Category: Fact Check

Wisconsin Assembly Speaker Robin Vos says it is possible for children as young as three years old to get medical gender transition treatment despite medical guidelines saying otherwise.

Vos, R-Rochester, made the assertion in an Oct. 12 Assembly floor speech as lawmakers debated a bill that would bar Wisconsin doctors from providing gender-transition treatment for minors.

“So, you say that kids aren’t old enough to know right from wrong when they commit a crime, but somehow permanent bodily changes, that, when you’re 3 years old, you’ve got it all figured out?” Vos said. 

“Stop using that empty rhetoric and start talking about the reality of why you believe that mutilating kids who don’t even know what day it is or their colors can decide to permanently change themselves in a way that harms them for the rest of their lives,” he added.

Vos is wrong. Practice standards and recommendations from Wisconsin health providers indicate that getting medical gender transition treatment for young, prepubescent children is effectively impossible.

Vos response

When asked to provide evidence to back up the claim, Vos spokesperson Angela Joyce pointed to a document from Children’s Hospital of Wisconsin’s Gender Health Clinic that provides information on medical gender transition treatments for patients and families.

The document, as Joyce correctly pointed out, has no hard age limits for medical gender transition treatments, including puberty blockers and hormone therapy.

It included three criteria for getting treatment: A written “letter of support” from a knowledgeable mental health provider, reasonable control of any medical and mental health problems a child may have and informed written consent from a legal guardian.

And, in a section that walked through treatment procedures for children who had not started puberty or were in early-to-mid-puberty, Children’s Wisconsin mentions both puberty blockers and medical interventions as treatment options.

“This demonstrates that medical gender-transition treatment may be done for children who have not gone through puberty yet,” Joyce said in an email. 

But that’s not the full story.

Clinics follow national guidelines that restrict treatment of young children

Some Wisconsin health providers, like others nationwide, offer medical transition treatments to treat gender dysphoria, which occurs when people have a mismatch between their biological sex and their gender identity. These options include gender-affirming hormone treatments, chest masculinization (“top surgery”) and genital surgery (“bottom surgery”). 

But Wisconsin clinics do not provide these procedures for young children, in accordance with guidelines set by the World Professional Association for Transgender Health (WPATH) that prohibit such practices. 

Under the guidelines, partially reversible and irreversible treatments in particular are reserved for adolescents and adults who meet specific criteria, and genital surgery is limited to patients who reach the legal age of medical consent.

Puberty blockers, a reversible treatment that delays puberty, come with their own WPATH guidelines. 

These guidelines instruct health providers to offer puberty blockers only for adolescents who demonstrate a “long-lasting and intense pattern” of gender incongruity and reach Tanner stage 2 of puberty, among other criteria. Stage 2 typically occurs between ages 9 and 11 for children assigned female at birth and around 11 for children assigned male at birth.

A Children’s Wisconsin spokesperson told us the clinic follows WPATH guidelines, which means Children’s Wisconsin does not provide medical gender-affirming treatments to children prior to the onset of puberty.

As for the “what to expect” document, it is not a comprehensive policy, but rather a guide for families who are looking for more information about treatment.

Other Wisconsin gender health providers follow similar guidelines, and some set strict age limits.

UW Health does not perform genital surgery on patients younger than 18, and both UW Health and Children’s Wisconsin require parental consent and letters of support from mental health providers before considering top surgery or hormone treatments for older adolescents.

Froedert Hospital’s Inclusion Health Clinic in Milwaukee, which provides gender-affirming hormone therapy, only sees patients 15 and older. Planned Parenthood of Wisconsin provides gender-affirming hormone therapy to patients 18 and older.

Our ruling

Vos claimed that “kids who don’t even know what day it is or their colors can decide to permanently change themselves” through medical gender transition.

Although Wisconsin gender health clinics offer an array of treatment options for transgender youth, none offer medical transition treatments for prepubescent youth, in accordance with professional guidelines.

We rate this claim False.

In Hialeah, a Cuban American enclave in south Florida, former President Donald Trump compared prosecutions by dictators in the Cubans’ homeland with the Biden administration’s actions.

“Just like the Cuban regime, the Biden regime is trying to put their political opponents in jail, shutting down free speech, taking bribes and kickbacks to enrich themselves and their very spoiled children,” Trump said in the Nov. 8 speech that countered the Republican presidential primary debate in Miami. 

