact on the environment for other gay and bisexual men. Hospitals can't discriminate against people based on sexual orientation and gender identity. Hospitals that receive funding from the Centers for Medicaid and Medicare are required to have nondiscriminatory hospital visitation policies, so that same-sex partners and other family members can visit loved ones in the hospital.

Whether you are gay or straight, you can help reduce homophobia, stigma, and discrimination in your community and decrease the negative health effects. Even small things can make a difference, such as supporting a family member, friend, or co-worker.

Bouris A, Guilamo-Ramos, Pickard A, Shiu C, Loosier PS, Dittus P, Gloppen K, Walmiller JM. A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: Time for a new public health research and practice agenda. Journal of Primary Prevention 2010; 31:273-309.

Espelage DL, Aragon SR, Birkett M. Homophobic teasing, psychological outcomes, and sexual orientation among high school students: What influence to parents and schools have? School Psychology Review 2008; 37:202-216.

Ryan C, Huebner D, Diaz RM, Sanchez J. Family rejection as a predictor of negative health outcomes in white and Hispanic/Latino lesbian, gay, and bisexual young adults. Pediatrics 2009;

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Learn more about Homophobia, Stigma, and Discrimination among MSM.

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Exploring the cause and effects of subtle discrimination

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Exploring the cause and effects of subtle discrimination

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Although laws protect stigmatized groups from overt forms of discrimination, there are no laws to protect against more subtle forms of bias-from the ways customers may negatively perceive companies that publicly advocate for Black Lives Matter to the rudeness an LGBTQ+ customer might experience in a store.

"If we just look at overt discrimination, we are missing a lot of negativity that the targets of discrimination experience," says Michelle "Mikki" Hebl, PhD, a professor of psychology and management at Rice University. In fact, Hebl argues that in some cases subtle, or interpersonal, discrimination can be more damaging than more overt forms because the recipient may have to exert a great deal of cognitive resources questioning whether they are just imagining it or to whom to attribute it.

In her lab at Rice, Hebl and her colleagues study the causes and consequences of this type of discrimination and develop interventions to help organizations and individuals combat it.

"In the absence of laws, organizations and organizational leaders can adopt policies that prevent both [overt and subtle] discrimination," Hebl says.

Stigma at work

Hebl credits her undergraduate education at Smith College, a women's institution, for opening her eyes to inequality. She spent her days there thinking about the battles that women have fought and continue to fight for equal rights. She went on to earn her PhD at Dartmouth College, where she studied discrimination against people who are obese or have a physical disability, and she arrived at Rice University 22 years ago, committed to better understanding different forms of discrimination and how to remediate them.

Much of Hebl's research focuses on how disadvantaged groups are treated in the workplace and in hiring situations. In one study, she asked people to wear hats with either the phrase "Gay and Proud" or "Texan and Proud" and apply for jobs in Houston, which had a city ordinance prohibiting employers from discriminating based on sexual orientation ( Barron, L.G., et al., Psychology, Public Policy, and Law, Vol. 19, No. 2, 2013). Participants did not know which hat they were wearing. Although the two groups reported no differences in overt forms of discrimination, such as being allowed to complete an application, the participants who donned the "Gay and Proud" hats perceived less positivity, had shorter interactions and experienced more rudeness. Their instincts were confirmed by independent coders who listened to audiotapes of the interviews and rated higher levels of subtle discrimination against people wearing the "Gay and Proud" versus the "Texan and Proud" hat.

While this study shows that subtle discrimination persists, other research by Hebl suggests that laws preventing overt discrimination can tamp down subtle discrimination as well. In a related study, individuals wore these same hats in workplaces in Dallas suburbs, where the presence of LGBTQ+ nondiscrimination laws varies. She found that participants experienced less overt and subtle discrimination in jurisdictions with protective laws compared with those that did not. To get at whether antidiscrimination laws caused this decrease, the researchers conducted a follow-up lab study with Houston-area participants trained to conduct job interviews and who were told either that sexual orientation discrimination was legal or illegal. Then they carried out mock interviews of people who had a visible "Gay and Proud" pin on their backpacks and listed involvement in a gay and lesbian organization on their résumés. Interviewers who believed discrimination was illegal spent more time talking with the applicant and showed lesser degrees of interpersonal discrimination compared with interviewers who thought it was legal.

