Transsexual Women on the journey of sexual re-alignment in a hetero-normative Healthcare

207 Pages·2015·2.11 MB·English

Transsexual Women on the Journey of Sexual Re-alignment in a Hetero-normative
Healthcare System in the Western Cape
By
Douglas David-John Newman-Valentine
B CUR, M CUR (UWC)
Submitted in accordance with the requirements
Of
Doctor of Philosophy
In the
Department of Health and Rehabilitation Sciences
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At the
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University of Cape Town T

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Supervisor: Associate Professor Sinegugu Evidence Duma
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2015
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The copyright of this thesis vests in the author. No
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quotation from it or information derived from it is to be

published without full acknowledgeement of the source.
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The thesis is to be used for private study or non-
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commercial research purposes only.

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Published by the Universit y of Cape Town (UCT) in terms
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of the non-exclusive license granted to UCT by the author.
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Declaration
I, Douglas David-John Newman-Valentine, declare that “Transsexual Women on the Journey of
Sexual Re-alignment in a Hetero-normative Healthcare System in the Western Cape” is a product of
my own original work unless otherwise stated, and that all sources that I have used or quoted
have been indicated and acknowledged by means of complete and accurate referencing. I
also declare that this research has not been submitted to any other university.

Signature: _____________________ Date: ___________________
Douglas David-John Newman-Valentine
Student Number: NWMDOU001

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Abstract
Transsexual women who embark on the journey of sexual realignment in pursuit of
achieving synergy between their gender identity and physical embodiment may experience
side-effects directly related to their treatment. Even though access to sexual realignment
treatment for transsexual women is liberating, these side-effects may impact negatively on
their physical and psychological health. Women are forced to seek care for their sexual
realignment services and side-effects of treatment in a hetero-normative healthcare system
which seems to be unprepared for and even hostile towards the needs of this marginalised
community.
The purpose of this study was to understand the life-world of transsexual women in relation
to their awareness of their unique health needs as a direct result of sexual realignment
treatment, and their health-seeking behaviours, practices and experiences of responses in
negotiating health care for their transgender-related health needs in the healthcare system.
The overarching question asked in this research was: What are the lived experiences, and
meaning of these experiences, for transsexual women during the sexual-realignment process
when negotiating health care for their transgender-related healthcare needs in the healthcare
system?
Participants in this study were selected through purposive and snowball sampling. In-depth
interviews were conducted with ten participants selected from urban, peri-urban, and rural
areas of the Western Cape. Theoretical saturation was reached with the tenth participant, and
further selection of participants was ceased.
The data was viewed through a trans-inclusive feminist lens with a concurrent collection and
analysis process as guided by the steps of analysis of Interpretative Phenomenological
Analysis (IPA), as developed by Smith (2010). IPA is a modern qualitative approach to
research inquiry which harnesses the strengths of phenomenology, hemeneutics, and
ideography.
The analysed data were illustrated in a master theme graphic which contained one
superordinate theme, two subordinate themes and various categories. The superordinate
theme of this study was named “Towards organic Womanhood”, while the two subordinate
themes were coined “Embracing Womanhood”, and “Facing the Giant in order to Become”.
The subordinate theme Embracing Womanhood gives insight into aspects of transsexual
women’s journey of moving towards a state of organic womanhood, whereas the subordinate
theme Facing the Giant in order to Become maps out powers in the healthcare system which
prevent transsexual women from having a smooth transition journey.
This study illustrates that transsexual women have a need to align their bodies with their
gender identities, but even though South Africa has legislation which protects the health and
rights of transsexual women, transsexual women find it challenging to make the transition.
Health practitioners are ill-equipped to manage transsexual women, the care which they
receive in the government-funded healthcare system is of a poor standard, and they are
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subjected to extremely long waiting periods to have access to surgical sexual realignment
services.
Recommendations are made for the healthcare system, policy makers and educational
institutions in order to stimulate the South African healthcare system to become inclusive
and affirming to the needs of transsexual women. Furthermore, recommendations for
researchers are made to stimulate the debate around transsexual health care in the scientific
literature.

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Dedication

I dedicate this thesis to the two most inspirational people in my life: my late maternal
grandmother, Magdalene Jones, and my late father, Douglas Newman.

