Greetings from Board of Directors of WHO

Distinguished Delegates,
It’s an honor to welcome all of you in World Health
Organization (WHO) Council and most definitely in JAVA Model
United Nations 2017, brought to you by International Studies Club
UIN Jakarta. Bonjour my name is Muhammad Faisal Sila Fajrin.
It’s my pleasure to serve you as the director of this council.
Currently, I’m in my 2nd year of study majoring in English
Literature UIN Jakarta. MUN has always been a passion for me.
My mun experience dated back when I joined the first General
Assembly SOCHUM UI in 2014. Luckily, I got Honorable
Mention from that experience. Later on, I have the privilege to
represent UIN Jakarta for Nanyang Technological University
MUN 2016 in Singapore with other ISC members which had been
a tremendous time and an eye opener moments for me. After that, I
joined JAVA MUN 2016, which I learned so much mun skills here, sharing with new colleagues and not
to forget having the time of my life there. Lucky for you! You got to experience all of this in JAVAMUN
2017
WHO has been a major key for the world to solve health related issues, in this council we’d like
to bring up cases that society needs to addressed and find the solution for. Which are “Contemplating
Castration Punishment for Criminal Sexual Abuse” and “Addressing the Need of Transgender Health”.
As a delegate I urge all of you to voice your opinion and come up with fresh and unique ideas that based
on research and each countries perspectives. Keep in mind that diversity is the key to enrich each
solution, I hope all delegates could work together to achieve our goal.
This year, I’m given the chance to direct in WHO council of JAVAMUN 2017 and I will be
accompanied by two outstanding co-directors, Mr. Dwi Luthfan Prakoso and Ms. Maulida Ayu.
Mr. Dwi Luthfan Prakoso is the final year International Relations student in UIN Jakarta.
Mr. Luthfan as we commonly call him, has been renowned for his work in MUN. In 2015 he snatched his
first award for Best Position Paper in the prestigious Indonesia MUN. Later on, he joined Nanyang
Technological University MUN 2016 representing UIN Jakarta. He was the Board of Directors of
JAVAMUN 2016 in UNHRC Council, aside from MUN he’s best known for his writing that has been
published in idntimes.com.
Ms. Maulida Ayu is the final year International Relations student in UIN Jakarta. This beautiful
feisty lady has always been a natural born speaker. Her work in MUN has been notified with The Most
Outstanding Delegate in Grand General Assembly UI 2014, she has won several competitions in speech,
journalistic and modelling. She was also the Co-directors of JAVAMUN 2016 in UNHRC council. She is
also a writer for Idntimes.com and etc. We are looking forward to see you in JAVAMUN 2017!
Sincerely,
Muhammad Faisal Sila Fajrin
Director, World Health Organization
JAVAMUN 2017
ABOUT WHO
WORLD HEALTH ORGANIZATION
The World Health Organization (WHO) was created in 1948 by member states of the
United Nations (UN) as a specialized agency with a broad mandate for health. The WHO is the
world's leading health organization. Its policies and programs have a far-reaching impact on the
status of international public health.

Defined by its constitution as "the directing and coordinating authority on international

health work," WHO aims at "the attainment by all peoples of the highest possible standard of
health." Its mission is to improve people's lives, to reduce the burdens of disease and poverty,
and to provide access to responsive health care for all people.

RESPONSIBILITIES AND FUNCTIONS

WHO's responsibilities and functions include assisting governments in strengthening

health services; establishing and maintaining administrative and technical services, such as
epidemiological and statistical services; stimulating the eradication of diseases; improving
nutrition, housing, sanitation, working conditions and other aspects of environmental hygiene;
promoting cooperation among scientific and professional groups; proposing international
conventions and agreements on health matters; conducting research; developing international
standards for food, and biological and pharmaceutical products; and developing an informed
public opinion among all peoples on matters of health.

WHO operations are carried out by three distinct components: the World Health
Assembly, the executive board, and the secretariat. The World Health Assembly is the supreme
decision-making body, and it meets annually, with participation of ministers of health from its
191 member nations. In a real sense, the WHO is an international health cooperative that
monitors the state of the world's health and takes steps to improve the health status of individual
countries and of the world community.