Gender disparities

Hebl has also explored how discrimination affects women in academia. In a series of studies, she and her colleagues at Rice and other U.S. universities explored 624 letters of recommendation that had been submitted on behalf of 174 applicants for assistant professor positions in a psychology department ( Madera, J.M., et al., Journal of Business and Psychology, Vol. 34, No. 3, 2019). A team of trained research coders identified so-called doubt raisers in the letters, which could take the form of a negative statement (the applicant does not have much teaching experience), faint praise (the applicant has adequate experience), hedging (the applicant may not be the most outstanding) and irrelevant statements (the applicant is an avid runner).

The letters for female applicants had significantly more doubt raisers than those for male applicants, regardless of whether they had been written by a woman or a man. Among women's applications, 54% had at least one doubt raiser and 13% had more than one, compared with 51% and 7% for men's applications. Such bias may not be intentional, Hebl explains, but it is strong and has measurable harmful implications for women.

In a follow-up study, Hebl and her colleagues asked about 300 professors across the United States to look at whether sample recommendation letters with doubt raisers soured their impression of the candidate. The team found that letters with a negative or hedging doubt raiser hurt the evaluation of the applicant, whether they were female or male.

In another study, Hebl and two of her PhD students, Christine Nittrouer and Rachel Trump-Steele, studied gender disparities among psychology, sociology, biology, bioengineering, history and political science faculty invited to give colloquium talks at the top 50 U.S. universities-talks that can be an important career boon by increasing visibility and leading to collaborations and job opportunities. The study found that male faculty overall were more than twice as likely as female faculty to give talks. In a more positive finding, colloquium organizing committees chaired by women resulted in more female speakers than those led by men (PNAS, Vol. 115, No. 1, 2018).

Overweight job seekers

Similar to her studies looking at the effects of wearing "Gay and Proud" hats, Hebl's lab documented the experiences of people applying for jobs while wearing a full-body obesity prosthetic. In these types of studies, the role of the stigmatized individual is often played by graduate students and undergraduate research assistants in Hebl's lab, of which there are usually 10 to 40 each semester. It's an "all hands on deck" time, says Abby Corrington, PhD, who earned her PhD while working in the lab and is now an assistant professor of management at Providence College.

For this study, Hebl and her colleagues focused on overweight men because ample research had already documented discrimination against overweight women ( Ruggs, E.N., et al., Journal of Applied Psychology, Vol. 100, No. 5, 2015). Hebl and her team found that the seemingly overweight men in their study were not overtly discriminated against when inquiring about job positions in retail stores-they were told that jobs were available and given an application to complete at similar rates as men not wearing prosthetics. However, they experienced more rudeness and other interpersonal forms of discrimination.

Hebl's research also sheds light on what happens to members of disadvantaged groups once they get a job. In a study of large companies, Hebl and her collaborators at other universities and in industry found that overweight employees were more likely to be reviewed poorly by their supervisors and peers compared with employees who were not overweight ( King, E.B., et al., Human Resource Management, Vol. 55, No. 2, 2016). To the researchers' surprise, this relationship held whether the employees were in the company's top leadership or more middle level, suggesting that power does not protect individuals from weight-based stigma.

Hebl has also been curious about how companies are perceived by consumers when they publicly advocate for Black Lives Matter (BLM). Recently, Hebl, Corrington and colleagues conducted an online survey asking participants to read communications from a large food company voicing their support for BLM and then indicate their approval of the company and desire to work for them (unpublished data).