My grandmother never had the opportunity to become educated, but through her hard
work she laid the foundation to fulfil her vision of having educated children. My father
played a fundamental role in my life through being a public advocate for the rights of the
LGBTI community, even when he himself was ostracised by his family for believing that
LGBTI rights are equal to human rights.
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Acknowledgements
On my own, I would have never been able to complete this thesis. Therefore I wish to
acknowledge the following people who formed part of my support network while
undertaking this study:
 My heavenly Father who kept his hand of protection over my life
 Dr Katts and ds Adams for their spiritual guidance and support on my study journey
 My supervisor, Associate Professor Sinegugu Duma, for her academic support,
mentorship, patience, and for being a friend who I could call on any time when I
needed help or just a smile and words of encouragement
 All the academics who formed part of the SANTRUST predoctoral programme group,
who assisted me with the development of the research proposal, and my general
research skills
 Wayne Muller for professionally doing all the translation work required during this
study
 Leverne Gething for assisting with the editing of this thesis
 Mary Shelton and the staff of UCT libraries who were always willing to assist with
literature and referencing
 Drs Mignonne Breyer and Charles Masongo from the research office who supported
this study financially
 The staff at Gender Dynamix, in particular Whitney Booysen, for their support and
assisting with identifying possible participants for this study
 My dear friend and colleague Zaida Damons, who not only assisted me on a
professional level with regular debriefing sessions, but as a friend always supported
me on this journey
 All my colleagues at the UCT Department of Health and Rehabilitation Science who
offered their support and words of encouragement
 My friend Jeffrey Hoffman for his critical voice and support throughout this study
 All of my friends and family who were always accommodating and understood that
my attention was divided for three years. Still, they continued to shower me with love
and support
 All the women who participated in this study. You opened my eyes to the concept
“women of strength”.
It was during this time of intensive study that I realised how much support, love and care I
receive from friends, family and the various communities in which I venture. It would be
impossible to acknowledge every person who provided me with support on my journey.
However, I need to acknowledge the three most important people in my life:
 My mother, Gail Newman, who remains my pillar of strength and provides
unconditional love and support in a manner only a mother can
 My daughter, Rebecca Newman-Valentine, who in her innocence always smiled and
understood that Pappa has to “work” all the time and attend “meetings”
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 My husband, spouse, lover, friend, and confidant Marlow Newman-Valentine. I have
no words to ever thank you for your support on my journey. You allowed me to
become fully immersed into the life-world of transsexual women, and never once
complained about being the full-time operations manager of our family unit. You
have showed me the meaning of true love.

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List of figures and tables

List of figures
Figure 4.1. Schematic representation of the sampling process………………………………...49
Figure 5.1. Development of an emerging theme………………………………………………...63
Figure 5.2. Emergence of a connected theme with the connections right down to the initial
noting phase………………………………………………………………………………………...65
Figure 6.1. Superordinate theme, subordinate themes and clusters which emerged from the
data in this study. ………………………………………………………………………………….70

List of tables
Table 5.1. How comments were made against the transcriptions of the
interviews……………………………………………………………………………………………61

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Table of Contents
Abstract……………………………………………………………………………………………….
Declaration ........................................................................................................................................... 2
Abstract................................................................................................................................................. 3
Dedication ............................................................................................................................................ 5
Acknowledgements ............................................................................................................................ 6
Chapter 1 Background to the study ........................................................................................ 15
1.1 Introduction ............................................................................................................................ 15
1.1.1 Framing the T in LGBTI ................................................................................................. 15
1.1.2 Gender realignment........................................................................................................ 15
1.1.3 Finding assistance with sexual realignment ............................................................... 16
1.1.4 Politics and care .............................................................................................................. 16
1.1.5 Framing the context of the study .................................................................................. 17
1.2 Problem statement ................................................................................................................. 17
1.4 Research question .................................................................................................................. 18
1.5 Study objectives ...................................................................................................................... 18
1.6 Assumptions ........................................................................................................................... 19
1.7 Terminology ............................................................................................................................ 19
1.8 The voice used in this report ............................................................................................ 20
1.9 Organisation of the research report ..................................................................................... 20
1.10 Conclusion .............................................................................................................................. 21
2.1 Introduction ........................................................................................................................... 23
2.2 Paradigm of inquiry ............................................................................................................. 23
2.2.1 Theoretical underpinnings of method of inquiry ................................................... 24
2.3 The researcher as the research instrument ....................................................................... 24
2.4 Feminist research .................................................................................................................. 25
2.4.1 Transsexual Women and Feminism ........................................................................... 25
2.4.2 Males and feminism ...................................................................................................... 26
2.5 Ontological assumptions ..................................................................................................... 27
2.6 Conclusion .............................................................................................................................. 27
Chapter 3 Literature review ..................................................................................................... 28
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