Allegation letter regarding the legal gender recognition procedure in Ukraine, as specified in Order No. 60 of the Ministry of Health of Ukraine

 

Attention:

Juan Mendez

Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment

Dainius Pūras

Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health   

 

Human Rights Watch, Insight, and Transgender Europe (TGEU) (the complainants) submit that the provisions of the current Ukrainian legal gender recognition procedure and the manner in which it is implemented violate internationally protected human rights of transgender people in Ukraine, including the right to health and the prohibition on inhuman and degrading treatment or punishment. 

The Complainants

Human Rights Watch is an independent international human rights organization working to defend human rights of people worldwide. Our researchers investigate human rights abuses in some 90 countries around the world.

Insight is a Ukrainian feminist organization that works to improve the quality of life of lesbian, gay, bisexual, transgender, and intersex (LGBTI) people in Ukraine by empowering them, providing services, and implementing various informational, social, psychological, medical, cultural, legal, and human rights programs.

Transgender Europe (TGEU) is an European third sector umbrella organization, which works towards the full equality and inclusion of all transgender people in Europe.

State Agents Responsible

The complainants submit that the Ministry of Health Protection of Ukraine and the Commission on the Issues of Change (Correction) of Gender Identification (created under Order of Ministry of Health No. 60 on February 2, 2011)[1] (“the State Evaluation Commission”) are the primary state agents responsible for the legislation and its implementation, and therefore for the resulting violations of the rights of transgendered persons.

The current State Evaluation Commission consists of 11 specialists and meets twice a year in Kyiv, the capital of Ukraine. The eleven specialists include two sexologists, a surgeon, an endocrinologist, and seven staff members of the Ukrainian Scientific Research Institute of Social and Forensic Psychiatry and Narcology. Iryna Pinchuk is the head of the commission and is also the director of the Ukrainian Scientific Research Institute of Social and Forensic Psychiatry and Narcology. Borys Vornyk is currently deputy head of the commission and professor of sexology and medical psychology at Kharkiv Medical Academy of Continuing Education. He was the head of the commission from 1993 to 2013.

The Facts

Human Rights Watch and Insight documented human rights violations that occurred in the course of the legal gender change process at state psychiatric facilities in different cities in Ukraine, including Simferopol, Donetsk, Luhansk, Kyiv, Kryvyi Rih, and Odessa, as well as during assessments by members of the State Evaluation Commission in Kyiv.

Human Rights Watch interviewed 16 transgender people from 6 cities in Ukraine about their experiences with the legal gender recognition procedure. The interviews were conducted between September 2013 and May 2014. The transgender community in Ukraine is very small and interviewees have expressed well-founded fears of repercussions for sharing information about their experiences. In order to protect the identities of interviewees, we use pseudonyms and do not specify cities of residence in our case descriptions. Names of interviewees and details of their medical experiences, including locations and dates, are on file at Human Rights Watch.

According to Ministry of Health Order No. 60, the current legal gender recognition procedure in Ukraine includes the following (among other) requirements for transgender people seeking to change their legal gender:[2]

  • Mandatory in-patient psychiatric evaluation of 30 to 45 days in an individual’s region of residence to confirm or reject a diagnosis of ‘transsexualism’;
  • A requirement that the person seeking legal gender recognition not be married or have biological children under 18;
  • Coerced sterilization (see details below);
  • Numerous medical tests, which often require extensive time commitment, expense, and travel, and that are unrelated to Ukraine’s legal gender recognition procedure; 
  • Evaluation by the State Evaluation Commission to confirm the diagnosis of ‘transsexualism’ and authorize the change in legal documents;
  • Observation by a sexologist for a period of one year to determine degree of “social adaptation.”

The procedure for changing legal gender in Ukraine is very lengthy and requires expensive procedures; some individuals Human Rights Watch interviewed said they spent between one to four years in the process. Some individuals reported to Human Rights Watch that they were made to feel deeply humiliated during meetings or evaluations by staff in psychiatric institutions and in the State Evaluation Commission.