Effective interventions

In one study, Hebl found that graduate students who wore an obesity prosthetic were less successful at recruiting people on campus for a short survey and were treated more rudely than when they were not wearing the prosthetic ( Randall, J.G., et al., European Review of Applied Psychology, Vol. 67, No. 3, 2017). The heavy recruiters had more luck, however, when they were also wearing a T-shirt from a recent running event and holding a water bottle, compared with when they had a high-calorie dessert in their hand, suggesting that cues that run counter to overweight stereotypes can reduce discrimination.

Likewise, people with visible disabilities were found to face less discrimination when they claimed their disability or acknowledged it in a positive way ( Lyons, B.J., et al., Journal of Management, Vol. 44, No. 5, 2016). Hebl and her colleagues conducted an online survey in which the participants were asked to respond to various scenarios involving a co-worker in a wheelchair; participants rated the co-worker as more competent when they claimed their disabilities as opposed to downplaying or ignoring them.

However, Hebl emphasizes that the burden of reducing discrimination should not fall on stigmatized individuals, but on society. "If we only focus on the individual, we won't get there," she says.

To that end, she has also spent the last decade looking at ways that legislation, organizations, leaders and allies can stem discrimination. In one study, she found that transgender people who worked at companies that had policies prohibiting anti-transgender discrimination, and had supportive nontransgender co-workers with whom they socialized, were less likely to report feeling discriminated against ( Ruggs, E.N., et al., Psychology of Sexual Orientation and Gender Diversity, Vol. 2, No. 4, 2015).

In another study of the role of co-workers, Hebl and colleagues asked participants to watch a video in which one employee said it was not appropriate for a gay person to work there and another employee responded by mildly disagreeing, confronting the perpetrator of the homophobic comment in a calm manner or confronting them in a hostile manner ( Martinez, L.R., et al., Journal of Vocational Behavior, Vol. 103, Part A, 2017). Then they asked the participants to complete an online survey evaluating the two employees. Participants were more likely to give the perpetrator negative ratings if the other employee confronted them. They were also more likely to report that they would confront such a perpetrator if they viewed a calm confrontation. The authors suggested that confrontation could help create "an informal coalition of employees that could in turn shape the organizational climate."

Hebl hopes that her research will pave the way for legislation against overt discrimination as well as interpersonal discrimination. Although she admits that the idea of prohibiting hostile behavior may seem difficult to imagine, many people used to think that it would not be possible to pass laws against sexual harassment. Yet individuals who feel they are experiencing sexual harassment in the workplace-for example, through unwelcome comments or inappropriate glances-can now file complaints with their employer and take legal action. The same should be true for all types of subtle discrimination in the workplace, Hebl says.

Corrington hopes that the lab's work to make people aware of their social expectations and reactions can help reduce discrimination. "None of us are immune to biases," she says, "and having bias doesn't make you a bad person; it makes you human. But we should be questioning ourselves and questioning our reactions."

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Exploring the cause and effects of subtle discrimination

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A Rice University psychology lab is studying the more elusive forms of discrimination and ways to protect stigmatized groups.

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Understanding how discrimination can affect health

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Understanding how discrimination can affect health

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Effects of gender discrimination on health

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Effects of gender discrimination on health

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Gender discrimination has a significant impact on mental and physical health worldwide. It can limit peoples' access to healthcare, increase rates of ill health, and lower life expectancy.

While it is true that women live longer than men on average, they experience higher rates of ill health during their lifetimes. It is likely that gender discrimination and inequity contribute to this.

In this article, we look at what gender discrimination is and include specific examples. We then explore the effects of this discrimination on mental health, physical health, and healthcare.

Gender discrimination is any action that excludes or disadvantages people based on their gender. It includes actions that are deliberately unfair and actions that are unintentionally unfair.

Gender discrimination is fueled by sexism, which is prejudice based on sex or gender. In most countries, sexism devalues women and femininity and privileges men and masculinity.

