Report on Suspension of Gender-Affirming Care and Conflict with Sustainable Development Goals

Executive Summary

Recent actions by major healthcare providers in California, including Kaiser Permanente, Stanford Medicine, and Children’s Hospital Los Angeles, to pause or curtail gender-affirming medical services for minors represent a significant challenge to public health and human rights principles. These decisions, prompted by federal pressure from the Trump administration, directly conflict with California state laws designed to protect access to such care. This report analyzes these developments through the framework of the United Nations Sustainable Development Goals (SDGs), highlighting direct contraventions of SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), SDG 10 (Reduced Inequalities), and SDG 16 (Peace, Justice and Strong Institutions).

Challenges to SDG 3: Good Health and Well-being

SDG 3 aims to ensure healthy lives and promote well-being for all at all ages. The suspension of essential medical services for transgender youth directly undermines this objective by denying access to necessary healthcare, thereby impacting both physical and mental well-being.

• Kaiser Permanente: The Oakland-based provider, serving over 12 million people, paused treatment, citing “significant risks” from the evolving legal and regulatory environment. This action directly affects the continuity of care and well-being of its transgender patients.
• Stanford Medicine: The institution scaled back gender-related surgical procedures for minors, limiting the availability of comprehensive healthcare options.
• Children’s Hospital Los Angeles: The closure of its Center for Transyouth Health and Development eliminates a leading provider of specialized care that has been operational for three decades, creating a critical gap in health services.

Setbacks for SDG 5 (Gender Equality) and SDG 10 (Reduced Inequalities)

SDG 5 and SDG 10 are centered on eliminating discrimination, ensuring equal opportunities, and promoting social inclusion for all, irrespective of gender or other status. The targeting of gender-affirming care is a discriminatory practice that exacerbates inequality.

1. Discriminatory Federal Policies: The Trump administration’s executive orders and the Department of Justice’s issuance of subpoenas to clinics providing gender-affirming care create a discriminatory environment. This directly opposes the SDG 10 target of empowering and promoting the inclusion of all and eliminating discriminatory policies.
2. Increased Health Disparities: By yielding to federal pressure, healthcare institutions are creating significant barriers to care for a specific demographic. This action widens health disparities and contravenes the core principle of SDG 10 to reduce inequalities of outcome.
3. Contradiction of State-Level Protections: The decisions by healthcare providers ignore California’s legal framework, which protects medical services for youth and prohibits discrimination. California Attorney General Rob Bonta affirmed that state law mandates “equal access to healthcare services,” aligning with the equality principles of SDG 5 and SDG 10.

Erosion of SDG 16: Peace, Justice and Strong Institutions

SDG 16 calls for effective, accountable, and inclusive institutions and access to justice for all. The current situation reveals a systemic conflict that weakens institutional integrity and obstructs justice.

• Institutional Conflict and Accountability: A severe conflict exists between federal administrative pressure and established California state law, including the 2022 law designating the state as a “safe refuge.” The response of healthcare institutions to this pressure raises questions about their accountability to patients and state law versus federal politics.
• Weakening of Institutions: State Senator Scott Wiener described the federal actions as “bullying” and warned that institutional capitulation is how “fascists succeed.” This highlights a threat to the resilience and independence of healthcare institutions, which are pillars of a just society.
• Impediments to Justice: The suspension of legally protected medical services denies transgender youth access to care they are entitled to under state law, representing a fundamental failure in providing access to justice.
• Societal Division: The protests and counter-protests surrounding these decisions illustrate a polarized public discourse, undermining the goal of SDG 16 to promote peaceful and inclusive societies.

SDGs Addressed in the Article

SDG 3: Good Health and Well-being

• The article’s central theme is the provision and suspension of healthcare services, specifically gender-affirming care for transgender youth. It discusses how healthcare providers like Kaiser Permanente are pausing treatment, directly impacting the health and well-being of this population.

SDG 5: Gender Equality

• The issue revolves around discrimination based on gender identity. The actions by the Trump administration and the subsequent decisions by some hospitals target individuals seeking care related to their gender identity, which is a matter of gender equality and the right to live free from discrimination.

SDG 10: Reduced Inequalities

• The article highlights the creation of inequality in access to healthcare. Transgender youth are being denied services that are available to others, creating a disparity based on their status. California’s laws, described as making the state a “sanctuary” and “safe refuge,” are direct attempts to reduce this inequality.

SDG 16: Peace, Justice and Strong Institutions

• The conflict between federal executive orders and state laws (e.g., California’s) is a key focus. The article discusses the role of institutions—hospitals caving to political pressure, the Department of Justice issuing subpoenas, and the California Attorney General warning hospitals to uphold state law. This points to challenges in maintaining the rule of law and ensuring institutions are just and non-discriminatory.

Specific SDG Targets Identified

Target 3.8: Achieve universal health coverage, including access to quality essential health-care services.

• The article directly addresses the denial of access to what is considered essential healthcare for transgender youth. The decision by Kaiser Permanente, Stanford Medicine, and Children’s Hospital Los Angeles to pause, scale back, or close services for minors is a clear barrier to achieving universal access to quality healthcare for this group.

Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices.

• This target is relevant as the article describes a conflict between discriminatory federal pressure (“The Trump administration has aggressively targeted gender-related health care for trans youth”) and state-level actions to promote equality (“California has doubled down on protecting medical services for youth”). The suspension of care is an inequality of outcome for transgender youth.

Target 16.b: Promote and enforce non-discriminatory laws and policies for sustainable development.

• The article showcases efforts to enforce non-discriminatory laws. California Attorney General Rob Bonta’s warning that “denying or pausing care for trans youth based on political pressure could violate state law” and Senator Scott Wiener’s 2022 law to “make California a safe refuge” are direct examples of promoting and enforcing non-discriminatory policies.

Indicators for Measuring Progress

Number of healthcare providers suspending or limiting gender-affirming care.

• The article explicitly names providers that have changed their services: “Kaiser Permanente…pause treatment,” “Stanford Medicine scaled back gender-related surgical procedures,” and “Children’s Hospital Los Angeles closed its Center for Transyouth Health and Development.” Tracking this number serves as a direct indicator of access to care (Target 3.8).

Existence of protective state laws versus restrictive federal policies.

• The article contrasts the “series of executive orders” from the Trump administration with California’s “2022 law to make California a safe refuge.” The existence and enforcement of such laws can be used as an indicator to measure progress towards eliminating discriminatory practices (Target 10.3) and enforcing non-discriminatory policies (Target 16.b).

Number of legal actions taken to restrict or protect care.

• The article mentions that the “U.S. Department of Justice issued more than 20 subpoenas to doctors and clinics.” Conversely, it notes the California Attorney General “warned hospitals” about their legal obligations. The number and nature of these legal actions serve as an indicator of the institutional and legal battle over healthcare access (Target 16.b).

Summary of SDGs, Targets, and Indicators

Source: ww2.kqed.org