Human Rights Watch, Insight, and Transgender Europe believe that the requirements of Order No. 60 violate transgender people’s rights to the enjoyment of the highest attainable standard of physical and mental health, to physical integrity and freedom from inhuman and degrading treatment, as well as to private and family life. As such, the procedure set out in law for legal gender recognition in Ukraine does not permit transgender people to define their own gender identity, and develop their person according to it.[3].

Mandatory Psychiatric Treatment

Order No. 60 requires that people seeking legal gender recognition undergo 30-45 days’ confinement in a state psychiatric institution, where doctors confirm or refute a diagnosis of “transexualism.” Such a lengthy in-patient clinic stay is not necessary and cannot be justified on medical grounds. This extended in-patient treatment creates an undue burden on transgender people, significantly disrupting their personal, family, and work lives. 

Two people interviewed by Human Rights Watch stated that they had been required to spend more than 30 days in psychiatric institutions when seeking legal gender recognition. Robert R., a transgender man, had to spend over 60 days in a psychiatric institution because during his first evaluation, the doctors said that they did not see how he could be a man and that his clothes were not “male enough.”[4] In another example, Tina T., a transgender woman in the eastern Ukraine region, completed her required institutional stay of 30 days, but was diagnosed with “egodystonic sexual orientation” rather than “transsexualism”. She will therefore need to re-commence the process, including another 30-day minimum stay in the psychiatric institution. She is appealing her diagnosis in court.[5]  

Such stays in psychiatric institutions as part of the gender recognition procedure are neither medically necessary nor beneficial for transgender people. In requiring transgender people to put their life on hold for a month without compensation, this requirement places an undue burden on them.

Medical specialists in Ukraine justify the choice of psychiatric detention for the evaluation as a medical necessity. For example, Dr. Borys Vornyk, who contributed to the establishment of the legal gender recognition procedure in Ukraine, wrote in his dissertation:

“In order to assess psychiatric status, most patients, in addition to out-patient evaluations and dynamic observation, underwent 30 day evaluations inside psychiatric institutions which helped to conduct differential diagnostics and was a unique test to assess the assertiveness of the patient to go ‘all the way’[6]”.

In other words, the medical justification offered for putting transgender people in a psychiatric detention is to test whether they are really transgender.

Coerced Sterilization

Order No. 60 does not explicitly specify that sterilization is a requirement for legal gender recognition. It notes that the patient has the option to undergo surgeries; if the patient chooses to do so, he or she retains the power to choose which surgeries specifically.  However, de facto, the State Evaluation Commission only reaches a “transsexualism” diagnosis in cases where transgender people undergo irreversible sterilization surgeries. In addition, the Ministry of Health Protection of Ukraine and Institute of Urology of the National Academy of Sciences of Ukraine have both interpreted Order No. 60 as requiring irreversible sterilization. The complainants therefore consider the process to be coerced, if not legally mandatory. Specifically:

  • In August 2011 the Ukrainian Ministry of Health Protection, in written correspondence with Insight, noted that the Evaluating Commission defines the “surgical interventions” required for gender recognition, which include “full removal of primary and secondary sexual characteristics.”[7] The Ministry also noted that transgender patients’ disagreement with the volume of surgical interventions would constitute a “medico-biological and socio-psychological counter-indication” for seeking legal gender recognition.  The Ministry cited that these criteria are based on the 2nd edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-II), which has not been in use since 1980 internationally and has never been used in Ukraine. 

 

  • In written correspondence with Insight dated March 13, 2013, the Institute of Urology of the National Academy of Sciences of Ukraine noted that the minimal required surgeries for transgender people seeking legal gender recognition was “removal of sexual organs and mammary glands” for transgender men and “removal of sexual organs (testicles and penis)” for transgender women.[8]

These responses indicate that state authorities require irreversible sterilization through surgical interventions for people who seek to change gender on their government-issued identification papers. On January 19, 2015, the District Administrative Court of Kyiv ruled that the requirement of social adaptation and that the candidate for gender change cannot have biological children under 18 years violates Ukrainian law and the right to privacy.[9] The Ministry of Health is currently in the process of appealing the decision. 