For years, Trump has been saying the prosecutions are politically motivated and “election interference.” But in his remarks in Hialeah, he went much further by comparing the cases against him with actions of the Cuban government.

Trump’s statement downplays the realities of Cuba’s authoritarian regime, experts said. The actions of the Cuban government — including jailing political prisoners without due process, controlling the media and stifling dissent — are not comparable with Trump being charged with crimes and guaranteed due process.

When contacted for comment, the Trump campaign pointed to the multiple criminal indictments against the former president and gag orders in criminal and civil cases.

Trump’s remarks likely resonate with the audience in Hialeah, said Ted Henken, a sociologist at Baruch College, City University of New York and an expert on Cuban culture.

“He was telling a Cuban-American audience what they wanted to hear by tapping into a real ‘red-meat’ trauma for them related to the destruction of Cuban democracy and civil society by the Castro regime,” Henken said. “But the comparison to the Biden administration has no basis in fact.”

Cuban regime ‘has no parallel in the United States’

The Cuban government represses and punishes nearly all forms of dissent and public criticism, according to Human Rights Watch, an international nonprofit organization. The Cuban government is known for intimidating activists and political opponents by temporarily detaining them, and for arresting journalists and subjecting them to violence. 

Prisoners Defenders, a Madrid-based rights group, reported that as of October, Cuba was holding 1,062 people who met the definition of political prisoners. These people are typically not guaranteed due process, such as the right to a fair public hearing or legal representation. 

Cuba’s government not only punishes public criticism, but also controls all media and restricts access to information from outside the island. 

Cuba’s penal code that took effect in December increased limits on freedom of expression and assembly for journalists and activists, Amnesty International found.  

“The Castro regime canceled general elections and outlawed all political parties except for the Communist Party; systematically persecuted, repressed, and harassed dissenting opinions; incarcerated large numbers of political prisoners; and carried out extrajudicial executions,” Jorge Duany, director at Florida International University’s Cuban Research Institute, told PolitiFact. “The well-documented pattern of violation of basic human rights in Cuba has no parallel in the United States.”

Trump charged with crimes, not for speech or political beliefs

Biden is not the person in charge of the criminal investigations. The decisions about who to investigate and prosecute are in the hands of the Justice Department. Attorney General Merrick Garland, a Biden nominee, named special counsel Jack Smith to oversee the Trump investigations. 

Trump has been charged twice in federal court and separately in Manhattan and Fulton County, Georgia.

• In the federal election case, Trump faced charges related to his efforts to overturn the 2020 election. Trump tried to sway state lawmakers and Vice President Mike Pence to act illegally, and he participated in a fake elector scheme. Experts have told PolitiFact that constitutes conduct, not speech.

• In Fulton County, Trump was also accused of crimes related to trying to overturn the election. He was one of 19 people charged under Georgia’s Racketeer Influenced and Corrupt Organization, or RICO, statute. The case is being prosecuted by District Attorney Fani Willis.

• The federal charges in the documents case include willful retention of national defense information. The charges followed an FBI seizure of documents from Trump’s Mar-a-Lago home in Palm Beach, Florida, after more than a year of back-and-forth communication with the federal government.

• In Manhattan, District Attorney Alvin Bragg charged Trump with falsifying business records over hush money paid to adult film actor Stormy Daniels. 

New York Attorney General Letitia James also filed a lawsuit alleging that Trump and the Trump Organization created 200 false and misleading valuations of assets in New York, Florida and Scotland to defraud financial institutions. The civil fraud trial continues as of this publication.

Arguing that Biden is trying to jail a political opponent, Liz Harrington, a Trump campaign spokesperson, said that one of Trump’s trials — the federal election subversion case — starts the day before Super Tuesday and that some cases against Trump are in Democratic jurisdictions. Trump faces charges in those jurisdictions because he is accused of committing wrongdoing there.

Gag orders do not limit all free speech

Trump’s comments about the Biden administration’s efforts to shut down “free speech” was a nod to gag orders.

U.S. District Court Judge Tanya Chutkan, a Barack Obama appointee, issued an October gag order in the election case and instructed Trump not to make statements targeting Smith, court staff or witnesses. But she ruled that Trump could still make statements criticizing the current administration.  The gag order was temporarily paused while Trump is appealing.

