A Note on Vocabulary
When considering sexual orientation and gender identity, the vocabulary used in LGBT human rights discourse may be unfamiliar. Even words taken for granted deserve reconsideration, as pointed out by the prominent Australian gender researcher Raewyn Connell:
Whenever we speak of “a woman” or “a man”, we call into play a tremendous system of understandings, implications, overtones and allusions that have accumulated through our cultural history. The “meanings” of these words are enormously greater than the biological categories of male and female. (Connell 2009)
“Gender” refers to the societal meaning assigned to male and female and to the socially constructed roles, behaviors, activities, and attributes that any given society considers appropriate for men and women. Even this term is open to more nuanced meaning, as the American transgender activist and biologist Julia Serano describes:
Each of us has a unique experience with gender, one that is influenced by a host of extrinsic factors, such as culture, religion, race, economic class, upbringing, and ability, as well as intrinsic factors including our anatomy, genetic and hormonal makeup, subconscious sex, sexual orientation, and gender expression. Together, these factors help determine the gendered experiences we are exposed to, as well as the ways we process and make sense of them. (Serano 2007)
Moving from “gender” to “transgender” is an invitation to confusion and misunderstanding, but Serano unpacks “transgender” when she says that transgender is:
Used primarily as an umbrella term to describe those who defy societal expectations and assumptions regarding femaleness and maleness; this includes people who are transsexual (those who live as members of the sex other than the one they were assigned at birth), intersex (those who are born with a reproductive or sexual anatomy that does not fit the typical definitions of female or male), and genderqueer (those who identify outside of the male/female binary), as well as those whose gender expression differs from their anatomical or perceived sex (including cross-dressers, drag performers, masculine women, feminine men, and so on). (Serano 2007)
It is common to differentiate between “LGB” (lesbian, gay, and bisexual) persons, and those who are “T” (transgender and intersex) by describing the former as having to do with sexual orientation, and the latter to be primarily about gender identity. Yet even with the term “gender identity” there are complications, as noted again by Serano:
With regard to transsexuals, the phrase “gender identity” is problematic because it seems to describe two potentially different things: the gender we consciously choose to identify us, and the gender we subconsciously feel ourselves to be. To make things clearer, I will refer to the latter as subconscious sex. (Serano 2007)
Finally, theorists and writers on transgender concerns frequently use the term “cisgender,” which is simply intended to distinguish between those who are transgender from those who are not. In short, a cisgender person is someone who feels that their gender identity agrees with their recognized sex as assigned at birth. The vocabulary around LGBT issues is much more extensive, frequently in dispute, and far from settled, but the reader should now have sufficient vocabulary to allow me to return to further consideration of human rights.
The Inadequacy of Popular Human Rights Frameworks
Addressing LGBT human rights in developing countries fits seamlessly into the international human rights regime, from the 1948 Universal Declaration of Human Rights to the more recent Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity. Evolving conceptions of international human rights law include a broad interpretation that proves to be very inclusive of the rights and protection sought by LGBT people around the world. The 2007 Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity also provide a human rights protection framework for LGBT individuals, addressing a broad range of human rights standards and their application to issues of sexual orientation and gender identity.
The human rights thinking of the United Nations Development Programme (UNDP), influenced significantly by Nobel Laureate economist and philosopher Amartya Sen, argues that development should be conceived as a process of expanding the real freedoms that people enjoy so that their lives may become more truly “human” (Sen 1999). UNDP, borrowing from Sen, distills its human rights approach into seven fundamental freedoms:
Freedom from discrimination
Freedom from want
Freedom to develop and realize one’s human potential
Freedom from fear
Freedom from injustice
Freedom of thought and speech and participation
Freedom for decent work (UNDP 2000)
Concerns about the treatment experienced by LGBT persons in developing countries are relevant across all seven categories of the UNDP’s “seven freedoms” human rights framework. LGBT persons are subject to severe and extensive forms of discrimination, often sanctioned within a country’s legal code. They are frequently subject to loss of employment, housing, and insecurity due to their sexual orientation or gender identity, and until the recent yet still largely nascent mobilization of LGBT human rights civil society advocacy movements they have been denied participation in shaping decisions that most directly affect their well-being. Clearly there are also many justice issues affecting LGBT persons that remain unresolved throughout the world, including in countries with more advanced economies such as the United States.
