Alabama Governor Kay Ivey has signed a bill that could imprison doctors for up to to a decade for prescribing medical treatments to transgender youth.
The bill criminalising gender-affirming care for transgender people younger than 19 years old is the first in the US to make healthcare for young transgender patients punishable by up to 10 years in prison.
Senate Bill 184 prohibits doctors from prescribing puberty blockers, hormone therapy and surgeries for transgender youth, though Alabama health care providers have repeatedly told legislators that such surgeries were not performed on minors in the state.
The legislation – which passed the state House on 7 April following its passage in the Senate earlier this year – also prohibits “a nurse, counselor, teacher, principal or other administrative officials at a public or private school” from “encouraging or coercing a minor” to withhold from a parent or guardian whether their “perception of his or her gender or sex is inconsistent with the minor’s sex.”
It landed on the desk of Republican Governor Kay Ivey on Friday.
“There are very real challenges facing our young people, especially with today’s societal pressures and modern culture. I believe very strongly that if the Good Lord made you a boy, you are a boy, and if he made you a girl, you are a girl,” the governor said in a statement.
“We should especially protect our children from these radical, life-altering surgeries when they are at such a vulnerable stage in life. Instead, let us all focus on helping them to properly develop into the adults God intended them to be.”
The American Civil Liberties Union, Lambda Legal and the Transgender Law Center had vowed to sue the state if the bill is signed into law.
“Anti-equality legislators in the state capital have recklessly passed a bill that goes directly against the best advice of the medical community and intrudes on the rights of parents and families to make their own medical decisions,” according to Human Rights Campaign’s Alabama State Director Carmarion D Anderson-Harvey.
Governor Ivey also approved another bill – House Bill 322 – that bans transgender youth from using restrooms or locker rooms in schools that match their gender identity.
A last-minute amendment also added language mirroring what opponents have called “Don’t Say Gay” legislation, creating a broad prohibition on classroom speech related to sexual orientation and gender identity.
“Here in Alabama, men use the men’s room and ladies use the ladies’ room – it’s really a no brainer. This bill will also ensure our elementary school classrooms remain free of any kind of sex talk,” she said.
“Let me be clear to the media and opponents who like to incorrectly dub this the ‘Don’t Say Gay’ amendment: That is misleading, false and just plain wrong. We don’t need to be teaching young children about sex. We are talking about five-year-olds for crying out loud. We need to focus on what matters – core instruction like reading and math.”
Alabama state Rep Neil Rafferty, the only openly gay member of the state legislature, said last month that the transgender healthcare bill amounts to “putting [legislators] in the doctor’s office and wagging our fingers at parents.”
“We’re talking about an unprecedented move…dictating what parents do with private family medical decisions they make with a team of medical providers,” he said.
Chase Strangio, deputy director for Trans Justice with the ACLU’s LGBTQ & HIV Project, said that if the bill is signed into law, “Alabama will have the most deadly, sweeping, and hostile law targeting transgender people in the country.”
“The way to reduce harm to trans youth is to provide them with gender-affirming health care where it is medically indicated,” he said in a statement. “This bill takes that lifesaving treatment option off the table and makes it a felony. Moving forward with this bill will be deadly for trans youth, push doctors out of a state that has a shortage of medical providers, hurt Alabama’s economy, and subject the state to costly litigation.”
Medical groups including the American Academy of Paediatrics have repeatedly objected to similar measures, arguing that laws are denying patients and families access to comprehensive and evidence-based care. A joint statement from six major medical associations in 2019 said the groups are “strongly opposed to any legislation or regulation that would interfere with the provision of evidence-based patient care for any patient, affirming our commitment to patient safety.”
Last year, Arkansas became the first state to pass a measure banning gender-affirming care for transgender youth and prohibiting providers from referring them to gender-affirming care. The state legislature voted to override the governor’s veto of this bill.
The ACLU promptly filed a lawsuit challenging the law, and a federal judge granted an injunction halting its enforcement.
At least 30 similar measures have been introduced in state legislatures this year.
Texas Governor Greg Abbott also directed state agencies to investigate families with transgender children, which a judge has stalled with a statewide injunction. Texas Attorney General Ken Paxton has sought an appeal.
The US Department of Justice issued a letter to all state attorneys general last week reminding them of federal constitutional and statutory provisions that protect transgender people from discrimination.
“State laws and policies that prevent parents or guardians from following the advice of a healthcare professional regarding what may be medically necessary or otherwise appropriate care for transgender minors may infringe on rights protected by both the Equal Protection and the Due Process Clauses of the Fourteenth Amendment,” according to Assistant Attorney General Kristen Clarke for the Justice Department’s Civil Rights Division.