Separately, Trump is under a gag order in the New York civil trial, banning him from speaking about communications involving the judge and his staff. Judge Arthur Engoron has fined him twice for violating that order.

Trump frequently criticizes Biden at public rallies and on social media, and he has been given due process.

“We have no evidence in any of the four criminal trials that former President Donald Trump’s due process rights have been violated,” said Steve Swerdlow, a lawyer and University of Southern California associate professor of the practice of human rights. 

Sebastian A. Arcos, associate director of the Cuban Research Institute at Florida International University, said Trump’s statement is hyperbole.

“Cuba is a totalitarian regime where free speech is systematically restricted and political opponents are routinely harassed and incarcerated, with no independent judiciary or media, and no legal recourse. The U.S. is still an open society under the rule of law,” Arcos said. “Regardless of the many interpretations of Mr. Trump’s legal troubles … the U.S. remains an open society with checks and balances under the rule of law.”

Our ruling

Trump said, “Just like the Cuban regime, the Biden administration is trying to put their political opponents in jail, shutting down free speech.”

His statement amounts to a reckless downplaying of the authoritarian regime in Cuba, where leaders have shut down dissent for decades.

Cuba’s political prisoners are jailed for exercising free speech and challenging the actions of the party in power. Trump has been charged with crimes and is guaranteed due process, including the right to a fair public hearing and legal representation. 

Trump has been the subject of gag orders issued by federal and state judges  presiding over two cases. He retains his right to criticize Biden or his political rivals, as he frequently does on social media and at rallies.

We rate this statement False.

RELATED: No, former President Donald Trump is not ‘officially a political prisoner’

RELATED: Trump says DOJ is trying to criminalize asking questions. That’s not what indictment says.

The U.S. infant mortality rate rose 3% in 2022, the first year-to-year increase in 20 years, a Nov. 1 report from the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics shows.

The increase’s cause is unknown, but some social media users are blaming a familiar target — COVID-19 vaccines.

A Nov. 10 Instagram post stitched together screenshots of several CNN articles with headlines that showed health officials urging pregnant women to get vaccinated against COVID-19, and one Nov. 1 headline that read, “US infant mortality rate rises for first time in more than 20 years.”

A caption with the post read, “The dots are basically touching each other and some still can’t connect them.”

The Instagram post was flagged as part of Meta’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Meta, which owns Facebook and Instagram.)

We found other social media posts making the same claim.

(Screenshot from Instagram)

There is no evidence connecting the infant mortality rate increase to the COVID-19 vaccines, which went to market in early 2021. Health officials say getting the COVID-19 virus can complicate pregnancy and that a growing body of studies have proved the vaccines to be safe to take during pregnancy.

What the report said

The report’s data shows the provisional (not final) infant mortality rate increased from 5.44 deaths per 1,000 live births in 2021 to 5.6 deaths in 2022, a 3% rise.

It was the first year-to-year rise in the rate since 2002, when the rate increased 2.94% over 2001. 

The total number of deaths among infants, babies younger than a year old, for 2022 was 20,548, also a 3% increase. Overall, the infant mortality rate has declined 22% since 2002, the report said.

Among the report’s findings were significant mortality rate increases for male infants, infants born to American Indian, Alaskan native and white women and infants born to women ages 25 to 29.

Two of the 10 leading causes of infant mortality increased significantly, maternal complications of pregnancy and bacterial sepsis of a newborn, the report said.

The report listed no cause for the mortality rate increase and did not mention COVID-19 or vaccines.

No connection to vaccines

Dr. Rachel Moon, a University of Virginia School of Medicine pediatrics professor, said the claim about COVID-19 vaccines causing the rise in infant mortality is unsubstantiated.

“There has been no association of COVID-19 vaccines increasing mortality in general, and there is no biological plausibility to the claim,” Moon said.

If it were true that vaccines were causing higher rates of infant mortality, Moon said, then we would see higher rates of infant mortality in areas with high vaccination rates — but that’s not what the data shows. 

The report highlighted significant increases in infant mortality rates in four states: Georgia (+13%), Iowa (+30%), Missouri (+16%) and Texas (+8%). 

Moon noted that in those four states, the percentage of residents who received the primary COVID-19 vaccine series was lower than Northeastern states with higher vaccination rates, according to CDC vaccination data. 