Arbitrary and Burdensome Medical Tests

According to Order No. 60, each person seeking legal gender recognition must undergo a series of medical tests and examinations by different medical specialists in the city or town where he or she has official residency.[10] Without the results of these tests, they cannot receive a referral for the subsequent steps in the process: the mandatory 30-45 day psychiatric clinic stay, or a meeting with the State Evaluation Commission. The justification the Ukrainian government offers for the medical tests is to determine if a person has any condition that would contraindicate hormonal treatments or gender reassignment surgeries.

Some of these tests are expensive and are not covered by the state. The tests are not available everywhere in Ukraine, so some people have to travel significant distances to undergo the tests, which involves additional expense.  In some cases Human Rights Watch documented, doctors required transgender people to undergo additional tests unrelated to the sterilization surgeries the authorities ultimately will require.

One transgender woman Human Rights Watch interviewed spent 2,000 hryvna or US$170 on these medical tests, which amounted to approximately half her monthly salary[11]. Another transgender woman from eastern Ukraine told Human Rights Watch that she had spent over 3,000 hryvna (US$250) on medical tests and later had to retake the tests because the State Evaluation Commission demanded test results that were less than a month old.[12] In another case, an interviewee told Human Rights Watch that local doctors required her to go to another town, located 100 km away, four times within a two-week period to visit three different doctors, including an optometrist and ear, nose, and throat doctor to obtain the referral to enter mandatory in-patient evaluation.  

A 27-year-old transgender woman, Sveta S., from eastern Ukraine told Human Rights Watch that she ended up taking three months off work in order to undergo a range of medical tests as well as the in-patient psychiatric ‘evaluation’.[13] At the time, Sveta S. lived in a small town far from the regional center and had to undertake a two-hour bus ride each time to see different medical specialists. Alina A.,[14] a transgender woman, told Human Rights Watch that she did not have enough money to travel from her home in southern Ukraine to Kiev to undergo the evaluation. Her inability to get legal gender recognition impacted on her ability to find employment due to the disparity between her appearance and her legal gender. For example, she sought informal labor on farms because it did not require her to present her documents for a contract, but on one occasion her employer discovered her identity when he observed her urinating and subsequently sexually harassed her, leading her to quit that job.

The requirement to undergo these tests in their official residence also creates obstacles for many transgender people, such as people who have moved to a different town for work or other reasons, or those displaced as a result of the current conflict in eastern Ukraine.  In some cases, people have relatives working for medical institutions in their official place of residence and are reluctant to undergo the required tests for fear of retaliation or involuntary disclosure of their identity.

For example, three interviewees from eastern Ukraine told Human Rights Watch in June and July 2014 that the doctors in Kyiv asked them to obtain various documents from cities in eastern Ukraine, which are in the zone of conflict. Returning to these cities could put the individuals concerned in immediate physical danger. 

Conditions and Treatment in State Psychiatric Institutions

Some interviewees told Human Rights Watch that doctors in state psychiatric institutions pressured them not to dress according to their preferred gender, not to use makeup or wear skirts, not to let their hair down, and use pronouns according to their passport gender.

