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43. The Use of Discretionary Power of Parents, Teachers, Physicians in Enactments of Structural Violence Against Transgender and Nonbinary Young People During Childhood and Adolescence

      Purpose

      Transgender and nonbinary children and adolescents experience complex risks for violence (e.g., physical, sexual, structural) targeting them in all aspects of their social environments (e.g., home, school, healthcare). These risks can be mitigated by affirming parents, teachers, peers, and healthcare professionals. While these risks and mitigating factors for violence are becoming broadly understood, little is known about when these factors develop during childhood and adolescence. This study aimed to explore how violence against transgender and nonbinary young people emerges during their childhood and adolesence and from which areas of their social ecologies.

      Methods

      Twenty-two transgender and nonbinary young people ages 18-29 participated in two-hour life history interviews describing their experiences of violence and gender development during childhood, adolescence, and young adulthood. Participants were recruited nationally and interviewed via Zoom. Interview transcripts were qualitatively coded using abductive grounded theory to assess for patterns in relation to the study purpose.

      Results

      A major pattern to emerge from the qualitative analysis revealed the unique and critical role of the discretionary (decision-making) power of adult authority figures in granting or denying access to safety, resources, and affirming healthcare. Participants described gender-rejecting parents using their authority during participants’ childhood and adolescence to surveil and/or deny participants’ access to privacy, freedom of movement, healthcare, and connections to social networks (e.g., friends, phone, social media, email, the internet). Participants whose healthcare was covered by parents’ insurance during young adulthood were especially vulnerable to parent’s discretionary violence in denying them gender-affirming healthcare even as adults. Teachers were described as using their authority to excessively discipline participants for their gender identities, resulting in hostile and stressful school environments and loss of educational opportunities. Participants described experiences when physicians would deny the participant’s gender and therefore deny gender-affirming healthcare. Physicians were also described using their authority to pathologize the participant’s gendered behavior, resulting in involuntary hospitalizations, over-medicating participants, and ignoring or missing signs of abuse and neglect.

      Conclusions

      These findings contribute to the growing literature demonstrating the clear role of social environments in the health and wellbeing of children and adolescents, specifically transgender and nonbinary young people. During childhood and adolescents, transgender and nonbinary youth are particularly vulnerable to the decisions made by those adults with power over them. Physicians, teachers, parents, and other adult authority figures have a duty to protect vulnerable youth and this duty starts with managing their own decision-making powers. Parents, teachers, and physicians need clear education on how their decisions to affirm or reject transgender and nonbinary young people can have a direct impact on their health and wellbeing.

      Sources of Support

      University of California President's Dissertation Year Fellowship; SHARE Program at University of California, Berkeley.