European network of legal experts in gender equality and non-discrimination Trans and intersex equality rights in Europe – a comparative analysis Including summaries in English, French and German Justice and Consumers EUROPEAN COMMISSION Directorate-General for Justice and Consumers Directorate D — Equality and Union citizenship Unit D.1 Non-discrimination and Roma coordination Unit D.2 Gender Equality European Commission B-1049 Brussels EUROPEAN COMMISSION Trans and intersex equality rights in Europe – a comparative analysis Authors Marjolein van den Brink Peter Dunne Coordinators Susanne Burri Alexandra Timmer November 2018 Directorate-General for Justice and Consumers 2018 The text of this report was drafted by Marjolein van den Brink and Peter Dunne, and coordinated by Susanne Burri, Alexandra Timmer and Franka van Hoof for the European network of legal experts in gender equality and non-discrimination Europe Direct is a service to help you find answers to your questions about the European Union. Freephone number (*): 00 800 6 7 8 9 10 11 (*) The information given is free, as are most calls (though some operators, phone boxes or hotels may charge you). LEGAL NOTICE This document has been prepared for the European Commission; however, it reflects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein. More information on the European Union is available on the Internet (http://www.europa.eu). Luxembourg: Publications Office of the European Union, 2018 ISBN 978-92-79-95764-2 doi:10.2838/75428 Catalogue number DS-06-18-129-EN-N © European Union, 2018 Contents ABBREVIATIONS 7 EXECUTIVE SUMMARY 8 RÉSUMÉ 15 ZUSAMMENFASSUNG 23 1 INTRODUCTION 31 1.1 Trans and intersex rights in the EU and EFTA 31 1.2 Report: Trans and intersex equality rights in Europe – A comparative analysis 32 1.2.1 Methodology 33 1.2.2 Terminology 34 2. INTERNATIONAL AND REGIONAL NON-DISCRIMINATION PROTECTIONS FOR TRANS AND INTERSEX PEOPLE 36 2.1 United Nations human rights system 36 2.1.1 Human Rights Council, Independent Expert on SOGI and the High Commissioner for Human Rights 36 2.1.2 UN human rights treaty bodies 38 2.1.2.1 UN Human Rights Committee 38 2.1.2.2 UN Committee against Torture 39 2.1.2.3 UN Committee on the Rights of the Child 39 2.1.2.4 UN Committee on the Elimination of Discrimination against Women 39 2.2 Council of Europe human rights system 40 2.2.1 European Court of Human Rights 40 2.2.1.1 Equality and non-discrimination 40 2.2.1.2 Legal gender recognition – movements towards recognition 41 2.2.1.3 Legal gender recognition – requirements 41 2.2.1.4 Reimbursement for gender confirmation treatments 43 2.2.2 Committee of Ministers of the Council of Europe 43 2.2.3 Parliamentary Assembly of the Council of Europe 44 2.2.4 Commissioner for Human Rights of the Council of Europe 45 2.3 European Union rights system 46 2.3.1 Primary and secondary legislation 46 2.3.2 Court of Justice of the European Union 49 2.3.2.1 Case law of the CJEU 49 2.4 Concluding remarks 53 3. LEGAL GENDER RECOGNITION 55 3.1 Existence of a right to legal gender recognition 55 3.2 Procedures for obtaining legal gender recognition – judicial or administrative? 57 3.3 Conditions for obtaining legal gender recognition 58 3.3.1 Self-determination 59 3.3.2 Conditions for recognition 59 3.3.2.1 Medicalisation 60 3.3.2.2 Divorce 64 3.3.2.3 Age 65 3.4 Non-binary recognition 66 3.5 Concluding remarks 67 4. NATIONAL EQUALITY AND NON-DISCRIMINATION LAW FRAMEWORKS 69 4.1 Legal provisions on trans and intersex discrimination 69 4.1.1 Material scope of protection 72 3 4.2 National equality bodies and public interest litigation 72 4.3 Forms of unequal treatment and conditions for invoking protection 72 4.4 Concluding remarks 74 5. ACCESS TO HEALTHCARE 77 5.1 Access to and funding of healthcare services 77 5.2 Conditions for access 80 5.3 Comparators 81 5.4 Lack of case law 82 5.5 Concluding remarks 82 6. SINGLE-SEX FACILITIES 84 6.1 Case law 86 6.2 Concluding remarks 87 7. EDUCATION 89 7.1 National state of play 89 7.2 Concluding remarks 92 8. RETIREMENT PENSIONS 93 8.1 National state of play 94 8.2 Concluding remarks 96 9. EMPLOYMENT 97 9.1 Absence because of trans or intersex-related treatment 98 9.2 Discriminatory treatment at work 98 9.3 Harassment 99 9.4 Pregnancy protection 100 9.5 Concluding remarks 101 10. SANCTIONS AND REMEDIES 103 10.1 Sanctions and remedies: an absence of national case law 103 10.2 Sanctions and remedies: domestic case law penalising transphobic discrimination 103 10.3 Sanctions and remedies: policy change 105 10.4 Concluding remarks 106 11. CONCLUSION 108 BIBLIOGRAPHY 111 4 Members of the European network of legal experts in gender equality and non-discrimination Management team General coordinator Marcel