Some transgender women told Human Rights Watch that they were pressured to stay in male wards, including in one instance in a high security ward.  Tina T., a 38-year-old transgender woman, told Human Rights Watch that her stay in a psychiatric institution felt like detention in a prison. Institution staff forced her to live in a high security male ward with prison-like bars and metal doors. Tina T. told Human Rights Watch that she was only allowed to walk around the perimeter of a 30 square meter yard 45 minutes a day.[15] She said that restrooms in the institution did not have locks, which made her feel very unsafe. According to Tina T. the doctors did not allow her to take female hormones while she was under their care. Transgender women who have been taking daily hormones can suffer withdrawal symptoms, including severe headaches and hot flashes, if they abruptly discontinue them. Tina T. said that in order to avoid experiencing withdrawal, she had no alternative but to smuggle hormones into the ward and take them in secret.[16]

Sveta S. told Human Rights Watch that when she arrived at the psychiatric clinic, staff requested to see her passport, and said: “It says that you are of male sex, then we have to put you in male ward.” She resisted, and was sent to be evaluated by a psychiatrist who told her: “Either you change into male clothes and get yourself in order [adjust appearance to look like a man] of your passport or you can't be here.” She sat outside the male ward for several hours, but she resisted going in despite doctors threatening her that they would not diagnose her with “transsexualism,” a requirement for legal gender recognition, if she refused.[17] Sveta S. also told Human Rights Watch that doctors later convinced her to talk to medical students about her sexual practices by insisting it was part of the institution’s procedure. In front of the students, the doctors described her as an “unusual patient.”[18]

For those who undergo the gender recognition procedure, the stay in a psychiatric institution is both humiliating and medically unnecessary. The five transgender people Human Rights Watch interviewed who had spent time in a psychiatric institution as part of their gender recognition procedure said they spent most of their time in the facilities reading books or watching TV because the medical personnel only spent one week at most ‘evaluating’ them. Some interviewees said that they were allowed to go home on weekends while others reported being confined to the psychiatric institution for the full ‘evaluation’ period.

Disclosure of Personal Information

In three cases Human Rights Watch documented, psychiatrists in eastern Ukraine called the relatives of transgender people undergoing compulsory evaluation in psychiatric institutions and disclosed their personal information without consent, a clear violation of the right to privacy. One married transgender woman told Human Rights Watch that the doctors told her wife that if she disagreed with a diagnosis of “transsexualism,” they could diagnose her transgender spouse with schizophrenia instead.

Doctors told Tina T.’s mother about her plans of seeking legal gender recognition and then ended up not diagnosing her with “transsexualism.” 

Limited Access to the State Evaluation Commission

Currently the State Evaluation Commission is based in Kyiv and only meets twice a year for one day. It evaluates only 8 to 10 transgender people each session, or a maximum of 20 people each year. The role of the commission is to confirm the diagnosis that has been received in a regional psychiatric institution, and to determine whether or not a transgender individual has fulfilled the requirements of the Order No. 60. In most other countries in Eastern Europe and Central Asia, such decisions are made locally after a diagnosis has been made. In Ukraine, however, transgender people living outside of Kyiv may have to travel long distances and often at significant expense to the capital to appear before the commission so that they can confirm, in a 10 minute evaluation meeting, a diagnosis that the transgender person has already had to spend 30 to 45 days in a psychiatric institution to obtain.

Humiliating Treatment by Members of the State Evaluation Commission

Two interviewees told Human Rights Watch that the commission asked them very invasive questions about their sexual practices. One of them felt so humiliated that she left the room and only returned to the commission years later. She told Human Rights Watch that she felt as if the commission “turned her inside out.”[19]

Ivan I., 35, from southern Ukraine said that when he refused to speak about his sexual life, one of the members of commission, a doctor, put him under significant pressure. The doctor said that Ivan would be required to stay in Kyiv and undergo further medical examinations if he did not respond. He also asked whether Ivan would continue with the same sexual practices if he had his uterus removed. “I felt as if I had been spat on,” Ivan I. told Human Rights Watch. Later the commission told Ivan I. that he needs to undergo a hysterectomy and then bring evidence to the commission before he is able to change his gender in his state documents. Ivan has no plans to undergo surgeries.[20] 

During the evaluation session on November 20, 2013, which Human Rights Watch staff attended, we observed similar treatment of transgender people whose applications were reviewed that day. The doctors in the room did not introduce themselves and asked questions which were not relevant to the evaluation, including about the names that applicants personally chose, and their profession. In one case, a member of the commission insisted that a transgender man have a hysterectomy in order to secure legal gender recognition.  