Missing from the UNDP’s list, however, is any direct reference to “freedom of identity” or a human right simply to be oneself. Is there a human right or other persuasive moral basis upon which transgender persons can be justified in claiming a gender identity contrary to that which was assigned to them at birth? Any moral consideration of gender identity must first begin with an assessment of whether “gender identity” is a moral category. The assertion that multiple and often conflicting relativistic moral values are linked with societal perceptions of masculine and feminine is unchallenged. Disagreements emerge when we consider whether certain universal moral values ought to be assigned to or associated with the standard gender categories, and instrumentally even the act of assignment of gender arguably gives rise to certain moral concerns as Connell says, “Gender is a key dimension of personal life, social relations and culture. It is an arena in which we face difficult practical issues about justice, identity and even survival.”
Moral Dimensions of Gender Assignment and Classification
As challenging as gender categories and assignments may be in moral terms, the situation gets exponentially more complicated when the basis for gender assignment itself is open to moral questions. Moral disputes start from the question of who has the moral right to assign a person’s gender identity and on what basis, move on to what constitutes “authentic” gender, and include whether gender categories are framed by a binary structure or lie upon a gender continuum. There are some people who reject the notion of gender categories altogether and seek to be respected as dignified but ungendered human beings. Others would make the moral case for a “third gender,” which may or may not be defined to include transgender persons. Still others question whether “transgender” constitutes a rational identity, worthy of respect.
The standard convention adopted around the world is that the state has the responsibility to legally recognize the name and sex of an infant soon after birth, with sex almost always determined on the basis of genitalia. The gender role of the state is not to be underestimated:
The state makes policies concerned with gender issues. As these policies are put into effect, the state regulates gender relations in the wider society. This is not a minor aspect of what the state does. It involves many policy areas, from housing through education to criminal justice and the military. (Connell 2009)
The state’s role in this context is an adequate and satisfactory convention for cisgender persons but is woefully inadequate for transgender persons where genitals have no bearing on their subconscious sex, although this conflict will not be apparent until the infant is an older child. In the case of some intersex persons where genital manifestations may be indeterminate there is no clear or established convention, but most jurisdictions will adopt a sex marker designation as decided by a physician or by the infant’s parents.
The debate over classification of a transgender person’s sex and gender remains contentious. Many transgender persons who live full time presenting in their perception of their authentic gender (with or without sex reassignment surgery) are classified as “transsexual women” or “transsexual men,” but the term “transsexual” is an adjective, not a noun describing some third gender status. Some persons who accept the “transsexual” label however reject the gender binary and express some comfort in being considered as “genderqueer”—a separate or third gender category. The moral issue here is not the classification itself but the moral right of any individual to express agency through articulating his or her own sense of authentic gender.
Some moral consideration of gender classification is however appropriate. While different in character, the classification of homosexual sexual orientation offers an illuminating history. In the United States until 1973, gay and lesbian people were classified by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) as mentally ill. The World Health Organization’s International Classification of Diseases (ICD) did not drop this pejorative label until 1990. Yet with respect to gender identity variance (transgender identity), this remains classified as a mental health disorder in both the DSM and the ICD—often providing grounds for employers to justify dismissal when transgender people disclose their status and begin a gender transition. A growing movement in the United States now advocates that the transgender condition should be reclassified as a medical condition, as this would provide a diagnostic category that would accommodate the needs of those gender identity variant people who require medical care for their condition, but without the stigma attached to a mental disorder. Some transgender people reject this too, arguing that “medical condition” also brings unfavorable stigmatization. Instead, such people argue that the moral right of any individual to determine and express their own gender identity is fundamental, requiring no psychiatric or medical justification.