The vaccination rates in Georgia (57.5%), Iowa (64.5%), Missouri (59.2%) and Texas (63.5%) don’t show how many pregnant people were vaccinated, but Moon said they would likely reflect overall vaccination trends in those states.

“If vaccines were indeed the reason, I would expect the infant mortality rates to be the highest in the Northeast, which has the highest vaccination rates,” Moon said.

New York, for example, had 81% of residents vaccinated, but the infant mortality rate there rose 2%. Connecticut had 83% or residents vaccinated, but had a 9% decrease in its infant mortality rate.

The report also highlighted Nevada’s 22% decrease in its infant mortality rate. That state had 63.8% of its residents receive at least two doses of the COVID-19 vaccine, a rate comparable to the four states highlighted in the report with significant increases in infant mortality.

Moon also said the report showed a larger increase in infant mortality rate in male infants. “I would anticipate that the rates in females and males would be the same,” if vaccines were the cause, she said.

In response to the report’s findings, American Academy of Pediatrics President Dr. Sandy Chung released a statement saying there are many reasons the infant mortality rate in the U.S. is “shockingly high.” She cited poverty and racial and ethnic disparities related to accessible health care among them.

COVID-19 vaccines and pregnancy

The CDC and other health organizations recommend that pregnant women be vaccinated against COVID-19.

The CDC said people who are pregnant or were recently pregnant are more likely to get very sick from COVID-19 compared with people who aren’t pregnant. Getting the virus can increase the risk of pregnancy complications, the CDC said.

Studies of women before and during pregnancy have shown no increased risk for pregnancy complications such as miscarriage, preterm delivery, stillbirth or birth defects, the CDC said.

The American College of Obstetricians and Gynecologists said on its website there’s “no evidence of adverse maternal or fetal effects” from the vaccine and a growing body of evidence proves its safety for use during pregnancy.

The National Institutes of Health, the World Health Organization and the Society for Maternal-Fetal Medicine also recommend COVID-19 vaccination during pregnancy.

Our ruling

An Instagram post claimed that a rise in infant mortality rates in 2022 is tied to COVID-19 vaccines.

National data shows a rise in infant mortality in the U.S. for the first time in two decades, but the CDC report documenting this trend did not determine a cause. 

COVID-19 vaccination rates in four states highlighted in the report that had significant increases in infant mortality rates were much lower than vaccination rates in states with small increases or decreases in infant mortality. Studies have shown no increased risk of birth complications in people who were vaccinated while pregnant. Getting the COVID-19 virus can increase the risk of pregnancy complications, the CDC said.

We rate the claim False.

In a White House event to promote climate change awareness, President Joe Biden argued that  rising temperatures and extreme weather come with a significant cost.

“Last year alone, natural disasters in America caused $178 billion in damages,” Biden said in his Nov. 14 remarks. 

The number Biden cited is consistent with a widely cited federal statistic, but it’s worth noting what that figure does — and doesn’t — reflect.

The National Oceanic and Atmospheric Administration calculates the most commonly cited statistic on disaster losses. It adds together the total costs for weather events that individually cost at least $1 billion. The disasters counted include drought, flooding, freezing, severe storms, tropical cyclones, wildfires and winter storms.

In 2022, these disasters cost a cumulative $178.8 billion, right about what Biden said. That’s the third-highest annual amount since the statistic was first calculated and trails only 2017, when Hurricanes Harvey, Irma, and Maria made landfall, and 2005, when Hurricanes Katrina and Rita took their toll.

The annual dollar figures have been adjusted for inflation.

Although the cost total zigzags from year to year, the statistic shows an overall rise in the cost burden. Between 1980 and 2016, the average disaster cost per year was $40.1 billion. But from 2017 to 2022, the average figure more than quadrupled to $168.5 billion.

This cost increase has paralleled a rise in the number of $1 billion disaster events. From 2017 to 2022, the U.S. has averaged more than 18 billion-dollar events — triple the average from 1980 to 2016. So far, 2023 has brought a record 25 incidents.

Although these numbers are widely shared, they do not encompass the full range of disaster losses.

If losses from disaster events totaling less than $1 billion were included, the total amount “would be higher,” said Craig Fugate, who headed the Federal Emergency Management Agency for most of President Barack Obama’s tenure. “It’s hard to capture all of the damages from smaller events.”