Arbitrary Refusal of Requests for Legal Gender Recognition

Human Rights Watch documented two instances of refusals by the head of the State Evaluation Commission to accept applications for legal gender recognition because of what they identified as age limitations. In one case, the applicant was 16-years-old at the start of hormone therapy, which the commission deemed too young and a disqualifying factor. In another case, the applicant was 54-years-old at the time of review by the commission, and the commission specifically mentioned her age as too old in its dismissal of her application. Borys Vornyk of the State Evaluation Commission has been repeatedly quoted in the Ukrainian media stating that he would want the current legal gender recognition procedure to be limited to people who are under the age of 45.[21]

Long Wait Times to Access and Complete the Process

Transgender people in Ukraine have to wait for extended periods of time to be able to access legal gender recognition, due to the limited number of times the State Evaluation Commission meets each year, the number of unnecessary medical tests they must undergo, and the lengthy mandatory stay in psychiatric institutions. Additionally, a stipulation in Order No. 60 requires observation by a sexologist for a period of one year before a transgender person may start seeking legal gender recognition.[22] Some people Human Rights Watch interviewed stated that they had been in the process of changing their legal gender identity for between 1 to 4 years.

Impact on Transgender Persons of Absence of Access to a Fair and Transparent Process

Transgender persons who are unable, or have to wait long periods in order, to obtain legal gender recognition variously state that they encounter several difficult situations with the police, employers, travel, and other institutions that require official identification.

Insight documented cases of transgender people in Ukraine being denied employment when employers discovered the “mismatch” in their employee’s passport gender and their appearance. A 2012 survey found that 18 out of 37 transgender people were employed in informal sectors because they did not have proper identification and because of their desire to avoid issues with employers. In this study, transgender people also reported that they decided not to seek to change their legal gender on their state documents because they worried about a negative reaction from their employer.

Likewise for some transgender people, in Ukraine as elsewhere, since the sex listed on their documents does not match their appearance, travel that includes document inspections can expose them to discrimination and harm.

International Standards Relevant to Legal Gender Recognition

International Human Rights Standards

Concerning the separation of medical procedures and legal recognition of gender identity

Current international standards and best practices call for separation of legal and medical processes of gender reassignment for transgender people.

A recommendation of the Committee of Ministers of the Council of Europe adopted unanimously (including by Ukraine) in 2010 called on member states to take “appropriate measures to guarantee the full legal recognition of a person’s gender reassignment in all areas of life, in particular by making possible the change of name and gender in official documents in a quick, transparent, and accessible way.”[23]

The 2010 recommendation also included a set of recommendations on measures to combat discrimination based on sexual orientation and gender identity.[24] These recommendations are clear about transgender people’s right to seek legal gender recognition without medical interventions and that all medical interventions have to be performed with the person’s consent:

20. Prior requirements, including changes of a physical nature, for legal recognition of a gender reassignment, should be regularly reviewed in order to remove abusive requirements.

35. Member states should take appropriate measures to ensure that transgender persons have effective access to appropriate gender reassignment services, including psychological, endocrinological, and surgical expertise in the field of transgender health care, without being subject to unreasonable requirements. No person should be subjected to gender reassignment procedures without his or her consent.

