Background

On November 29, 2021, Bill C-4, an Act to amend the Criminal Code (conversion ‘therapy’) (the Bill), was introduced in the Canadian House of Commons and came into force on January 7, 2022. The Bill created new Criminal Code offences prohibiting causing another person to undergo conversion ‘therapy’, regardless of age or consent (section 320.102); removing a child from Canada to subject them to conversion therapy abroad (paragraph 273.3(1)(c)); promoting or advertising conversion ‘therapy’ (section 320.103); and receiving a financial or other material benefit from the provision of conversion ‘therapy’ (section 320.104). It also amended the Criminal Code to authorize courts to order that advertisements for conversion ‘therapy’ be disposed of or deleted. The Criminal Code defines conversion ‘therapy’ as any practice, treatment or service designed to make a person conform to heteronormative or cisnormative standards (section 320.101).

The definition further clarifies that interventions that help a person explore or develop their identity are not conversion ‘therapy’ unless they are based on the false assumption that a particular sexual orientation, gender identity or gender expression is preferable to another. This important policy shift was the result of years of grassroots advocacy efforts from within Two-Spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual, and other sexual and gender minority (2SLGBTQIA+) communities to criminalize these harmful, widely discredited practices [2-4]. Subsequently, the Bill’s passage has been celebrated by community members and academics as an important step towards protecting the health and wellbeing of 2SLGBTQIA+ people in Canada [5-6].

In this report, we use the term conversion ‘therapy’ to refer to a broad set of practices that involve organized and sustained efforts to pressure someone to deny, suppress, or change their sexual orientation, gender identity, or gender expression to heterosexual and/or cisgender. Since conversion ‘therapy’ is not a real form of medical therapy but is a harmful practice and criminal offense, quotation marks are used whenever referring to conversion ‘therapy’ in this report. These practices usually involve an institution, most frequently occur within religious or faith-based settings or within healthcare environments and may be advertised [7]. Conversion ‘therapy’ is rooted in the pathologization of 2SLGBTQIA+ identities. Today conversion ‘therapy’ has been discredited as being ineffective, inappropriate, dangerous, and lost its support from mainstream health institutions.

In contrast, the term, sexual orientation and gender identity and expression change efforts (SOGIECE) describes broader efforts, including subtle ones, to change, suppress, or discourage a person’s sexual orientation or gender identity. Since SOGIECE includes practices that are less organized, sustained, and defined, and do not always involve an institution, these practices may not be as clearly delineated as conversion ‘therapy’. For example, parents or teachers may tell children that boys are not supposed to wear skirts, which can encourage boys to avoid showing gender expressions that are socially constructed as feminine.

Similarly, there have been a significant number of anti-2SLGBTQIA+ rallies and education policies in Canada, which can make it harder for 2SLGBTQIA+ people to develop, express, and affirm their sexual orientation or gender identity or expression. These are examples of SOGIECE that are not covered by Bill C-4, but are harmful to 2SLGBTQIA+ people. Additionally, there is not always a clear distinction between conversion ‘therapy’ and SOGIECE; what is initially SOGIECE may gradually progress into conversion ‘therapy.’ Although Bill C-4 may help protect 2SLGBTQIA+ people from practices that are clearly recognized as conversion ‘therapy’ in the future, to prevent all forms of conversion ‘therapy’ and SOGIECE, there need to be effective mechanisms in place, including education and legal supports. Additionally, the impacts of conversion ‘therapy’ need to be much better understood, and there remain questions about how to ensure survivors can be best supported within this new legal context.

Previous research on conversion ‘therapy’ in Canada demonstrates that, shortly before the passage of Bill C-4, these practices were widespread and detrimental to the health and wellbeing of 2SLGBTQIA+ people. For example, the Community-Based Research Centre’s (CBRC) 2019 Sex Now survey found that approximately 10% of GBT2Q (gay, bisexual, trans, Two-Spirit, and queer men) participants reported ever experiencing these practices, with 21% indicating that they or any person with authority had tried to change their sexual orientation or gender identity [7]. Recent conversion ‘therapy’ prevalence estimates among trans and non-binary people from the Trans PULSE study are similar at 11% [8], although this is likely a low estimate due to the narrower definition of conversion ‘therapy’ used within that study.

Canadian data about the prevalence of conversion ‘therapy’ among queer and trans women is comparably sparse, and there is a need to address this gap. However, existing data demonstrates that conversion ‘therapy’ is experienced unevenly across 2SLGBTQIA+ communities, with higher prevalence among younger people, trans and non-binary people, immigrants, racial/ethnic minorities, and people with lower socioeconomic status [7-9]. Conversion ‘therapy’ has been associated with negative psychosocial health outcomes, including increased rates of reported loneliness, mental health service access, anxiety, and depression [7; 9; 10-12]. Additionally, suicidality is a common impact, with one study finding that a third of GBT2Q participants who had experienced conversion ‘therapy’ had attempted suicide [9].

Existing research has also highlighted major gaps in support and the need for various low-barrier and low-cost services, including affirming and trauma-informed mental health supports [7; 9; 11; 13]. Improving knowledge among healthcare providers about 2SLGBTQIA+ people and the harms caused by conversion ‘therapy’ is essential in addressing these gaps [13; 14]. Barriers to accessing support persist, including shame, internalised homophobia and transphobia, and costs associated with accessing services [13]. In contrast, key facilitators for recovery and healing include building affirming social relationships, including with other 2SLGBTQIA+ people and organisations, and having space to process emotions and trauma [13; 24].

Additionally, previous scholarship has emphasised the need to further explore the intersection of ethnoracial identity and immigration status with conversion ‘therapy’ [13], particularly given the over-representation of BIPOC communities and immigrants in recent conversion ‘therapy’ estimates [7]. However, these experiences have not been fully explored through qualitative research in Canada. To address this gap, this report aims to qualitatively explore the conversion ‘therapy’ experiences of 2SLGBTQIA+ survivors who are BIPOC, immigrants, newcomers, refugees, and those without immigration status across Canada, including the nature and impact of their experiences and the types of support (e.g., programs, policies, or resources) survivors desired and accessed.