The executive board, composed of thirty-two individuals chosen on the basis of their
scientific and professional qualifications, meets between the assembly sessions. It implements
the decisions and policies of the assembly.
 The secretariat is headed by the director general, who is elected by the assembly upon the
nomination of the board. The headquarters of the WHO is in Geneva. The director general,
however, shares responsibilities with six regional directors, who are in turn chosen by member
states of their respective regions. The regional offices are located
in Copenhagen for Europe, Cairo for the eastern Mediterranean, New Delhi for Southeast
Asia, Manila for the western Pacific, Harare for Africa, and Washington D.C. for the Americas.
Their regional directors, in turn, choose the WHO representatives at the country level for their
respective regions. There are 141 WHO country offices, and the total number of WHO staff, as
of 2001, stands at 3,800. WHO is the only agency of the UN system with such a decentralized
structure

The founding fathers of the UN purposely set aside a network of specialized agencies
with their own assemblies, intending that technical cooperation among member states would be
free of the political considerations of the UN itself. It has not always worked out this way,
however. WHO could not escape entirely the political fights that occurred in the specialized
agencies, and the assembly's deliberations have often reflected the political currents of the time.

The decentralized structure of WHO has added a political dimension that has its pluses
and minuses. Many of the resources are assigned to the regional centers, which better reflect
regional interests. On the other hand, the regional directors, as elected officials, can act quite
independently—and occasionally they do. This has given rise to the impression that there are
several WHOs.

Moreover, because the regional directors are elected, they need to give consideration to
the requirements of reelection. Since the regional directors choose country representatives in
their regions, the dynamics of personnel interaction in WHO's administration is quite unique in
the UN system. Regional control over country offices is strong, leaving the WHO country
representatives with limited authority or leeway for program implementation.

The focus of WHO work has shifted over time. This is not surprising, considering the
broad scope of WHO’s mandate that the organization tends to focus its work around only some
of its functions at any given time. The organization’s Eleventh General Programme of Work
2006-2015 details the six core functions it is focusing on between 2006 and 2015.
These functions are:

1. Providing leadership on matters critical to health and engaging in partnerships where

joint action is needed;

2. Shaping the research agenda and stimulating the generation, translation and
dissemination of valuable knowledge;

3. setting norms and standards and promoting and monitoring their implementation;

4. Articulating ethical and evidence-based policy options;

5. Providing technical support, catalyzing change, and building sustainable institutional

capacity;

6. Monitoring the health situation and addressing health trends.

This set of functions, according to WHO are based on an analysis of WHO’s comparative
advantage as an actor in the international system. This advantage WHO believes, lies in the
organization’s “neutral status and near universal membership, its impartiality and its strong
convening power.” This set of functions and WHO’s claims about its comparative advantage will
be examined in greater detail later in this paper.

Two points become apparent from reading WHO’s Eleventh General Programme of
Work 2006-2015, the first is that WHO is acutely aware of the challenges it faces if it is to
remain a relevant actor in international health. WHO is aware of the fact that it cannot function
as an independent actor in the international system. Any action WHO takes must be informed by
the actions of other actors in the international system. Therefore, WHO has taken cooperation
with government and non-government organization.
 MEMBER STATES:

Region Headquarters Notes Website

AFRO includes most of Africa, with the exception

Brazzaville,
of Egypt, Sudan, Djibouti, Tunisia, Libya, Somalia and Morocc
Africa Republic of AFRO
o (all fall under EMRO). The Regional Director is Matshidiso
Congo
Moeti.

Copenhagen, EURO includes Europe, Israel, and former USSR,

Europe EURO
Denmark. except Liechtenstein.

New Delhi,
South-East Asia North Korea is served by SEARO. SEARO
India

Eastern Mediterranean Regional office includes the countries of

Eastern Africa that are not included in AFRO, as well as the countries
Cairo, Egypt EMRO
Mediterranean of the Middle East, except for Israel. Pakistan is served by
EMRO.

WPRO covers all the Asian countries not served by SEARO

Manila,
Western Pacific and EMRO, and all the countries in Oceania. South Korea is WPRO
Philippines.
served by WPRO.

Also known as the Pan American Health Organization (PAHO),

Washington
The Americas and covers the Americas. The Regional Director is Carissa F. AMRO
D.C., USA.
Etienne.
 Topic Area A
Contemplating Castration Punishment for Criminal Sex Abuse

A. Background of the Issue

The idea of modern castration has been introduced since 1899 at the United States of
America when Dr. Sharp began his pioneer operations on convicts. He is also the one who
successfully passed the first law of castration. The first tried of chemical castrations itself has
begun since a half century ago by using the Hormone Suppresors and has proven highly effective
for certain sex offenders. The most common drug used at that time is medroxyprogesterone
acetate, a synthetic progesterone originally developed as a contraceptive marketed as Depo-
Provera. Based on the article in the American Journal of Criminal Law, this treatment, when
given to men, will reduce the production and effects of testosterone, thus diminishing the
compulsive sexual fantasy1.