Principle 3 of the Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity notes that:

Everyone has the right to recognition everywhere as a person before the law. Persons of diverse sexual orientations and gender identities shall enjoy legal capacity in all aspects of life. Each person’s self-defined sexual orientation and gender identity is integral to their personality and is one of the most basic aspects of self-determination, dignity, and freedom. No one shall be forced to undergo medical procedures, including sex reassignment surgery, sterilisation or hormonal therapy, as a requirement for legal recognition of their gender identity. No status, such as marriage or parenthood, may be invoked as such to prevent the legal recognition of a person’s gender identity. No one shall be subjected to pressure to conceal, suppress, or deny their sexual orientation or gender identity.[25] 

Concerning coerced sterilization and other compulsory medical treatment

The UN Special Rapporteur on Torture has called upon all States “to repeal any law allowing intrusive and irreversible treatments, including forced genital-normalizing surgery, involuntary sterilization, unethical experimentation […] when enforced or administered without the free and informed consent of the person concerned.” He also called upon states “to outlaw forced or coerced sterilization in all circumstances and provide special protection to individuals belonging to marginalized groups.”[26]

In July 2013 the UN Human Rights Committee’s concluding observations on Ukraine expressed concernat reports that according to the Ministry of Health order No. 60 of 3 February 2011 “On the improvement of medical care to persons requiring a change (correction) of sex:”

Transgender persons are required to undergo compulsory confinement in a psychiatric institution for a period up to 45 days and mandatory corrective surgery in the manner prescribed by the responsible Commission as a prerequisite for legal recognition of their gender.

The Committee also noted that:

The State party should also amend order No. 60 and other laws and regulations with a view to ensure that: (1) the compulsory confinement of persons requiring a change (correction) of sex in a psychiatric institution for up to 45 days is replaced by a less invasive measure; (2) any medical treatment should be provided in the best interests of the individual with his/her consent, should be limited to those medical procedures that are strictly necessary, and should be adapted to his/her own wishes, specific medical needs and situation.[27]

In June 2013, the Parliamentary Assembly of the Council of Europe passed Resolution 1945, which calls for an end to coercive sterilization and castration. Transgender people are listed as one of the groups in the Council of Europe countries disproportionally affected by coercive sterilization. The resolution called on member states of the Council of Europe to:

7.1. Revise their laws and policies as necessary to ensure that no one can be coerced into sterilization or castration in any way for any reason;

7.2. Ensure that adequate redress is available to victims of recent (and future) coerced sterilisation or castration, including the protection and rehabilitation of victims, the prosecution of offenders, and financial compensation which is proportionate to the seriousness of the human rights violation suffered;

7.3. Issue official apologies and offer at least symbolic financial compensation to surviving victims of coerced sterilisation or castration programmes;

7.4. Work towards eliminating prejudice, stereotypes, ignorance, and paternalistic attitudes which have a negative influence on the capacity of medical providers to provide evidence-based healthcare respectful of free and informed consent to vulnerable people, including through awareness raising and human rights education.[28]

Relevant national practice

Sweden, the Netherlands, Malta, and Denmark recently changed their legal recognition procedures to remove invasive medical requirements, and Denmark and Malta, along with Argentina, also do not require a medical diagnosis for legal gender recognition. [29] Argentina and Malta are widely considered to set best standards in legal gender recognition procedures.[30] In the Eastern Europe and Central Asia region, Belarus does not require either surgeries or hormone therapy for legal gender recognition. In addition, no country in the Council of Europe requires individuals seeking legal gender recognition to undergo any in-patient mandatory psychiatric evaluation.

Expert reports

The World Professional Association for Transgender Health (WPATH), an international multidisciplinary professional association aimed at promoting evidence-based care, education, research, advocacy, public policy, and respect in transgender health and comprised of over 700 members worldwide, called for removal of any sterilization requirements as part of legal gender recognition in a 2010 statement.[31] WPATH stated:

“No person should have to undergo surgery or accept sterilization as a condition of identity recognition. If a sex marker is required on an identity document, that marker could recognize the person’s lived gender, regardless of reproductive capacity. The WPATH Board of Directors urges governments and other authoritative bodies to move to eliminate requirements for identity recognition that require surgical procedures.”[32]

Concerning forced psychiatric treatment, the WPATH noted in a June 2014 letter to the Ukrainian Ministry of Health Protection that “Psychological assessment need not be conducted in a confined setting. The goal of treatment is to enable the patient to live comfortably in the gendered self: social integration is an important gauge of successful treatment, and this is impossible to evaluate in isolation or confinement”. WPATH also alerted the Ministry of Health Protection that “confinement disrupts normal life activities and imposes trauma and stigma on the transsexual person. We respectfully urge the Ministry to establish clinical evaluation of transsexual individuals in more normalized settings outside of residential psychiatric institutions.”[33] At the time of the writing of this complaint, there has been no response from the Ukrainian government to the WPATH letter.