When PolitiFact noted this point to the White House, it pointed us to a National Oceanic and Atmospheric Administration statement that said past research showed that the $1 billion threshold captures at least 80% of disaster costs. 

But those that don’t are often significant, too. In April, Fort Lauderdale, Florida, received a record 26 inches of rainfall over two days. The flooding closed the Fort Lauderdale-Hollywood International Airport for two days and damaged homes and businesses. State officials determined that 1,095 homes sustained major damage and 255 had minor damage. Some homes were contaminated with raw sewage. The basement of Fort Lauderdale’s City Hall flooded, forcing employees to move to rented space; city officials are moving toward razing the building.

Biden declared parts of the city a federal disaster area. WLRN, a public radio station and PolitiFact partner, reported in October that the Federal Emergency Management Agency had provided $36.2 million to 9,570 uninsured and underinsured households in Broward County. The agency also paid out $218.3 million to 3,100 policyholders through the National Flood Insurance Program.

Despite the widespread damage, the preliminary cost estimate was about $100 million, the Sun Sentinel reported. That number could rise — our efforts to confirm a final figure with officials were unsuccessful. But even if it did, it would likely fall short of the $1 billion in losses needed to qualify for inclusion in the $178 billion figure Biden cited.

Our ruling

Biden said, “Last year alone, natural disasters in America caused $178 billion in damages.”

That’s in tune with official federal government statistics, and it ranks as the third-highest annual total since disaster cost records started being kept in 1980.

However, the statistic is calculated by adding up the damages only for weather disasters that individually caused $1 billion in damages. This excludes smaller weather events, which would add to the total. 

The statement is accurate but needs additional information, so we rate it Mostly True.

PolitiFact Staff Writer Amy Sherman contributed to this report.

RELATED: All of our fact-checks about natural disasters 

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A video circulating on social media has some users questioning whether it’s authentic or not. It’s not. 

“My name is Jill Biden, and I want to tell you about my husband, Joe,” first lady Jill Biden appears to say in the video. “Joe is the world’s biggest cheerleader for the atrocities happening now in Gaza.”

The video then cuts to a clip of Joe Biden saying: “The United States stands with Israel.” 

Then a voice that sounds like Jill Biden’s says: “Right now, the right-wing, extremist government of Israel is raining down hell on Palestinian civilians. They’ve killed over 1,000 children in the last few days. This is a genocide. Normal people around the world are standing up and demanding an end to the horror. But the only one who can stop it is Joe. The United States of America is supporting the actions of Israel. And the U.S. taxpayer is funding it. So, come on, Joe from Scranton. Tell Israeli George W. Bush no more money for his bombs, cut the funding, call for a ceasefire, end this f— nightmare.” (An image of Israeli Prime Minister Benjamin Netanyahu appears on the screen during the mention of “Israeli George W. Bush.”)

An Instagram post was flagged as part of Meta’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Meta, which owns Facebook and Instagram.)

The footage of Jill Biden comes from a 2020 presidential campaign ad for Joe Biden. She doesn’t make the remarks in the video circulating Instagram. 

Rather, she says, “My name is Jill Biden, and I want to tell you about my husband, Joe. I first met Joe two years after a car accident that injured his sons and killed his wife and his baby daughter. His life had been shattered. But as one of Joe’s favorite quotes remind us, ‘Faith sees best in the dark.’”

We rate claims that the video that appears to show her calling Joe Biden a cheerleader for atrocities is authentic Pants on Fire!

A recent Instagram post takes a potshot at Pfizer CEO Albert Bourla for supposedly donning a face mask days earlier to protect himself against COVID-19.  

“Pfizer CEO Albert Bourla wearing a mask in November 2023,”says the Nov. 15 post, which is overlaid with a clown emoji. Bourla appears in the photo with four other people wearing face masks that read, “SCIENCE WILL WIN.”  

This post was flagged as part of Meta’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Meta, which owns Facebook and Instagram.)

Bourla posted the photo Nov. 9 on X, but he makes clear in the post that the photo isn’t new. 

“Three years ago today, we were able to share with the world the joyous news that our #COVID19 vaccine was highly effective in preventing disease,” Bourla said in the post. “It was one of the best moments of my career. We could not have reached this point without the extraordinary efforts of our talented and dedicated @Pfizer colleagues and @BioNTech_Group partners. This photo was taken moments after we received the good news from our R&D (research & development) team, and you can see the smiles through our masks.”