The issue of modern castrations has became controversy for a long time ago. The groups
who support this treatment argue it is clinically effective for decreasing the number of sex
offenders. Just as in surgical castration, the subject have an erections, and many successfully
impregnate their wives. For this reason, hormone treatment does not work for antisocial
personalities or for those whose offenses are motivated by feelings of anger or power. The
treatment does not work reach the causes of their harmful behaviour. Furthermore, some may
argue that hormone treatment as an alternative to incarceration is too lenient for seriuous sex
crimes. Therefore, there is an option to combine treatment with incarceration.

The other groups say it violates human rights for having children and wrench their
happiness. They argue that violent sex offenders are not victims of their heightened sex drives.
Rapist may be “expressing their rage”. Pedhopiles may be “replaying their old scripts”. But any
sexual sadist, they do what they do because they want to do it. Their behaviour is not the product
of sickness, it is volitional. These groups believe castration will not remove the source of a
violent sex offenders’ rage, which only one of a single instrument of its expression. The

1
Louis Le Maire. 1956. Danish Experiences Regarding the Castration of Sexual Offenders. Northwestern University
School of Law Scholarly Commons: Journal of Criminal Law and Criminology Volume 47 Issue 3 Article 3.
castration remedy implies some biomedical cause for sexual offenses. Once fixed, the offender
ceases to be a danger. This is nonsense-the motivation for sexual assault will not dissapear with
the severed genitalia or altered hormones.

The studies of the physiological effects of castration itself in more recent times have been
relatively limited (presumably because fewer castrated men are available for study), and most
studies of androgen deficiency focus on hypogonadal states rather than castration. However, in
the 1940s, researcher in United States namely JB Hamilton and his colleague, J. Bremer, did
pioneering work in the United States on mentally deficient men who were castrated as a
consequence of eugenics laws, quantifying the effects on skeletal development, hemoglobin
production, and metabolism. Bremer subsequently defined the relation between testicular
secretions and male sexual drive and function in men who were castrated in Norway because of
sexual offenses2.

B. Current Situation

The issue of child abuse has been a significant problem for many countries. The largest
number of castrations occurred in Germany and Denmark. In Germany, the practice of castration
during the period 1934 to 1945 arose from the Nazi German Act of November 24, 1933, as a
sentence and become the involuntary castration of sex offenders.3 Germany also enacted laws
governing voluntary castration of sex offenders that persisted effective after 1945. 4 Between
1934 and 1944, at least 2,800 sex offenders were compulsorily castrated in Germany, and,
between 1955 and 1977, 800 sex offenders were castrated in West Germany. 5

In Great Britain, the terrible incident in 2000 had brought a large number of the anti-
pedophile campaign after pedophile Roy Whiting murdered eight-year-old-schoolgirl Sarah
Payne.6 As a response growing number of sex offenders and pedophile crimes, The Home Office

2
Douglas J. Besharof & Andrew Vachs. 1992. Sex Offenders : Is Castration an Acceptable Punishment?. ABA Journal.
Available on http://www.welfareacademy.org/pubs/legal/sexoffenders_92.pdf. Accessed on 24 January 2016.
3
Heim N, Hursch CJ: Castration for sex offenders: treatment or punishment? A review and critique of recent
European literature. Arch Sex Behav 8:281–304, 1979
4
Ibid.
5
Scott CL, Holmberg T: Castration of sex offenders: prisoners' rights versus public safety. J Am Acad Psychiatry
Law 31:502–9, 2003
6
Ibid
of Great Britain has offered a “chemical castration” to reduce sex crimes in the country.7
Chemical castration involves the administration of libido-reducing drugs and, unlike “physical
castration” which is the removal of male reproductive (sexual organ), the effects are reversible.
The current method of chemical castration used in almost every state that approves of the
procedure relies on the drug antiadrogen synthetic progesterone, known also as Depo-Provera,
Depot Medroxyprogesterone Acetate, and MPA.8 The practice of chemical castration is not
actually a new issue, although the goverment still attempt to advance the provision.9

Presently, it could be argued that prisoners and mentally ill persons are two groups of
vulnerable populations in which even “voluntary” agreement to orchiectomy may be suspect.
they argue that it is unethical to deprive them of an intervention that might restore their freedom
to live in the community. There are several countries such as Argentina, Australia, Estonia,
Israel, Moldova, New Zealand, Poland and Russia that has been applied the process of chemical
castration in different forms. It is either voluntary or as a way for offenders to reduce their jail
time.