Are individuals to be deemed rational moral agents when they manifest the physical attributes of one sex but consistently claim that their authentic gender is different? If we assume that they are mentally ill, their moral status as dignified human beings entitled to exercise their own agency is gravely undermined. Even assuming that such persons demonstrate consistent rational behavior—as they nearly always do in all other aspects of their lives—is there an inherent human right to gender self-determination? This decision has consequence; many transgender persons insist that the process of satisfying the human rights claim to one’s gender identity involves more than a moral assertion to that effect. The transgender person’s quest for validation in the claimed identity must be first internalized through a sense of achieving that integrity physically, mentally, and emotionally. Societally, the person who transitions across the gender divide ideally should be able to be perceived by the public as being of the gender that they claim is authentic. This ability to “pass” (a term with unfortunate connotations of a deception being carried out) depends on many factors and is often only accomplished by those few transgender persons with adequate means in more developed countries through access to complicated and expensive medically supported transition procedures. In developing countries, transgender persons who have no access to such transition support may at best only be able to achieve a persona of androgyny or variant gender expression (a “masculine woman” or a “feminine man”) instead of a publicly perceived gender identity that aligns with their own sense of their authentic subconscious sex. An inability to transition one’s gender to a point where one is generally accepted in one’s claimed and authentic gender identity raises many negative implications; such persons feel trapped in the wrong body. Their ability to participate in public and economic life depends on “performing” their assigned gender even though they experience this to be a fundamental, existential untruth. Experientially, many transgender persons describe how sustaining this falsehood generates a profound sense of gender dissonance that progressively becomes less and less tolerable. Severe depression and very high rates of suicide come to characterize such a life. In these circumstances, is it a rational choice not to transition gender?
The moral question therefore is not simply one of the human right to claim one’s gender identity; the more familiar human right to access to health (especially health in the sense of wholeness) becomes integral to a transgender person’s exercise of a gender identity claim. In such circumstances, does the state bear any responsibility to share in the costs or to provide other resources to assist the transgender person to overcome the debilitating gender dissonance that they experience, by helping them align mind and body through a process of gender transitioning? In short, ought the desire of transgender persons to achieve gender integrity and overcome dissonance be seen as exerting a moral claim on cisgender persons and public institutions? What if this “desire” is accepted as a need, fundamental to that person’s agency and well-being, and possibly to that person’s ability to stay alive?
A Harrowing Journey and the Claim to Moral Agency
Well-being is the goal of development, broadly speaking, and yet, accurate or even rudimentary data is largely unavailable about transgender people’s well-being, agency, and their overall quality of life. A growing body of anecdotal evidence in more developed societies makes it clear that simple generalizations are inappropriate. Many transgender people appear to experience gender dissonance as a mild irritant or a yearning, and while they may resort to expanding the range of their gender expression (e.g., through cross-dressing) they harbor no intention to physically, socially, and legally cross over to live full-time in a gender other than that which they were assigned at birth. Other transgender people experience gender dissonance more acutely but muster the strength to deny, avoid, or at least defer as long as possible the radical changes that would be entailed in transitioning—changes that impact many more people than just the transgender person (e.g., a spouse, children, parents, siblings, employers, coworkers, and friends). Often this tactic is a recognition that the financial and support resources needed to assist such a transition are inaccessible. Some transgender people pursue a lateral move by rejecting the gender binary of masculine and feminine entirely, although society—particularly in developing countries—makes this stance extremely awkward or even untenable. Cisgender people feel a strong sense of necessity or entitlement to classify others as one gender or the other with no tolerance for ambivalence.
The prospect of life in the “wrong body” is emotionally and psychologically daunting if no alternative appears to be available, and transgender people in this category probably account for the exceptionally high suicide rates referred to earlier. Those who avoid this tragic end are commonly subject to deep depression and other forms of dysfunction—unless they are able to transition. For those who do transition and become transsexual women or men, consistent accounts indicate that they ultimately achieve a sense of well-being, wholeness, healing, integrity, and agency. The qualifier of “ultimately” is significant, however, as the decision to transition and its subsequent expression frequently generates extreme forms of persecution, economic loss, stigmatization, and emotional disruptions that require enormous stamina, persistence, and comprehensive support resources (e.g., counseling, friends, supportive family and faith community, access to medical supervision, access to legal mechanisms to change name and gender markers, and in some cases access to gender confirming surgery and other related interventions). For those who do, and who succeed in being accepted or at least perceived by their societies as the gender that they know themselves to be, the sense of fulfillment, agency, and future possibilities is profound. These anecdotal accounts—if studied more rigorously—may shed some light on the choice or necessity of transgender persons to transition to transsexual women or men but do they help us to understand what “gender” is or how it is constituted?