A 2014 Amnesty International report called on several countries in Europe ”to abolish any medical requirement in relation to legal gender recognition, including surgeries and sterilization.”[34]

Ukrainian National Legal Standards

The complainants submit that Order No. 60 is not compatible with other provisions in Ukrainian national law, such as Article 38 of Principles of Ukrainian Legislation on Health Protection,  which notes that “any patient over the age of 14 who opts for medical treatment has the right to choose the healthcare provider freely and a free choice of methods of treatment.”[35] 

Response at National Level

Insight has been engaging with the Ministry of Health and State Evaluation Commission through letters and meetings consistently since 2011, providing legal and human rights analysis of Order No. 60. According to Insight, despite these efforts and awareness among Ministry of Health officials and the State Evaluation Commission of the discriminatory nature of the Order, there have been no changes in its text or implementation[36].  

Redress Sought

The complainants ask the Special Rapporteurs to raise the issues described above with the government of Ukraine and propose the following recommendations to redress the violations:

  • In cooperation with transgender people and their organizations, revise Order No. 60 and develop a new efficient, inexpensive, and transparent legal gender recognition procedure that would be in line with Ukraine’s international obligations;
  • Abolish any requirements of medical tests or procedures, including coerced or de facto mandatory sterilization, as a prerequisite for the legal gender recognition;
  • Abolish psychiatric confinement as a requirement for legal gender recognition;
  • Abolish the requirement for people seeking legal gender recognition to be evaluated by the State Evaluation Commission, which duplicates the work of regional medical evaluations and places substantial burdens on transgender people seeking legal gender recognition;
  • Abolish requirements related to divorce and the absence of biological children under 18 which violate transgender people’s right to private and family life and the right to found a family;
  • Ensure all staff in psychiatric institutions and state bodies or agencies involved in legal gender procedure receive human rights training, in particular in relation to transgender rights and non-discrimination, and are held accountable for behavior that is discriminatory, or inhuman and degrading to transgender persons.
 

[1] Ministry of Health of Ukraine Order No. 60, “On improvement of provision of healthcare services to people who need change (correction) of gender identification,” February 2, 2011, http://zakon4.rada.gov.ua/laws/show/z0239-11.  

[2] Ministry of Health Order No. 60, Instructions, http://zakon4.rada.gov.ua/laws/show/z0241-11.

[3] In an April 2015 resolution, the Parliamentary Assembly of the Council of Europe recognized “the emergence of a right to gender identity, first enshrined in the legislation of Malta, which gives every individual the right to recognition of their gender identity and the right to be treated and identified according to it.” Council of Europe Resolution 2048, “Discrimination against transgender people in Europe,” http://assembly.coe.int/nw/xml/XRef/X2H-Xref-ViewPDF.asp?FileID=21736&lang=en.

[4] Human Rights Watch interview with Robert R. [name withheld for confidentiality purposes], October 21, 2013.

[5] Human Rights Watch interview with Tina T. [name withheld for confidentiality purposes],January 6, 2014.

[7] Response from Ministry of Health of Ukraine to NGO Insight August 2011, on file with Human Rights Watch.

[8] Response from the Institute of Urology of the National Academy of Sciences of Ukraine to Insight NGO, March 13, 2013, on file with Human Rights Watch.

