General Strike For Bodily Rights: Understanding welfare in a capitalist state

According to Scottish Trans, the estimated wait time for a first appointment in Edinburgh is two years. In Glasgow, it's four. Reading over the information about Scotland's four NHS clinics, it's apparent that transition, regardless of the route you take, has an enormous cost. 

As sites where the bodily autonomy of marginalised people is contested, reproductive and gender affirming care are inextricably linked. Barriers to reproductive and gender affirming care constitute a class war in many ways. Being able to afford private care isn't necessarily the same thing as being able to buy whatever care you want, but, set against a public system riven with obstacles, it begins to feel that way. Free care that you have to wait years for isn't free. The cost of dysphoria, of waiting, of trying to live as yourself in a culture that refuses to see you is crushing. It's like owing myself a debt that I will never pay off.

Trans people medically transition for infinitely varied reasons – while medical transition has nothing to do with the validity of trans identity, it's a common choice amongst us. In medical care, medical transition is posited as a way of 'treating' gender dysphoria, but the impacts reach so much further. To show gender presentation to be composed of arbitrary and changeable signs is to reclaim one's body back from the state. To have a trans body is to be written over with external meaning; to transition, medically or socially, is to take back our power as authors of our own meaning. 

Bodies are subjugated in Scotland in so many ways – beyond gender affirming care, people with uteruses face incredible obstacles to getting treated for the most commonplace issues. Of course, pretty much every kind of treatment has been affected by the incredible strain on the NHS, and this is not the fault of care providers. The difficulty of accessing reproductive and gender-related care speaks to a hostility towards trans people and women at a governmental level. While the NHS claims that you can get voluntarily sterilised, a GP can refuse to carry out the procedure or refer you for it if they 'do not believe it's in your best interests.' In practice, this means that a care provider can simply decide that they don't feel like it – and, frequently, they don't. There are few publicly available figures from the last ten years, but a 2008 pilot study found that fewer than half of the participants who asked their doctor about permanent birth control methods were referred to a specialist, and fewer than one in three actually got the procedure. 

The overwhelming consensus of these obstacles seems to be that whether or not you can do anything to affect your permanent baby-carrying capacity is not up to you. This keeps people reliant on state care – if there is no permanent option available, then I have to routinely see a doctor to get permission to not get pregnant. 

My point is that barriers to reproductive and gender affirming care are part of the same class war. This is not to say that one could drop £5,000 at a private clinic and get sterilised next week, but surely having such money laying around would make the process easier. The crushing emotional weight of being literally powerless to do what you want for your body extends far beyond people with marginalised genders. A body under austerity is a subordinated one. Any system in which access to care is defined by access to money is violent toward the majority of its citizens.

This is not a new thought – but it's important to me to remember that my ability to medically transition is my access to birth control which is my welfare under a capitalist state. Recently, the UK government blocked the implementation of Scotland's Gender Recognition Reform Bill, which would have reduced the red tape surrounding processes of medical transition. This honestly heinous intervention lays bare the threat that transness and transition – and, by extension, the legalisation of myriad forms of bodily autonomy – pose to state power.  

When I write about this, I sometimes wonder why I'm bothering. If you're reading this, surely you know the above already. Or maybe you've seen it in a tweet (sorry, post) recently. But it's important that I say it and write it, to then suggest a good old general strike – because if my right to medically transition is bound up in my status as a cog in the machine of capitalism, then solidarity across these movements, not just in ideology, but in methodology and action, is a liberating force. 

When my doctor tells me that if I legally change my gender marker, I will no longer be invited for routine reproductive health screenings, I hear, "General strike." When the waiting list to have an elective vasectomy in Edinburgh is under four months, but my care provider told me it was pointless to even bother asking about permanent sterilisation, I hear, "General strike." When the government continues to fund and profiteer from a genocide, while medical aid is attacked and rendered inaccessible, I hear –

Image credit: Phoebe Willison