In 2016, the Indonesian President, Mr. Joko Widodo, also had signed a decree amending
the country’s 2002 law on child protection to authorize judges to moderate the punishment at
their deliberation.10 In the other hand, The Indonesian Doctors Association (IDI) has reprised its
refusal to implement the chemical castration, saying this procedure violates medical ethics.11
Furthermore, the studies of Depo-Povera has released that there are side effects caused by
chemical castration. In the short-term, subjects reported weight gain, hyperinsulinemic response
to glucose, diabetes mellitus, irregular gall bladder functioning, diverticulitis, fatigue or lethargy,
testicular atrophy, sweats, nightmares, dyspnea, hypogonadism, hot and cold flashes, leg cramps,
hypertension, thrombosis, insomnia, elevated blood sugar, shortness of breath, and lessened testis
size.12

7
www.pravdareport.com/world/europe/13-06-2007/93263-castration-0/#sthash.mEpwlt6c.dpuf
8
William Green, Note, Depo-Provera, Castration, and the Probation of Rape Offenders: Statutory and
Constitutional Issues, 12 U. DAYTON L. REV. 1, 3 (1986).
9
Ibid.
10
https://www.nytimes.com/2016/05/26/world/asia/indonesia-chemical-castration.html?_r=0
11
Ibid.
12
Robert D. Miller, Forced Administration of Sex-Drive Reducing Medications to Sex Offenders: Treatment or
Punishment?, 4 PsYCHOL. PuB. POL'Y & L. 175, 182 (1998).
 Reliable data on violence against women in Turkey is hard to come by, and many cases
go entirely unreported. According to the independent Turkish press organization Bianet, 284
women were killed in Turkey in 2015. In 77% of cases, the murderer was the victim’s husband
or partner, or a male relative. At least 133 women were raped, and 42% of the victims were
under the age of 18. However, women’s rights groups, lawyers and doctors stated and
condemned Turkey’s decision to introduce a mandatory chemical castration programme for
convicted sex offenders, debating the treatment does not address the underlying reasons for
widespread violence against women, and that bodily punishment will instead lead to increased
abuse. 13

Some of them argued that the needs to change of attitude, of education, cannot be
accomplished only by the enforcement of law and create a new cruelty for men. Sexual behavior
is not exclusively determined by sex hormones. Therefore, as with other behavior, past
experiences as well as needs and interpersonal skills determine the form and intensity of sexual
behavior, both normal and deviant.14 An inadequate capacity to bond emotionally with adults
may lead to deviant attraction to underage minors.

The Langelüddeke study of sex offenders who were castrated reported several somatic
effects after surgery, including enlarged breasts (11%), slack and flabby skin (51%), reduced
body hair (69%), hot flashes and vertigo (42%), heart and respiratory disorders, night sweating
or chronic pain (19%).15 Thirty‐one percent reported psychological symptoms of depression,
isolation, and passivity since the castration.16 With respect to sex offenders who underwent
chemical castration only, hormonal treatments such as MPA (medroxyprogesterone acetate) or
CPA (cyproterone acetate) reduced testosterone levels and affected sexual deviance.17

The special drug treatment for pedophiles has proved to be successful in many European
countries and several states of the United States of America. According to politics.co.uk, the

13
https://www.theguardian.com/global-development/2016/aug/15/turkey-chemical-castration-law-sex-offenders-
condemned-womens-groups
14
Ibid.
15
Heim N, Hursch CJ: Castration for sex offenders: treatment or punishment? A review and critique of recent
European literature. Arch Sex Behav 8:281–304, 1979
16
Freund K: Therapeutic sex drive reduction. Acta Psychiatr Scand 287:5–38, 1980
17
Kravitz HM, Haywood TW, Kelly JR,et al: Medroxyprogester-one treatment for paraphiles. Bull Am Acad
Psychiatry Law 23:19–33, 1995
number of sex crimes was reduced by almost 50 percent. However, groups like Amnesty
International have called forced castration inhumane and a violation of United Nations human
rights treaties.18

C. International Community Responds and Past Actions

In 2006, the European Committee for the Prevention of Torture (CPT), established under
the European Convention for the Prevention of Torture and Inhuman or Degrading Treatment or
Punishment from 1984, 44 visit to the Czech Republic. The CPT communicated its serious
reservations regarding the medical intervention of surgical castration being performed in the
country. The CPT aware that it had doubt on this case that could lead up to depriving someone’s
liberty. The Czech authorities were asked to give additional information, so that the committee
could form an objective view regarding the actual practice and the conditions of its performed.
The CPT wanted more information on the annual number of surgical castrations carried out on
men subjected to ‘protective treatment’ during the past five years” as well as “statistics
concerning re-convictions, for a sexual offence involving violence against persons, of men who
have been surgically castrated.”