Because gender relates to how someone feels, rather than their biological characteristics, anyone who identifies with a gender that their society deems less valuable can experience gender discrimination. This includes trans and other gender-expansive people.
Learn more about different types of sexism.
Gender discrimination can take place in person-to-person interactions, as well as at an institutional or state level. It can occur:

In the workplace: Deciding not to hire or promote someone, treating employees differently, or paying them less based on their gender are all examples of workplace discrimination. Peers can participate by excluding women colleagues from important meetings, for example.

In schools: Preventing or discouraging girls and young women from participating in traditionally male-dominated fields, such as science, math, and sports, is an example of gender discrimination. Schools may also enforce gendered dress codes, punish those who do not conform to gender norms, or fail to punish bad behavior on the basis that "Boys will be boys."

In relationships: People who prevent their partners from doing things on the basis of their gender are also acting in a discriminatory way. This might include stopping women from working, managing their money, and driving, for example.

In public: Sexual harassment and catcalling are unwanted, and they are forms of discrimination. These behaviors can make people feel unsafe, and they can restrict how people use public spaces. This limits a person's freedom.

In institutions: Organizations, governments, and legal and healthcare systems can enact policies that discriminate against certain genders, either intentionally or unintentionally. Examples include laws that allow gender-based violence to thrive, that punish people for expressing their gender, or that disadvantage certain groups financially.

It is important to understand that discrimination based on gender can be coupled with discrimination based on race, class, disability, and sexuality.
Read more about the effects of racism on health.
Gender discrimination is a source of stress, and like any other stressor, it can directly affect mental health.

Research from 2020 refers to a study in which women who reported experiencing gender discrimination in the past 12 months scored more highly than others on a depression screening tool.

Depending on the situation, facing discrimination can also result in anxiety and psychological trauma.

The authors of the research paper argue that discrimination plays a key role in the "gender gap" in rates of mental illness. Women experience higher rates of most mental health conditions, including:

Women are also 1.5 times more likely to attempt suicide than men, although men are more likely to die by suicide.

For people assigned female at birth, biological factors may play a role in these differences. However, studies have found fewer gender differences in the rates of mental illness in societies with more equality among men and women. This suggests that inequity and discrimination play a major role in these disparities.

As the World Health Organization (WHO) notes, gender inequality is also a risk factor for gender-based violence.

Thirty percent of women worldwide have experienced physical or sexual violence at some point in their lives. The rate is higher, 47%, among trans people, and even higher among trans people of color and those who have done sex work, experienced homelessness, or have a current or past disability.

Experiencing any type of abuse or assault can lead to a mental health condition, as well as further complications that are traumatic in themselves. For example, if a person survives sexual assault, they may become pregnant, contract a sexually transmitted infection, or become excluded from their community.

Gender discrimination has direct and indirect effects on physical health. These include:

Illness

Some research suggests that experiencing discrimination is correlated with worse physical health.

For example, a 2018 study found that women who experience discrimination at work are more likely to report ill physical health, and particularly women who have experienced sexual harassment.

Stress from any source can also contribute to many chronic conditions, including chronic pain, high blood pressure, and diabetes.

Less healthy living conditions

Gender discrimination can also lead to a person having worse living conditions and less access to the things that they need to survive and thrive.

For example, in the United States, the gender pay gap means that women earn less than men overall - even when performing the same jobs. The pay gap is wider for women of color.

Women also have higher levels of student debt, lower savings in retirement, and higher rates of poverty, in comparison to men.

Not only does this cause more stress, it also reduces a person's ability to afford fresh food, safe housing, and health insurance. This results in health inequity - avoidable and unfair differences in the health of marginalized groups, compared with privileged ones.
Learn more about health inequity.
Injury and death

Discrimination in the form of violence also directly impacts health. Female genital mutilation (FGM) is just one example of this.