The Gender Debate
Achieving a definitive sense of gender is an elusive goal. Gender certainly exists as something experiential—the gender we experience ourselves as and the gender we perceive others to be, or that we assign to them. Gender has roots in society and is interpreted somewhat differently in differing countries:
Enduring or widespread patterns among social relations are what social theory calls “structures.” In this sense, gender must be understood as a social structure. It is not an expression of biology, nor a fixed dichotomy in human life or character. It is a pattern in our social arrangements, and in the everyday activities or practices which those arrangements govern. (Connell 2009, p. 10)
Philosophers and gender theorists such as Judith Butler have explained gender as something that is produced and performed, or more accurately that is produced through repeated performance. In a controversial article in 1988, and in much more detail in her 1990 book Gender Trouble: Feminism and the Subversion of Identity, Butler took the position that gender identity is a “performative accomplishment compelled by social sanction and taboo” (Butler 1988). In her view, gender emerges through a series of “acts” repeated by a person, which is always subject to further changes. To Butler, gender is conceptualized as repetitive social fictions that are created and built up over time, which in turn are embodied as “truth” or “natural” through the performance of what she termed “social scripts.”
From Butler’s perspective, gender is performative but gender doesn’t express any inner sense of subconscious sex as described by Serano and most transsexuals. Butler rejects the notion that any sense of subconscious sex or any essential “gendered core” exists in a body’s being, for an “essential” core identity would mean that a person constituted this identity and expressed it through accessing a set of preexisting characteristics that are inherent to that body.
Serano roundly rejects Butler’s performative argument:
I would argue that social gender is not produced and propagated because of the way we as individuals “perform” or “do” our genders; it lies in the perceptions and interpretations of others. I can modify my own gender all I want, but it won’t change the fact that other people will continue to compulsively assign a gender to me and to view me through the distorted lenses of cissexual and heterosexual assumption. . . . Cissexual academics eagerly cite aspects of gender-variant lives that support their claims that gender is primarily constructed, while ignoring those aspects that undermine their cases. For example, many academics have focused on the transsexual transition process to argue that gender does not arise “naturally,” but that it is learned, practiced, and performed. However, these same academics tend to overlook (or dismiss outright) the fact that most transsexuals experience a lifelong self-knowing that they should be the other sex. This self-knowing exists despite the overwhelming social pressure for a person to identify and behave as a member of their assigned sex, which strongly suggests that there are indeed natural and intrinsic gender inclinations that can precede and/or supersede social conditioning and gender norms. (Serano 2007)
My own life similarly offers a rebuttal to the claims of Butler, but also to those who argue that our bodies provide the essential, biological, “natural” explanation of what constitutes gender. Despite more than five decades of repetitive (and I would argue very persuasive) performance of a male script, I completely failed performatively to constitute a sustainable male gender. And despite a similar exposure to the reality of male hormones, male chromosomes, and a demonstrably male physical body, my gender dissonance remained and progressively became more unbearable. Serano’s alternative explanation—that each person possesses a subconscious sex that transsexuals come to discern in ways that cisgender persons cannot—resonates entirely with my lived experience.
In most developing countries, the gender identity dialogue is not articulated in terms of “performative” versus “natural” terms but is instead culturally imposed and not subject to revision on any terms. Rigid societal strictures determine that you are the sex and gender that your genitals marked you to be at birth, and any attempt to deal with internal gender dissonance by rejecting your biological sex assignment and redefining your gender identity is perceived by members of such societies as wrongheaded, delusional, or dangerous. In many if not most traditional societies in the developing world, gender roles are highly proscribed and define important power relationships. Challenges to such social gender structures are deemed unacceptable, and transgender persons’ appeals for understanding, support, or some modicum of acceptance are generally unsuccessful.
Other than the basic struggle to stay alive, there can hardly be a more compelling claim to moral agency than the demand to be accepted in the basic identity that you know yourself to be. The existential assertion “I am” takes on particular meaning for transgender persons, whose presentation of that “I” is frequently rejected as implausible, inconvenient, embarrassing to others, irrational, spurious, ridiculous, immoral, in violation of traditional cultural values, or simply as being patently absurd. The compulsion to be recognized in the only gender identity that feels authentic leads many transgender people to take enormous risks in their public presentation, and to such persons (and I was one of them) there is no acceptable option such as that endured by many gay and lesbian couples who live their deep affections discretely closeted. Cross-dressing in public is seldom discrete, but persisting in the public presentation of a gender that one knows to be wrong is among the most excruciating experiences of gender dissonance known to transgender persons. In time, for many of us, such duplicity is simply unsupportable. It is neither an exaggeration nor melodramatic at that juncture to describe the necessity to transition as a matter of life or death for many transgender persons.