The CPT noted although Act No. 20/1966 Coll. Requires the procedure to be performed
solely on voluntary basis, with an approval of a ‘specialist’ committee and the information to the
offender, this was not the reality in a number of cases. In all of the cases being checked, the
patients stated out that their application “was at least partially instigated by fear of long-term
detention.” The CPT met only two sex offenders who have spontaneously applied to be castrated.
The others replied that the treating sexologists were the ones to suggest the procedure. Some
offenders stated that the treating sexologist told them to either choose castration or face possible
lifelong detention.

One castrated sex offender stated that he was never informed that surgical castration can
lead to osteoporosis. Several offenders claimed that they would have never choose the operation
if it has a side effect. In one of the hospitals, there was no lawyer amongst the members of the
‘specialist’ committee. This is obviously not in line with the provisions of Act No. 20/1966 Coll.

18
http://www.huffingtonpost.com/entry/alabama-castration-sex-offenders-children_us_56ddea6ee4b0000de4057df6
regarding the composition of the committee. Further, the CPT stated that the procedural role of
’specialist’ committee was not standardized. “Members of the Prague commission declared
themselves to be technically incompetent to assess whether or not surgical castration was
advisable in a particular case.” The ’specialist’ committee rarely rejected the applications. The
Ministry of Health reported that it is aware of “only one case” in which the application was
rejected. The CPT concluded that surgical castration equals to degrading treatment and as such
should be immediately abandoned.

Europe and Americas, according to available data, lead the world in the number of reported
rape offenders per 100,000 people, followed – again with a very wide margin – by Africa, Asia,
and Oceania.

At least nine U.S. states, including California, Florida, Georgia, Iowa, Louisiana,
Montana, Oregon, Texas and Wisconsin have versions of chemical castration in their laws.
Medroxyprogesterone acetate (MPA), also known by brand names Clinovir, Cycrin, Depo-
Provera, and Hystron, is the hormone used for chemical castration in this country.

Florida, allows sentenced prisoners to choose surgical castration in lieu of prison time. In
another case, "A Houston man charged with sexually assaulting a 13-year-old girl won judicial
approval to undergo surgical castration. The decision would allow him to avoid a prison
sentence."

Other states are following suit: "Chemical castration may be required of repeat sexual
offender in California, Florida, Georgia, Iowa, Louisiana, Montana, Oregon, Texas and
Wisconsin. Only Texas and Louisiana offering the option of surgical castration.

MPA accelerates testosterone metabolism in the liver leading to lower circulating levels
of testosterone. Effects are seen within two to three weeks of starting a course of MPA. In a
study of 48 participants in 1981, reported forty participants who positively responded to MPA
and that all participants experienced lowered sexual fantasy, arousal and urges (particularly
masturbation). MPA leads to significant reduction in time spent engaging in sexual fantasies,
number of morning erections, number of ejaculations, frequency of paraphilic behavior and
circulating testosterone levels.
 The process of chemical castration has been used in various forms, either forcibly as a
sentence or as a way for offenders to reduce their jail time in other several countries including
Argentina, Australia, Estonia, Israel, Moldova, New Zealand, Poland, Russia, and Moldova

The idea of castration in response to rape is now emerging in other countries too. In India
just before the most recent election, "amidst continuing public rage against sexual crime against
women, India's ruling Congress party has decided to propose chemical castration of rapists,
among other strict measures".

In South Korea, authorities have decided to chemically "castrate a serial rapist who
preyed on young girls". In Zimbabwe, "Women parliamentarians are pushing for severe penalties
which include mandatory life sentences or castration for rapists".

E. Question A Resolution Must Answer (QARMA(s))

1. Should castration become a form of punishment to reduce criminal sex abused?

2. While concerning for the side effects of chemical castration, could the use of Depo-
Provera injections as a form of chemical castration be considered as a potentially
effective way to handle sex offenders?
3. Given that majority of the judges which drafting sex offender statutes have no medical
background or experiences, how could the state legislatures and the judiciary involves the
medical experts?
4. Regarding to the many types of castration that being invented throughout years of
medical research. What types of Castration best being conducted onto the sexual
offender? And is it effective enough to eradicate the criminal sex abused?
E. Further Research

The following literatures could be used as a reference to complete your research:

 Everything You Should Know About Castration

http://www.stuffyoushouldknow.com/blogs/castration.htm
 Scott MD, Charles L., Holmberg MD, Trent., Castration of Sex Offenders: Prisoners’
Rights Versus Public Safety.
http://isites.harvard.edu/fs/docs/icb.topic808480.files/Scott.Holmberg.Castration.of.Sex.
Offenders.pdf
 Coercion, Incarceration, and Chemical Castration: An Argument From Autonomy
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3824348/
 Is chemical castration an acceptable punishment for male sex offenders?
http://www.csun.edu/~psy453/crimes_y.htm
 Dipl.Jur. Voislav Stojanovski, LL.M., Surgical Castration of Sex Offenders and its
Legality: The Case of the Czech Republic. Czech Republic: Masaryk University.
http://www.iusetsocietas.cz/fileadmin/user_upload/Vitezne_prace/Stojanovski.pdf

