Report on the Conflation of Gender-Affirming Care and Female Genital Mutilation (FGM) and its Impact on Sustainable Development Goals

Executive Summary

This report analyzes the emergent trend in the United States of conflating gender-affirming healthcare with the harmful practice of female genital mutilation (FGM). This conflation poses significant legal, medical, and human rights risks, directly undermining progress toward key Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), and SDG 16 (Peace, Justice, and Strong Institutions). The analysis clarifies the fundamental distinctions between the two practices and examines how their misrepresentation threatens established protections against FGM while simultaneously jeopardizing access to essential healthcare for transgender individuals. The report provides a legal framework based on statutory interpretation, constitutional principles, and international human rights obligations to advocate for accurate, rights-based policymaking aligned with the 2030 Agenda for Sustainable Development.

Analysis of Key Risks and Contradictions to the SDG Framework

The conflation of consensual, medically-supported gender-affirming care with FGM, a non-consensual act of gender-based violence, creates a dangerous legal and social precedent. This mischaracterization actively works against the global development agenda.

• Undermining SDG 5 (Gender Equality): This conflation dilutes the global consensus and legal frameworks specifically designed to eliminate FGM, a target under SDG 5.3. By creating false equivalencies, it weakens the focused efforts required to protect women and girls from this specific form of gender-based violence.
• Threatening SDG 3 (Good Health and Well-being): It jeopardizes universal health coverage (Target 3.8) by creating legislative barriers that deny transgender individuals access to necessary medical care, thereby negatively impacting their physical and mental health.
• Violating SDG 10 (Reduced Inequalities): The policy trend disproportionately targets and marginalizes transgender individuals, a vulnerable population, thereby increasing inequality in direct opposition to the goals of SDG 10.
• Eroding SDG 16 (Peace, Justice and Strong Institutions): It promotes discriminatory legislation and undermines the rule of law by misinterpreting medical practice and human rights principles, weakening the integrity of legal and public institutions.

Implications for SDG 5: Gender Equality

Achieving gender equality requires eliminating all forms of discrimination and violence against all women, girls, and gender-diverse people. The current legislative trend represents a significant setback.

1. Dilution of FGM Protections: FGM is internationally recognized as a gross violation of the human rights of women and girls. Conflating it with gender-affirming care confuses legal definitions and diverts resources and attention from the critical work of eradicating FGM, as mandated by SDG Target 5.3.
2. Promotion of Gender-Based Discrimination: Denying individuals the right to gender-affirming care is a form of discrimination based on gender identity. This contravenes the core principle of SDG 5, which is to ensure full and effective participation and equal opportunities for all genders in all spheres of life.

Implications for SDG 3: Good Health and Well-being

The right to health is a fundamental human right and central to SDG 3. The conflation poses a direct threat to the health and well-being of multiple communities.

• Denial of Essential Healthcare: Gender-affirming care is recognized by major medical associations as medically necessary for treating gender dysphoria. Legislative bans on this care prevent individuals from receiving treatment that improves mental and physical health outcomes, in direct conflict with SDG Target 3.4 (promote mental health and well-being).
• Misinformation in Public Health: The false equivalence misinforms the public and policymakers, undermining evidence-based public health strategies for both preventing FGM and providing competent care for transgender people.

Legal and Policy Framework in the Context of SDG 16: Peace, Justice and Strong Institutions

SDG 16 calls for effective, accountable, and inclusive institutions at all levels. Policies based on the conflation of FGM and gender-affirming care fail this standard.

1. Statutory and Constitutional Concerns: Such legislation raises serious constitutional questions regarding equal protection, privacy, and freedom from discrimination. It represents a move away from just and rights-based lawmaking toward policy driven by misinformation.
2. International Obligations: The trend contradicts international human rights obligations to protect individuals from discrimination and ensure access to the highest attainable standard of health. Strong institutions, as envisioned by SDG 16, must uphold these commitments.
3. Call for Rights-Based Policymaking: To align with SDG 16, policymaking must be based on accurate information, medical consensus, and a firm commitment to the human rights of all individuals. This requires a clear and unequivocal rejection of the harmful conflation between FGM and gender-affirming care.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being

   • The article directly addresses health by discussing “gender-affirming care” and the threat to “access to healthcare for transgender individuals.” This connects to ensuring healthy lives and promoting well-being for all.

2. SDG 5: Gender Equality

   • This goal is central to the article. It explicitly discusses “female genital mutilation (FGM),” a harmful practice targeted for elimination under this SDG. It also touches upon discrimination against transgender individuals, which falls under the broader aim of achieving equality for all genders.

3. SDG 10: Reduced Inequalities

   • The article highlights the risks posed to a specific marginalized group, “transgender individuals.” The conflation of FGM and gender-affirming care creates discriminatory policies that increase inequality and threaten the rights and inclusion of this group.

4. SDG 16: Peace, Justice and Strong Institutions

   • The brief’s focus on “legal analysis on statutory interpretation, constitutional concerns, and international obligations” points to this SDG. It advocates for “rights-based policymaking” and addresses the need for just and non-discriminatory laws to protect human rights and prevent harmful practices like FGM.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 5.3: Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation.

   • The article is explicitly about the need to maintain clear “protections against FGM” and warns that conflating it with other issues undermines efforts to eliminate this specific harmful practice.

2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

   • The article’s concern that the conflation “threatens access to healthcare for transgender individuals” directly relates to ensuring universal access to quality essential healthcare services for all people.

3. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard.

   • The policy brief aims to counter a trend that leads to discriminatory outcomes for transgender people. It supports “accurate, rights-based policymaking” to eliminate practices that create inequality.

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

   • The article’s entire purpose is to inform policymaking to prevent the creation of discriminatory laws. It provides “legal analysis on statutory interpretation, constitutional concerns, and international obligations” to support the development of non-discriminatory policies.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicator 5.3.2: Proportion of girls and women aged 15-49 years who have undergone female genital mutilation/cutting.

   • While not stating the indicator, the article’s focus on “protections against FGM” implies that the ultimate measure of success is the reduction and elimination of FGM prevalence, which this indicator tracks.

2. Implied Indicator: Existence of laws and policies that protect access to healthcare for transgender individuals.

   • The article’s warning that the trend “threatens access to healthcare for transgender individuals” implies that a key measure of progress is the number and strength of laws and policies that explicitly protect this access, as opposed to restricting it.

3. Implied Indicator: Number of laws or policies that conflate FGM with gender-affirming care.

   • The article identifies the “growing trend of conflating gender-affirming care with female genital mutilation” as the core problem. Therefore, tracking the number of proposed or enacted state and federal laws that contain this conflation would be a direct indicator of the problem’s scale and the progress in combating it.

4. Summary Table: SDGs, Targets, and Indicators

Source: equalitynow.org