Child rights in trans healthcare – a call to action

Trans healthcare has seen some positive changes overthe past two decades, moving from the pathologisationof difference as ‘disorder’, to approaches that recognizeand embrace the diversity, dignity and value of translives. In a short time, we have also seen a shift fromwidespread clinical control and gate-keeping to thegrowing adoption of affirmative approaches to transhealthcare, which are predicated on respecting transand gender-diverse peoples’ rights to safe and respectfulhealthcare. Whilst these evolutions are welcome andimportant, progress is inconsistent and uneven, andsubject to legislative and political rollback. Progress isparticularly patchy and fragile in healthcare services fortrans, gender-diverse, and gender non-conforming chil-dren, with children defined here as encompassing allnon-adults under the ages of 18 (United Nations, 1989).In multiple countries affirmative healthcare is underattack, with children’s trans healthcare services bearingthe brunt of attacks on rights-based practice. There aremany locations where trans healthcare services for chil-dren fail to uphold trans children’s rights, withapproaches in children’s services not keeping up withthe improvements that are more widely being seen inadult trans healthcare.In this editorial we first call attention to the impor-tance of child-rights informed policy and practice intrans healthcare. We outline critical pillars ofrights-respecting healthcare for trans, gender-diverse,and gender non-conforming children. We highlightthe importance of embedding rights within servicedelivery, discussing the need for child participation inhealthcare design, evaluation and accountability. Inthe second section of this editorial we articulate andcall attention to a sector-wide ethical duty of care tochildren, building a sector where child rights viola-tions are no longer tolerated. We highlight the respon-sibilities of all trans healthcare stakeholders andprofessionals, including those in adult trans health-care, in ensuring a sector-wide shift to ethical andrights-respecting practice. Trans children in particularrequire greater allyship from professionals working intrans health, including those in adult healthcare, help-ing to ensure that as the wider field evolves andimproves, children are not left behind.