E. References

1. Maire, Louis Le. Danish Experiences Regarding the Castration of Sexual Offenders.
Northwestern University School of Law Scholarly Commons: Journal of Criminal Law
and Criminology Volume 47 Issue 3 Article 3. 1956.
2. Besharof, Douglas J., Vachs, Andrew. 1992. Sex Offenders : Is Castration an Acceptable
Punishment?. ABA Journal. Available on
http://www.welfareacademy.org/pubs/legal/sexoffenders_92.pdf Accessed on 24 January
2016.
3. N., Heim, CJ., Hursch. Castration for Sex Offenders: Treatment or Punishment? A
Review and Critique of Recent European literature. Arch Sex Behav 8:281–304, 1979
4. CL, Scott. T., Holmberg. Castration of Sex Offenders: Prisoners' Rights Versus Public
Safety. J Am Acad Psychiatry Law 31:502–9, 2003
5. Castration Report
 www.pravdareport.com/world/europe/13-06-2007/93263-castration-
0/#sthash.mEpwlt6c.dpuf
6. Green, William, Note, Depo-Provera, Castration, and the Probation of Rape Offenders:
Statutory and Constitutional Issues, 12 U. DAYTON L. REV. 1, 3 (1986).
7. Indonesia Chemical Castration
https://www.nytimes.com/2016/05/26/world/asia/indonesia-chemical-
castration.html?_r=0
8. Miller, Robert D., Forced Administration of Sex-Drive Reducing Medications to Sex
Offenders: Treatment or Punishment?, 4 PsYCHOL. PuB. POL'Y & L. 175, 182 (1998).
9. Turkey Chemical Castration Law: Sex Offenders Condemned Women’s Groups
https://www.theguardian.com/global-development/2016/aug/15/turkey-chemical-
castration-law-sex-offenders-condemned-womens-groups
10. N, Heim. CJ, Hursch. Castration for Sex Offenders: Treatment or Punishment? A Review
and Critique of Recent European Literature. Arch Sex Behav 8:281–304, 1979
11. K., Freund. Therapeutic Sex Drive Reduction. Acta Psychiatr Scand 287:5–38, 1980
12. HM, Kravitz. TW, Haywood. JR, Kelly.,et al: Medroxyprogester-one treatment for
Paraphiles. Bull Am Acad Psychiatry Law 23:19–33, 1995
13. Alabama Castration
http://www.huffingtonpost.com/entry/alabama-castration-sex-offenders-
children_us_56ddea6ee4b0000de4057df6
 Topic B
Addressing The Need of Transgender Health

A. Background

Transgender is an umbrella term for people whose gender identity, gender expression, or
behavior does not conform to that typically associated with the sex to which they were assigned
at birth. Gender is defined as a set of socially constructed characteristics describing what men
and women ought to be. Characteristics such as strength, rationality, independence, protector,
and public are associated with masculinity while characteristics such as, weakness, emotionality,
relational, protected, and private are associated with femininity. Gender identity refers to a
person’s internal sense of being male, female, or something else while gender expression refers
to the way a person communicates gender identity to others through behavior, clothing,
hairstyles, voice, or body characteristics19.

There is no single explanation for why some people are transgender. The diversity of
transgender expression and experiences argues against any simple or unitary explanation. Many
experts believe that biological factors such as genetic influences and prenatal hormone levels,
early experiences, and experiences later in adolescence or adulthood may all contribute to the
development of transgender identities.

The issue of transgender health become crucial since transgender people face numerous
health disparities as well as stigma, discrimination, and lack of access to quality care. Research
has shown that up to 78% of transgender people were harassed in school, and 57% experienced
rejection from their families. Some health disparities include an increased risk of HIV infection,
especially among transgender women of color, and lower likelihood of preventive cancer
screenings in transgender men. Based on statistical data, transgender women are around 49 times
more likely to be living with HIV than other adults of reproductive age with an estimated

19
Tim Dunne, et al. 2013. International Relations Theories: Dicipline and Diversity 3rd Edition. Oxford: Oxford
University Press.
worldwide HIV prevalence of 19%. Even in some countries the HIV prevalence rate in
transgender women is 80 times that of the general adult population20.