FGM is unnecessary surgery to remove part or all of the genitalia of young females, who are typically younger than 15. Communities that practice FGM may believe that it will make girls more pure and suitable for marriage, and less likely to have extramarital sex.

People who survive the procedure can experience severe pain, bleeding, infections, and lifelong sexual health problems. Some die as a result of complications.

Gender discrimination has a profound effect on healthcare, reducing the speed, accuracy, and quality of treatment. It affects diagnosis and treatment in many ways, including:

Dismissal of symptoms: According to a 2018 review, doctors are more likely to view women's chronic pain as psychological, exaggerated, or even made up, in comparison with men's pain. This can leave people without support or treatment.

Incorrect or delayed diagnoses: Prejudices about gender can result in people getting incorrect diagnoses or having to wait for years for any diagnosis. For example, a 2020 article found that it takes doctors 6.5 months longer to diagnose moderate hemophilia in females than in males, and 39 months longer to diagnose severe hemophilia. This is despite the fact that females are more likely to notice symptoms of bleeding disorders, such as hemophilia.

Withholding care: Research from 2017 found that doctors routinely deny cis women access to birth control until they undergo annual pap smears. This form of manipulation is unethical and harmful, as it denies a person the ability to choose what happens to their body when.

Obstetric violence: This involves forcing medical interventions onto a person who is giving birth, without their consent. The term also refers to verbal and physical abuse during labor. A found that out of 2,016 observed births taking place in Nigeria, Ghana, Guinea, and Myanmar, 41.6% of women experienced obstetric violence or abuse.

Gender discrimination also affects healthcare workers, the majority of whom are women. For example, a 2019 report on the British Medical Association found that the organization engaged in widespread discrimination against women, including bullying and sexual harassment.

In the face of this discrimination, doctors who are women are just as capable as doctors who are men. A 2017 study, for example, found that patients of female surgeons were less likely to die within 30 days of a procedure, compared with patients of male surgeons. Each patient in the study had undergone one of 25 types of surgery.
Learn more about gender bias in medical diagnosis here.
Sexism reduces the health and well-being of everyone. If a person experiences discrimination and this damages their health, it has a knock-on effect on their family, friends, and the wider community.

A 2017 report notes that gender inequality contributes to unemployment and poverty among women and has adverse effects on child health and development.

Indirectly, sexism also harms men. The need to live up to masculine stereotypes can result in men not seeking medical help when they need it, behaving in ways that damage their health, and becoming involved in violence.

The economic cost of this is huge. Research from 2016 found that institutional gender discrimination costs the global economy $12 trillion, or 16% of the world's total income.

Everyone has a responsibility to learn about and help end gender discrimination - it directly or indirectly harms everyone. People can learn more from:

UN Women, a United Nations entity that provides educational resources about the rights of women and girls

the , which publishes reports, fact sheets, and articles about the impact of sexism on health

Birth Monopoly, Human Rights in Childbirth, and ImprovingBirth.org, which are working to educate about and end obstetric violence

SisterSong, which focuses on healthcare and maternal mortality among Black and Indigenous women

The Trevor Project, which works to end suicide and provide crisis intervention and other support for LGBTQIA+ youth

The effects of gender discrimination are global. This discrimination harms mental and physical health, leads to poverty, creates and enforces cycles of abuse and violence, and restricts access to healthcare.

Anyone can counter gender discrimination by learning about its causes, manifestations, and effects - and by taking action to stop it.

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Effects of gender discrimination on mental and physical health

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Gender discrimination has a significant impact on mental and physical health worldwide. It can limit peoples' access to healthcare, increase rates of ill health, and lower life expectancy. While it is true that women live longer than men on average, they experience higher rates of ill health during their lifetimes.

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"Gender inequality and discrimination are root causes of violence against women, influenced by the historical and structural power imbalances between women and men which exist in varying degrees across all communities in the world."

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Gender inequality and discrimination are root causes of violence against women, influenced by the historical and structural power imbalances between women and men which exist in varying degrees across all communities in the world.