Given these conflicting bases for gender assignment, expression, recognition, or even substance, and the consequences of not recognizing the identity claims of transgender persons, do any grounds exist upon which it can be argued that the U.S. government should recognize and be responsive to the identity claims of transgender persons, for example through USAID’s programming and policies?
Responding to the Needs of Transgender People in the Developing World
USAID places progressively more emphasis on human rights; recently the agency took institutional steps to address human rights more comprehensively. While other moral theories, in particular the “capability approach,” arguably offer a more elegant and compelling account of the critical importance of moral agency to the achievement of a “truly human” or dignified human life, human rights–based moral approaches similarly attempt to define a threshold set of conditions below which the sanctity of human quality of life, the possibility for a meaningful and fulfilling life, and the very concept of human dignity all stand in jeopardy. Transgender persons face significant human dignity hurdles in obtaining human rights protections or enjoying human rights freedoms with respect to identity, no matter how these rights and freedoms are articulated. In many developing countries their transgender status is at the very least heavily stigmatized and in too many cases is criminalized or conflated with unrelated issues of sexual orientation. These situations are exacerbated by the lack of access in many less affluent countries to basic information about the transgender phenomenon, the inability of many transgender persons to achieve a presentation in public that sufficiently (i.e., persuasively) articulates their own sense of gender authenticity, and the often total lack of psycho-social, medical, financial, emotional, community, or family support for those who feel the necessity to transition. The risk of an unsuccessful transition in such circumstances is very high, and the consequences for that failure can be life threatening.
Many transgender persons in developing countries suffer harsh lives devoid of the profound satisfaction of being themselves. Many are left to survive in the rough and often violent world of sex work or in other menial low-status pursuits. Critics sometimes argue that gender expression is itself superficial and prone to exaggeration or deception. Transgender persons are frequently accused of being too obsessed by their bodies, their presentation, and their overzealous attempts to model gendered behavior that stands in contrast to their assigned gender. When transgender people in developing countries yearn for gender-confirming surgery, they are dismissed as seeking “cosmetic” treatments that are of negligible priority when contrasted with other health and social needs—even though the only known and demonstrated cure for gender dissonance is gender-confirming surgery. This procedure is now sophisticated and highly successful but cost-prohibitive for anybody who is forced to pay out of pocket. The dismissal of such interventions as frivolous or cosmetic by cisgender persons demonstrates how poorly understood the significance of appropriately gendered bodies is to the achievement of human agency.
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Bodies cannot be understood as just the objects of social process, whether symbolic or disciplinary. They are active participants in social process. They participate through their capacities, development and needs, through the friction of their recalcitrance, and through the directions set by their pleasures and skills. Bodies must be seen as sharing in social agency, in generating and shaping courses of social conduct. (Connell 2009)
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While the costs per procedure of gender confirming surgery is prohibitive, the incidence of transgender persons within the general population is exceptionally low and among this small group only some persons experience gender dissonance to such a degree that gender confirming surgery is recommended. While it may be unrealistic to argue that the state should subsidize or cover the costs of gender confirming surgery and related interventions when compared to the moral demands of other equally serious medical needs affecting more numerous or more severely unhealthy sections of the population, it isn’t unreasonable for the state to demonstrate its commitment to the moral rights and freedoms of its transgender citizens by seeking ways to defray these gender confirming surgery costs, to offer opportunities for financing and long-term, low-interest repayments, or to find other ways to assist transitioning transsexual men and women with viable trajectories toward bodily integrity and health. Similarly, USAID’s strong advocacy position on diversity arguably can be interpreted to signify that the state is morally obligated to make appropriate efforts to normalize the reality of transgender status within its cisgender population. While no policy position can be deduced beyond that point, USAID’s health programming priorities would seem a good platform from which to encourage the medical and counseling professions in developing countries to learn how best to support transgender citizens and perhaps even to encourage such countries to consider providing that support at affordable levels to the very few people affected.
Finally, due to stigmatization and rejection, many transgender persons in developing countries are denied the basic services that they need to live meaningful, productive lives. The state clearly has a moral obligation to these citizens—as it does to all citizens—to work toward improving their access to these basic services (i.e., security, health, education, employment, legal recognition of name and gender).