Transgender people also face many barriers to receive quality care. Sadly, many
transgender people avoid seeing a medical provider because they fear they will be discriminated
against, humiliated, or misunderstood. For example, one large study of transgender people found
that 28% had postponed necessary medical care when sick or injured, and 33% delayed or did
not try to get preventive health care due to discrimination by health care providers. There is also
a scarcity of health professionals who are trained in transgender medical and behavioral health
care. Fifty percent of transgender people report having to teach their doctors about transgender
care21.

B. Current Situations

Current estimates have suggested that 0.3% of US adults, or close to 1 million people,
identify as transgender (Other estimates have varied widely from a high prevalence of 1:500 or
more to 1:11 900–1:45 000 for male-to-female individuals and 1:30 400–1:200 000 for female-to-
male individuals. Studies to date have been limited because national surveys have not
recognizing the gender. It has been estimated people living in the United States let alone that
identifies as transgender is nearly 1 million. Health care for this population has been overlooked
and neglected by governmental, health care, and academic establishments.

Transgender people have a unique set of mental and physical health needs. These needs
are compounded by prejudices against transgender people within both the medical system and
society at large. These prejudices create barriers to accessing timely, culturally competent,
medically appropriate, and respectful care. These societal and medical barriers are associated
with increased risk of violence, suicide, and sexually transmitted infections.

20
____. Transgender People. Accessed through
http://www.who.int/entity/hiv/topics/transgender/about/en/index.html. On 24 December 2016.
21
____. 2013. Affirmative Care for Transgender and Gender Non-Conforming People: Best Practices for Front-line
Health Care Staff. Boston, USA: National LGBT Health Education Center, The Fenway Institute. Accessed through
http://www.lgbthealtheducation.org/wp-content/uploads/13-017_TransBestPracticesforFrontlineStaff_v6_02-19-
13_FINAL.pdf. On 24 December 2016.
 Additionally, transgender people may have health needs related to gender transition,
including hormonal therapy and surgery that can create an undesired and unavoidable
dependency on the medical system for basic identity expression. This combination of high
medical needs and barriers to accessing appropriate care may give rise to the transgender
community and create stigmatization, prejudice, and eventually poor health outcomes.

Medical professional associations are slowly but surely supporting inclusion of health
care for transgender people. Since the early 1980s, the World Professional Association for
Transgender Health (WPATH, formerly known as the Harry Benjamin International Gender
Dysphoria Association) has been publishing standards of care (SOC). Both SRS and hormonal
therapy are endorsed by the SOC as necessary care for gender dysphoria, being both effective
and often lifesaving. Other professional societies that have its marks are, including the American
College of Obstetricians and Gynecologists, the Endocrine Society, the American Medical
Association, and the American Psychological Association, have endorsed these
recommendations. They have each published statements encouraging care for transgender
patients and urging public and private health insurance coverage for treatment of gender
dysphoria.

Other issues that transgender people often encounter in their interaction with the health
care system include lack of respect and acceptance of chosen gender by health care staff, privacy
and safety, cultural appropriateness and understanding, and adequate knowledge of some of their
specific medical needs. Given the widespread lack of knowledge about transgender populations,
and the absence of transgender health issues from most medical school curricula, much remains
to be done to shape a medical workforce that is well informed regarding the needs of this
population and capable of providing appropriate care.

C. International Community Responds and Past Actions

All human beings are born free and equal in dignity and rights. Trans people have these
same human rights. The legal obligations of States to safeguard the human rights of trans people
are well established in international human rights law. As the United Nations High
Commissioner for Human Rights has emphasized, human rights treaty bodies have stated
repeatedly that States have an obligation to protect all people from discrimination on the ground
of gender identity. The fact that someone is trans does not limit that person’s entitlement to enjoy
the full range of human rights.

The Organization of American States (OAS) has strongly affirmed the rights of
transgender (trans) people through four OAS General Assembly Resolutions on Sexual
Orientation and Gender Identity. In June 2013, the OAS adopted the Inter-American Convention
against All Forms of Discrimination and Intolerance, which explicitly lists gender identity and
expression as prohibited grounds of discrimination. In April 2010, the Council of Europe’s
Parliamentary Assembly adopted a resolution on discrimination on the basis of sexual orientation
and gender identity. The right to development entitles every human being and all peoples “to
participate in, contribute to, and enjoy economic, social, cultural and political development, in
which all human rights and fundamental freedoms can be fully realized.” For trans people, this
vision is not yet reality in any region of the world.