Zwamborn Human European Consultancy Specialist coordinator Susanne Burri Utrecht University gender equality law Acting specialist coordinator Alexandra Timmer Utrecht University gender equality law Specialist coordinator Isabelle Chopin Migration Policy Group non-discrimination law Project management Ivette Groenendijk Human European Consultancy assistants Yvonne van Leeuwen-Lohde Human European Consultancy Gender equality Franka van Hoof Utrecht University assistant and research editors Raphaële Xenidis Non-discrimination Catharina Germaine1 Migration Policy Group assistant and research editor Senior experts Senior expert on racial or ethnic origin Lilla Farkas Senior expert on age Mark Freedland Senior expert on EU and human rights law Christopher McCrudden Senior expert on social security Frans Pennings Senior expert on religion or belief Isabelle Rorive Senior expert on gender equality law Linda Senden Senior expert on sexual orientation Krzysztof Smiszek Senior expert on EU law, sex, gender identity and gender Christa Tobler expression in relation to trans and intersex people Senior expert on disability Lisa Waddington 1 While on maternity leave, Catharina Germaine was replaced by Carmine Conte assisted by Edith Chambrier. 5 Trans and intersex equality rights in Europe – a comparative analysis National experts Non-discrimination Gender Austria Dieter Schindlauer Martina Thomasberger Belgium Emmanuelle Bribosia Jean Jacqmain Bulgaria Margarita Ilieva Genoveva Tisheva Croatia Ines Bojić Nada Bodiroga-Vukobrat Cyprus Corina Demetriou Evangelia Lia Efstratiou-Georgiades Czech Republic Jakub Tomšej Kristina Koldinská Denmark Pia Justesen Stine Jørgensen Estonia Vadim Poleshchuk Anu Laas Finland Rainer Hiltunen Kevät Nousiainen FYR of Macedonia Biljana Kotevska Mirjana Najchevska France Sophie Latraverse Hélène Masse-Dessen Germany Matthias Mahlmann Ulrike Lembke Greece Athanasios Theodoridis Panagiota Petroglou Hungary András Kádár Beáta Nacsa Iceland Gudrun D. Gudmundsdottir Herdís Thorgeirsdóttir Ireland Judy Walsh Frances Meenan Italy Chiara Favilli Simonetta Renga Latvia Anhelita Kamenska Kristīne Dupate Liechtenstein Wilfried Marxer Nicole Mathé Lithuania Gediminas Andriukaitis Tomas Davulis Luxembourg Tania Hoffmann Nicole Kerschen Malta Tonio Ellul Romina Bartolo Montenegro Nenad Koprivica Ivana Jelić Netherlands Titia Loenen Marlies Vegter Norway Else Leona McClimans Helga Aune Poland Łukasz Bojarski Eleonora Zielinska Portugal Ana Maria Guerra Martins Maria do Rosário Palma Ramalho Romania Romanița Iordache lustina Ionescu Serbia Ivana Krstić Davinic Ivana Krstić Davinic Slovakia Vanda Durbáková Zuzana Magurová Slovenia Neža Kogovšek Šalamon Tanja Koderman Sever Spain Lorenzo Cachón María-Amparo Ballester-Pastor Sweden Per Norberg Jenny Julen Votinius Paul Lappalainen Turkey Dilek Kurban Nurhan Süral United Kingdom Lucy Vickers Grace James 6 Abbreviations APA American Psychiatric Association CEDAW Convention on the Elimination of all Forms of Discrimination Against Women CJEU Court of Justice of the European Union CoE Council of Europe CoM Committee of Ministers of the Council of Europe ECHR European Convention on Human Rights ECJ European Court of Justice ECtHR European Court of Human Rights EFTA European Free Trade Association EHRR European Human Rights Report EU European Union FRA European Union Agency for Fundamental Rights GCT Gender confirmation treatment GE Gender expression GI Gender identity ICCPR International Covenant on Civil and Political Rights ICD International Classification of Diseases LGBTI Lesbian, gay, bisexual, trans and intersex m/f Male/female MtF Male-to-female NB Non-binary NEB National equality body PACE Parliamentary Assembly of the Council of Europe RLE Real life experience SC Sex characteristics SOGI Sexual orientation and gender identity TEU Treaty on European Union TFEU Treaty on the Functioning of the European Union UDHR Universal Declaration of Human Rights UN United Nations WHO World Health Organization 7 Executive summary Introduction In 2012, the European Commission’s Network of Legal Experts in the Non-discrimination Field authored a landmark report on discrimination motivated by sex, gender identity and gender expression. The report – drawing upon expert knowledge in 30 European jurisdictions – highlighted the significant levels of inequality which, despite promising developments in individual countries, trans and intersex people confronted across the European Union (EU) and the European Free Trade Association (EFTA). In the years since 2012, the attention paid to the human rights of trans and intersex people and to discrimination on the grounds of gender identity and sex characteristics has increased significantly. Across