Violence against women and girls is related to their lack of power and control, as well as to the social norms that prescribe men and women's roles in society and condone abuse. Inequalities between men and women cut across public and private spheres of life, and across social, economic, cultural, and political rights; and are manifested in restrictions and limitations on women's freedoms, choices and opportunities. These inequalities can increase women's and girls' risks of abuse, violent relationships and exploitation, for example, due to economic dependency and limited survival and income-earning options, or discrimination under the law as it relates to marriage, divorce, and child custody rights.

Violence against women and girls is not only a consequence of gender inequality, but reinforces women's low status in society and the multiple disparities between women and men. (UN General Assembly, 2006)

Risk Factors

A variety of factors at the individual, relationship, community and society (including the institutional/state) levels intersect to increase the risk of violence for women and girls. These factors, represented in the ecological model, include:

witnessing or experiencing abuse as a child (associated with future perpetration of violence for boys and experiencing violence for girls);

substance (including alcohol) abuse (associated with increased incidences of violence);

women's membership in marginalized or excluded groups;

low levels of education (for boys associated with perpetrating violence in the future and for girls, experiencing violence);

limited economic opportunities (an aggravating factor for unemployed or underemployed men associated with perpetrating violence; and as a risk factor for women and girls, including of domestic abuse, child and forced marriage, and sexual exploitation and trafficking);

the presence of economic, educational and employment disparities between men and women in an intimate relationship;

conflict and tension within an intimate partner relationship or marriage;

women's insecure access to and control over property and land rights;

male control over decision-making and assets;

attitudes and practices that reinforce female subordination and tolerate male violence (e.g. dowry, bride price, child marriage);

lack of safe spaces for women and girls, which can be physical or virtual meeting spaces that allow free expression and communication; a place to develop friendships and social networks, engage with mentors and seek advice from a supportive environment.

normalized use of violence within the family or society to address conflict;

a limited legislative and policy framework for preventing and responding to violence;

lack of punishment (impunity) for perpetrators of violence; and,

low levels of awareness among service providers, law enforcement and judicial actors. (Bott, et al., 2005;

Additional risk factors related to intimate partner violence that have been identified in the context of the United States include: young age; poor mental health levels related to low self-esteem, anger, depression, emotional insecurity or dependence, antisocial or borderline personality traits and social isolation; history of physical discipline as a child; marital instability and separation or divorce; history of perpetrating psychological abuse; unhealthy family relationships; poverty-related issues such as overcrowding or economic stress; and low levels of community intervention or sanctions against domestic violence. (Centers for Disease Control and Prevention, 2008)

Protective Factors

On the other hand, there are protective factors that can reduce women and girls' risk of violence, including:

completion of secondary education for girls (and boys);

delaying age of marriage to 18;

women's economic autonomy and access to skills training, credit and employment;

social norms that promote gender equality;

quality response services (judicial, security/protection, social and medical) staffed with knowledgeable, skilled and trained personnel;

availability of safe spaces or shelters; and,

access to support groups.

Other factors that require further research and analysis, but may be associated with risk of and protection from domestic violence include: women's prior experience as a survivor of violence (any form) at any age; men's communication levels with their female intimate partners; men's use of physical aggression against other men; as well as women and girl's restricted mobility. (WHO, 2005)

It is important to remember that risk and protective factors are not direct causal links, but rather correlated - that is to say, for example, that a boy who witnesses abuse of his mother by his father as a child will not necessarily become a perpetrator later in life; nor is a women of high socio-economic status and highly educated immune to domestic violence. Violence against women is a complex social, economic and cultural phenomenon.

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Gender inequality and discrimination are root causes of violence against women, influenced by the historical and structural power imbalances between women and men which exist in varying degrees across all communities in the world. Violence against women and girls is related to their lack of power and control, as well as to the social norms that prescribe men and women's roles in society and condone abuse.