Don’t Speak: The Consequences of Silencing Healthcare

On October 18, 2022, Representative Mike Johnson (R-LA) introduced H.R. 9197 – Stop the Sexualization of Children Act. This bill is but one of a slew of similar pieces of legislation introduced by Republican lawmakers at the state and federal level since the passage of Florida’s Parental Rights in Education bill in March of this year. H.R. 9197 is short (five pages plus two lines), though it would accomplish enough scary things in that space should it ever pass into law:

1. Prohibits the use of federal funds to “develop, implement, facilitate, or fund any sexually-oriented program, event, or literature for children under the age of 10”;
2. Prohibits any property or facility owned by the federal government from “promot[ing] any sexually-oriented program, event, or literature for children under the age of 10”;
3. Allows a parent or guardian to “bring a civil action for injunctive relief in any Federal district court of appropriate jurisdiction against a government official, government agency, or private entity” for violating the legislation; and
4. Implements a three-year moratorium of funding to any entity with two injunctions for violating the Act in a five-year period.

I have many things to say about this legislation, including how it supports much of what I talked about in June about the very real and ongoing battles facing LGBTQI+ communities today. But for the time being, this legislation is dead on arrival: Democrats control the House, meaning H.R. 9197 will very likely never make it out of either Committee the House referred it to. (For those policy watchers in the audience, H.R. 9197 currently sits with the Committee on Oversight and Reform and the Committee on Education and Labor.) So for now, or at least until the 118th Congress is sworn in, given the anticipated Republican reclaiming of the House, I will not belabor the point of what a terrible piece of legislation H.R. 9197 is.

It’s about more than what this Act says

Instead, I want to draw attention to a larger narrative arc within some legislative efforts: preventing people from talking. The “intent” of H.R. 9197 is to return authority of discussing sex and sexually-oriented topics to parents and guardians (in exchange for removing such authority from individuals such as teachers and federal employees). In the context of H.R.9197, “sexually-oriented” is defined as “any depiction, description, or simulation of sexual activity, any lewd or lascivious depiction or description of human genitals, or any topic involving gender identity, gender dysphoria, transgenderism, sexual orientation, or related subjects.” (My gut-check tells me that the primary focus of this legislation is the last of the three topics outlined in the definition.) This legislation aims to let parents and guardians control the narrative from which their children will hear and learn about very natural parts of the human experience: our bodies, who we are attracted to, and how we choose to identify. While H.R. 9197 (and legislation similar to it) may accomplish this goal, it will also accomplish another goal: effectively teaching our children how not to talk about very natural parts of their own human experience: their body, who they are attracted to, and how they are choosing to identify.

As early as three years old, children begin developing a sense of their gender identity. We historically have understood this on a very binary level: does a child understand themselves to a boy or a girl? This also means, however, that a child may begin understanding themselves as neither. Or that they are identifying as being a girl, even though they were assigned male at birth. Or any combination of those realities. The point is this: children do not wait until the convenient age of 10 (or any convenient age, for that matter) to begin asking questions about who they are, or how and why their body is the way it is. To believe otherwise is fallacy and, in my opinion, a way for parents to put off having conversations with their children they are not comfortable with.

When pieces of legislation such as H.R. 9197 exist, we teach children lessons we will (or at least should) come to regret later in life: someone else is controlling the narrative about how they can come to understand their own experience. It is no longer up to the individual child to identify the trustworthy adult to help make sense of an identity that is not cisgender and heterosexual. Instead, the implication is that parents or guardians know best, and that a child should wait for them to initiate conversation. (Side note: in my personal opinion, the parents who believe we need legislation like H.R.9197, that it protects our children, and that it does not cause harm to kids are likely the same parents who are not talking to their child about sex, sexuality, or identity.) As someone who very carefully vetted my teachers from the quiet of my seat in the class to find one or two that I could trust with my reality of being gay, so that I could establish a support system in school, I can tell you having either one of the teachers I ended up talking to tell me they were unable to discuss and support me would have caused irreparable damage. As a parent, I hope my child can find a person they trust to discuss topics such as their identity if I am unable to fill that role; and I hope that person is willing and able to support them.

That larger narrative arc? Don’t Speak.

H.R. 9197 or Florida’s Parental Rights in Education law are not the only legislation that effectively tells some segment of the population not to talk about a critical component of their human experience; we have been doing this through legislation and regulation for years:

• Since 1985, the United States has implemented (and rescinded, in a Republican-Democratic cycle) the Mexico policy (or Global Gag Rule) to prohibit non-governmental organizations outside of the United States from using our dollars to “perform or actively promote abortion as a method of family planning” with your trifecta of exceptions: rape, incest, and life-threatening conditions.
• The United States’ Immigration and Custom Enforcement (ICE) Agency continuously changes its priorities for which population(s) of individuals to pursue deportations and arrests.
• In recent years, states across the country have passed legislation preventing the inclusion of Critical Race Theory in classrooms and governmental agencies, including Iowa House File 802.

And the list goes on…

While these policies, regulations, and bills range in topics, and all approach “addressing” those topics in different ways, they all share at least one indirect consequence: they are telling some people not to talk about defining or important components of their identity. Women (and to the extent it is applicable to include their male partners) need to be able to discuss abortion as a tool for effective family planning. However, if providers fear civil action or other threats to their ability to practice (as many now do in states across the country), these conversations may never happen. Those who are in this country without citizenship (either officially or without a path towards it) are already underserved; fear of being targeted by ICE drives these communities further underground, thus preventing them from accessing a range of services necessary to achieve and maintain health (something Washington State is currently grappling with how to address as it expands access to healthcare for state residents regardless of immigration status). And can you imagine being unable to talk about some of the factors that created a cycle of generational trauma within your community? Well, that’s part of the impact of not allowing discussions like Critical Race Theory to happen in the classroom.

The Tie to Healthcare

Healthcare really drives home the importance of centering care around the patient, including assessing patient satisfaction, actively seeking receiving patient feedback, and improving the provider-patient relationship. These are all well and good goals, but accomplishing them is predicated on patients talking to us. While we like to think we make that easy for patients to do, we must remember that, well, we don’t always. But even if they are comfortable, our patients need more spaces than the provider’s office to talk about who they are and what they need. I did not learn to talk about being gay with my provider. I became comfortable with my identity amongst my peers and colleagues, which allowed me to then talk about my identity with my provider and the health concerns unique to members of the community(ies) I identify with.

The long and short of it is this: When legislation is in pursuit of controlling the narrative in one space, we automatically reduce the number of spaces in which someone is able to explore who they are, find their support system, and begin to integrate that part of their identity into their overall self. This, in turn, slows the pace at which any person can then feel comfortable discussing their identity in settings that matter; like the provider office. There are health risks and concerns members of the LGBTQI+ community face at higher rates than their heterosexual counterparts. People of color face disproportionate rates of negative health outcomes compared to White individuals. Someone who does not have citizenship, and has avoided systems of care except for emergencies, is running the risk of unnecessarily exacerbating a health issue that could be avoided altogether with regular primary care. 

We say we are moving towards a patient-centered approach in healthcare. And yet we face a reality where H.R. 9197 may pass into law. There’s a discrepancy there, and I think it is time we start paying attention to it.