USAID already enjoys a deserved reputation for demonstrating caring concern for the most vulnerable people in developing countries and is currently in the initial stages of embracing new initiatives in inclusive development that explicitly include LGBT persons. The moral claims of transgender people within the larger marginalized LGBT community in developing countries are no exception. As described in this article, the basic claim to have one’s gender identity respected, recognized, and protected is fundamental to the exercise of human agency by transgender people. On that basis, USAID should at a minimum clearly articulate support for the moral validity of such claims while simultaneously encouraging its development partners and the governments of countries in which USAID operates (through policies, programs, and public outreach) that these moral claims are deserving of respect. Respecting such claims will require working toward achievable measures to improve the well-being of those currently excluded: transgender persons in developing countries.
References
Butler, Judith. 1988. Performative acts and gender constitution: An essay in phenomenology and feminist theory. Theatre Journal 40(4): 519-531.
———. 1990. Gender trouble: Feminism and the subversion of identity. London: Routledge.
Connell, Raewyn. 2009. Gender. 2nd ed. Cambridge, U.K.: Polity.
Hare, Lauren et al. 2009. Androgen receptor repeat length polymorphism associated with male-to-female transsexualism. Biological Psychiatry 65(1): 93-96.
National Gay and Lesbian Task Force and National Center for Transgender Equality. 2011. National Transgender Discrimination Survey. Washington, DC.
Sen, Amartya. 1999. Development as freedom. New York: Alfred A. Knopf.
Serano, Julia. 2007. Whipping girl: A transsexual woman on sexism and the scapegoating of femininity. Berkeley: Seal Press.
United Nations Development Programme (UNDP). 2000. Human development report 2000. New York: Oxford University Press.
U.S. Department of State. n.d. Human rights. Web page under HYPERLINK “http://www.state.gov/j/index.htm” Under Secretary for Civilian Security, Democracy, and Human Rights, HYPERLINK “http://www.state.gov/j/drl/index.htm” Bureau of Democracy, Human Rights, and Labor.
Endnotes
The U.S. government adopted the acronym “LGBT” to describe a population that also includes intersex and genderqueer persons. This article uses this convention, and “LGBT” as used by this author is intended to be fully inclusive of the whole spectrum of those marginalized by their sexual orientation or gender identity.
These include successful legal arguments based on the rights to privacy as articulated in the Universal Declaration of Human Rights (UDHR) Article 12; and the International Covenant on Civil and Political Rights (ICCPR) #17, equality (UDHR, Article 7; ICCPR #26), and freedom from discrimination (UDHR 7, ICCPR #2). In addition, given the character and range of human rights violations against LGBT people documented worldwide, other UDHR articles such as Freedom from Arbitrary Arrest (Article 9), Right to Asylum (Article 14), Right to Life, Liberty and the Security of Person (Article 3), Right to Freedom from Torture and Degrading Treatment (Article 5), and Right of Peaceful Assembly and Association (Article 20) have also been successfully referenced in human rights caseworks involving LGBT people.
Transgender persons anecdotally typically describe their first experiences of dissonance between their sense of identity and their assigned gender as early as three years old, and quite commonly by the age of seven.
The science behind the transgender phenomenon remains controversial and unsettled, although relatively recent studies into genetic links with transsexuality show male-to-female transsexuals are more likely than non-transsexual males to have a longer version of a receptor gene for the sex hormone androgen or testosterone. That research suggests that reduced androgen and androgen signaling contributes to the female gender identity of male-to-female transsexuals. The researchers argue that it is possible that a decrease in testosterone levels in the brain during development might result in incomplete masculinization of the brain in male-to-female transsexuals, resulting in a more feminized brain and a female gender identity (Hare et al. 2009). While such scientific investigations may in time and with more comprehensive data prove to help explain the transgender phenomenon, the more important moral concerns have to do with the question of rationality and self-determination.
In one of the few instances where robust empirical data has been made available, American transgender persons were shown to experience a suicide rate twenty-six times higher than the national average (National Gay and Lesbian Task Force and National Center for Transgender Equality 2011).
USAID now recognizes an interrelated sector labeled “Democracy, Rights, and Governance” (DRG) in place of its previous institutional focus simply on “Democracy and Governance” (DG). Certain specially trained staff at USAID Missions hold the DRG portfolio, and USAID itself is engaged in strategic work to further articulate the meaning and significance of human rights within the new DRG strategy (under preparation).