[9] The official report on the results the lawsuit LAS against the Ministry of Health of Ukraine, with the participation of NPO CI "T-EMA" and with the support of Foundation for Strategic Affairs of the Coalition for Combating Discrimination in Ukraine. Available online at: http://t-ema.org.ua/Announcement_of_lawsuit_result_engl.html

[10] The list of required tests includes: various blood and urine analyses, syphilis test, hormone studies, an electroencephalogram and electrocardiogram, genetic studies, and radiographs of skull and chest. Order No. 60, art. 2.3.

[11] According to the Federation of International Employers, minimum wage in Ukraine is 1,218.00 hryvnias, or approximately US $53/month.

[12] Human Rights Watch interview with Sveta S. [name withheld for confidentiality purposes], November 17, 2013.

[13] Human Rights Watch interview with Sveta S. [name withheld for confidentiality purposes], November 17, 2013.

[14] Human Rights Watch interview with Alina A. [name withheld for confidentiality purposes], May 16, 2014.

[15] Human Rights Watch interview with Tina T. [name withheld for confidentiality purposes], January 6, 2014.

[16] Human Rights Watch interview with Tina T. [name withheld for confidentiality purposes] January 6, 2014.

[17] Human Rights Watch interview with Sveta S. [name withheld for confidentiality purposes], November 17, 2013.

[18] Human Rights Watch interview with Sveta S. [name withheld for confidentiality purposes], November 17, 2013.

[19] Human Rights Watch interview with Tatiana T. [name withheld for confidentiality purposes], December 15, 2013.

[20] Human Rights Watch phone interview with Ivan I. [name withheld for confidentiality purposes], May 16, 2014.

[21] For example, article from 2011 in Komsomolskaya Pravda – Ukraine, http://life.obozrevatel.com/social/ezhegodno-10-ukraintsev-menyayut-pol-....

[22] Ministry of Health of Ukraine Order No. 60, “On improvement of provision of healthcare services to people who need change (correction) of gender identification,” February 2, 2011, http://zakon4.rada.gov.ua/laws/show/z0239-11.  

[23] Council of Europe Recommendation CM/Rec(2010)5 of the Committee of Ministers to member states on measures to combat discrimination on grounds of sexual orientation or gender identity, https://wcd.coe.int/ViewDoc.jsp?id=1606669.

[24] Ibid.

[25] Principle 3 of The Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity, http://www.yogyakartaprinciples.org/principles_en_principles.htm.

[26] Report on torture in healthcare settings, UN Special Rapporteur on Torture (February 1, 2013), http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session....

[27] UN Human Rights Committee. Concluding observations on the seventh periodic report of Ukraine, adopted by the Committee at its 108th session (8–26 July 2013) http://www.ccprcentre.org/doc/2013/06/CCPR-C-UKR-CO-7_en.doc.

[28] Parliamentary Assembly of the Council of Europe, Resolution 1945 (2013), June 2013. http://assembly.coe.int/ASP/Doc/XrefViewPDF.asp?FileID=19984&Language=EN.

[29] Motion to Law amending the Law on the Central Office (Assigning new personal number for people who experience themselves as belonging to the other sex). Available online at: http://www.ft.dk/RIpdf/samling/20131/lovforslag/L182/20131_L182_som_frem... and for Malta see: http://justiceservices.gov.mt/DownloadDocument.aspx?app=lp&itemid=26805&l=1.

[30] IDENTIDAD DE GENERO Ley 26.743 Establécese el derecho a la identidad de género de las personas. Available online at: http://tgeu.org/argentina-gender-identity-law/.

[32] WPATH statement (June 10, 2010).

[33] WPATH Letter to Ministry of Health of Ukraine, sent June 15, 2014 on file with Human Rights Watch.

[34] Amnesty International, “Europe: The state decides who I am: Lack of legal gender recognition for transgender people in Europe,” February 2014, http://www.amnesty.org/en/library/asset/EUR01/001/2014/en/13af83a1-85f5-....

[36] Human Rights Watch communication with Insight throughout 2014.