International human rights standards recognize the diversity of humankind and explicitly
protect the rights of marginalized groups such as trans people. The legal, economic and social
marginalization of trans people affects every aspect of their lives. Social exclusion is reflected in
laws that do not acknowledge the existence of trans people, either as a third gender or as people
who wish to transition from male to female, or from female to male. Without legal protection,
trans people are vulnerable to daily violence and discrimination, with cumulative impacts. Some
impacts are visible, such as the HIV epidemic among trans women in many parts of the world.
Most impacts are insidious, with trans people, their families and communities left to support each
other and struggle for their rights. Human rights experts have offered guidance on how to apply
existing human rights standards to the very real problems that trans people experience. For
example, the Yogyakarta Principles on the Application of International Human Rights Law in
relation to Sexual Orientation and Gender Identity provide clear recommendations for applying
international human rights laws and standards to issues of sexual orientation and gender identity.

UN treaty bodies have raised concerns about trans people’s exclusion from anti-
discrimination legislation, and about inadequate efforts to combat such discrimination. The links
between inadequate legal protection, stigma and social exclusion of trans people are clearly made
in legal judgments from Fiji, Hong Kong, Nepal, Pakistan, Philippines and South Korea.
 In some parts of the world, including Hong Kong, protection from discrimination is only
available after someone is diagnosed with the mental health condition of ‘gender identity
disorder. This means that young trans people and others early in their transition have no
protection from discrimination. In the Philippines and South Africa, trans people have questioned
the extent to which the legal protections set out in their constitutions are effectively implemented
or enforced in practice. In parts of Asia, the Caribbean, the Pacific and Africa, ‘cross-dressing’
laws remain on the books from colonial times. In 2011, the United Nations Human Rights
Committee expressed concern about Kuwait’s new criminal offence of ‘imitating members of the
opposite sex’ and called for its repeal. In Samoa, female impersonation or cross-dressing was an
offence under section 58 of the Crimes Ordinance 1961. This law had not been enforced since
the late 1980s and was finally repealed by the Crimes Act 2013 as part of wider reforms
undertaken by the Samoa Law Reform Commission. In parts of Asia, Africa, Latin America and
Turkey, trans and gender-diverse people are targeted under general ‘public nuisance’ and
loitering laws. Trans sex workers are particularly vulnerable to prosecution under these
provisions.

D. Question A Resolution Must Answer (QARMA(s))

1. What are barriers and challenges to carte for transgender health either direct or indirect
that should be addressed?
2. How WHO could create a collaboration between trans communities and medical
providers?
3. What kind of regulation that will be needed regarding the harassment and oppression
against transgender in a way of having a basic health care? Do you think a cultural
education is effective both are for communities and transgender itself?
E. Further Research
 Sevelius, PhD. Jae. Current Issues in Transgender. San Fransisco: University of
California. Center of Excellence for Transgender Health.
https://www.nationalacademies.org/hmd/~/media/01BA01841A9345E3997A30A2ECED
A735.ashx
 Reports on Transgender Health
http://www.thetaskforce.org/static_html/downloads/resources_and_tools/ntds_report_on_
health.pdf
 Transgender Healthcare Coverage Prevalance Recent Trends and Considerations for
Prayers
http://www.milliman.com/insight/2016/Transgender-healthcare-coverage-Prevalence--
recent-trends--and-considerations-for-payers/
 Centers for Disease Control and Prevention: HIV Among Transgender People
https://www.cdc.gov/hiv/group/gender/transgender/
 Stroumsa, MD, MPH. Daphna. The State of Transgender Health Care: Policy, Law, and
Medical Frameworks.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953767/

F. References
1. Dunne, Tim Dunne. International Relations Theories: Dicipline and Diversity 3rd
Edition. Oxford: Oxford University Press. 2013.
2. Transgender People.
http://www.who.int/entity/hiv/topics/transgender/about/en/index.html Accessed on 24
December 2016.
3. Affirmative Care for Transgender and Gender Non-Conforming People: Best Practices
for Front-line Health Care Staff. Boston, USA: National LGBT Health Education Center,
The Fenway Institute. 2013.
http://www.lgbthealtheducation.org/wp-content/uploads/13-
017_TransBestPracticesforFrontlineStaff_v6_02-19-13_FINAL.pdf Accessed on 24
December 2016.
4. See CONGENID (2010) Preliminary draft documents of the First International Congress
on Gender Identity and Human Rights, Barcelona, 1-6 June 2010, at:
http://transgenderasia.org/docs-congenid-draft.pdf
5. Global Commission on HIV and the Law (2012) HIV and the Law: Risks, Rights and
Health, accessed on 21 December 2013 at: http://hivlawcommission.org/
6. UNDP (2013) Changing with the World: UNDP Strategic Plan 2014–17, at:
www.undp.org/content/dam/undp/library/corporate/4UNDP_strategic-plan_14-
17_v9_web.pdf
7. Universal Declaration of Human Rights (Article 1)