Republican senators in Texas have introduced draft legislation that equates gender-affirming healthcare with female genital mutilation (FGM) in an attempt to criminalise healthcare for trans and gender-diverse youth.

Bill SB249 amends the state’s health and safety code, modifying the felony of “female genital mutilation” for a person under 18 to just “genital mutilation” – by removing the word “female” and the specific language that defines this practice.

Senators Bob Hall, Donna Campbell and Charles Perry have replaced this definition with detailed descriptions of transition-related surgical procedures, conflating sex-reassignment treatments and FGM. The draft bill criminalises these procedures, with up to two years in jail and a maximum fine of $10,000.

The only exceptions are male circumcision, surgeries for intersex people, and those “necessary for the person’s physical health” – instead of the current “medical purposes”, which includes a mental health dimension.

Texas prohibited FGM, which is considered child abuse and a human rights violation, in 2017.

The draft bill ignores the fact that gender-affirming surgical procedures for under-18s are “extremely rare” and only prescribed under rigorous assessment and consent, medical experts told openDemocracy.

It “reflects hysteria”, said Kellan Baker, director of Whitman-Walker, an LGBTQ health clinic in Washington, DC. “The language has absolutely no relationship to the actuality of the medical needs of transgender young people. The bill is dangerous and it will hurt them.”

The three senators simultaneously introduced another bill prohibiting medical professionals, providers and insurers from delivering gender-affirming surgery and other treatment including puberty blockers. Hall and Campbell also proposed a resolution – like a motion signalling support for a particular position – supporting the ending in the US of gender-affirming care, which they compare to the “abhorrent practice of genital mutilation”.

“It is a grave injustice that lawmakers and politicians are again attempting to practise medicine in Texas,” Marci Bowers, president of the World Professional Association for Transgender Health (WPATH), told openDemocracy.

Bowers, who is a gynaecologist and surgeon, added: “Female genital mutilation/cutting (FGM/C) is a harmful, medically unnecessary injury done to girls without the child’s consent, and the World Health Organization strongly urges health care providers not to perform FGM/C.”

The Texas bill “attempts to insert politics precisely where it does not belong,” said Baker from Whitman-Walker. It also strips patients of the bodily autonomy that anti-FGM/C bills aim to restore, he added.

If passed, the bill would not just shut down care for gender-affirming surgeries: it would punish providers and parents who provide care for young Texans in other states, too, thanks to a clause about travelling for medical treatment.

The senators who drafted the bill have not responded to openDemocracy’s request for comments.

What is FGM?

The WHO defines FGM as procedures that involve “the partial or total removal of external female genitalia or other injury to female genital organs for non-medical reasons”. They entail no health benefits and can lead to a range of serious, negative physical and mental health outcomes.

More than 200 million women and girls globally have suffered FGM, estimates the WHO. Cases have been documented in at least 92 countries, including the United States, according to the US End FGM/C Network, a platform of survivors, civil society groups, activists, policymakers and healthcare providers.

Half a million women and girls in the US have experienced or are at risk of FGM, according to the Centers for Disease Control and Prevention (CDC) – but US End FGM/C considers this “severely underreported”. Ten states and the District of Columbia currently do not have laws prohibiting the practice.

“We are disheartened to see the current [Texas] legislation, which is intended to protect young girls, being hijacked for purposes to target and discriminate against vulnerable youth,” US End FGM/C’s director Caitlin LeMay told openDemocracy. The Stop FGM Act of 2020 defined FGM/C, “and we expect state laws to be consistent with the federal definition,” she added.

A new tactic against trans youth?

The attempt to conflate gender-affirming healthcare and FGM seems to be a new tactic in the conservative strategy to target trans people across the US via new restrictions on their rights to identity, health, education and sports. More than 300 bills have been introduced by state legislators in the last two years.

Last year, following direction from Republican governor Gregg Abbott, the Texas Department of Family and Protective Services ruled that “genital mutilation of a child through reassignment surgery is child abuse”. Abbot subsequently authorised investigations into families and providers engaged in gender-affirming care to trans children – though the directive was temporarily halted by courts.

Texas Republicans’ legislative agenda for 2022/23 includes a ban on any gender-affirming healthcare services, and in a new attempt at banning this care specifically mentions “genital mutilation”.

“There have been similar attempts in other states to legislatively link FGM/C with gender-affirming healthcare, though none of these attempts have succeeded,” said LeMay from US End FGM/C.

A more extreme version, introduced in Idaho in February, proposed amending the existing ban on FGM to criminalise not just gender-affirming surgery, but also puberty blockers and hormone therapies. Medical professionals providing such care faced lifelong prison terms. Ultimately, the Republican majority in the state senate decided not to move the bill forward.

In 2020, a draft bill to ban FGM in Wyoming, which had gathered bipartisan support, worried LGBTQ groups because it contained a clause saying that sex reassignment surgery would not be considered FGM for consenting over-18s – suggesting that it could be considered FGM for minors. The exception was eventually removed.

Approved by medical authorities

Healthcare for trans youth requires gender-affirming approaches, according to numerous national medical authorities, including the American Psychiatric Association, the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry.

State bodies, such as the Texas Medical Association, the Texas Counseling Association and the Texas Pediatric Society, agree.

Those attacking gender-affirming healthcare argue that doctors and parents are allowing young children to go through irreversible treatments. But Baker from the Whitman-Walker clinic reiterated that surgeries such as mastectomies and vaginoplasties are extremely rare for minors in the US, and only done after robust review by multiple medical professionals.

WPATH’s latest guidelines say that puberty blockers are “fully reversible [and] regarded as an extended time for adolescents to explore their gender identity by means of an early social transition”, while hormone therapies are partially reversible.

The guidelines also say that doctors should work with patients to ensure they are mature enough to consent to any treatments. WPATH suggests that, depending on a variety of medical, personal and family factors, surgical interventions could be performed at the age of 18 or earlier – but after “at least 12 months of gender-affirming hormone therapy”.