On Nov. 9, 2020, Pfizer announced that its vaccine “was found to be more than 90% effective, according to clinical results released by the company” that day, NPR reported. 

We rate claims this photo was taken in November 2023 False.

Did former President Donald Trump recently claim that he’s still the commander in chief? 

No, but a recent Instagram post points to a Nov. 11 campaign rally as evidence that he did. 

“I will 100% prevent World War III,” Trump says in a video clip in the post. Text above the video, from a Nov. 12 X post, reads: “Trump just told everyone he IS COMMANDER IN CHIEF.”

“You’re going to end up in World War III,” he continues. “You look at what’s going on right now in the Middle East and Ukraine, and you add it up and we have somebody that has no clue what the hell is going on. You’re going to end up in World War III because of this — no reason for it. Millions of people will die. I know the players, I know the job, I alone in this primary have borne the burden of having troops in harm’s way as commander in chief of the U.S armed forces.” 

This post was flagged as part of Meta’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Meta, which owns Facebook and Instagram.)

Trump’s comments in context, from a Nov. 11 campaign rally in Claremont, New Hampshire,

 make clear that he’s referring to his past experience relative to the other 2024 Republican presidential primary candidates.  None of them have previously served as commander in chief, as he has. 

President Joe Biden is the current commander in chief. 

We rate claims that Trump said Trump is now commander in chief False.

Since his firing from Fox News, former primetime host Tucker Carlson has taken his show on the digital road — to X, where he has interviewed public figures such as former President Donald Trump and independent presidential candidate Robert F. Kennedy Jr. 

On Oct. 4, Carlson released an episode titled “Trans, Inc” that focused on gender-affirming health care provided to transgender people.

“Genital mutilation is not just a fad. It’s a full-blown industry,” read the caption on Carlson’s X post sharing the episode. The 48-minute video criticized aspects of transgender health care, such as hormones, surgery and social affirmation. It describes “transgenderism” as “unnatural” and “demented,” comparing it with “human sacrifice.” Carlson could not be reached for comment. 

In the video, Carlson interviewed Chris Mortiz, whom Carlson introduced as a “policy guy” who has “taken a close forensic look at where the money is coming from.” From his limited online presence, we found that Moritz has worked as a lawyer, investment banker and consultant. Mortiz did not respond to our requests for comment. 

The video included some claims we have fact-checked before. But here are three new assertions involving hormone treatments, gender-affirming surgeries and the trans health care market. 

Moritz: “With respect to the transgender pharmaceuticals, there are no long-term studies, peer-reviewed, that show the efficacy or not of taking these very powerful pharmaceuticals.”

Moritz’s description of a total lack of research is inaccurate. The Endocrine Society’s Clinical Practice Guidelines state, “Prior to 1975, few peer-reviewed articles were published concerning endocrine treatment of transgender persons. Since then, more than two thousand articles about various aspects of transgender care have appeared.”

PolitiFact found several published and peer-reviewed studies examining the long-term effects and efficacy of cross-sex hormone treatment on bone health, cardiovascular risk, mortality, psychosocial functioning and more. There is enough research that we found systematic reviews — analyses of large numbers of individual research studies —  on specific aspects of treatment like bone health.

Although adolescent treatment for gender dysphoria started only in the late 1990s, transgender adults have received hormonal treatment and sex reassignment surgery since the early 1970s. 

Additionally, people who aren’t transgender, including men with low testosterone and women in menopause, sometimes rely on hormone therapy. 

“Hormone therapy for transgender males and females confers many of the same risks associated with sex hormone replacement therapy in nontransgender persons,” the Endocrine Society’s Clinical Practice Guidelines say. 

The guideline outlines safe dosages and provides guidance for how physicians should monitor for potential adverse effects.

Carlson: “I haven’t heard anybody mention female genital mutilation in the United States in quite some time now. Is that because we now officially engage in it?” 

Female genital mutilation is a nonconsensual procedure that can include the partial or total removal of the clitoris, labia minora or the narrowing of the vaginal opening. The World Health Organization said it is mostly forced on girls younger than 15. More than 200 million women have been affected in 30 countries in Africa, Asia and the Middle East.

The procedure aims to reduce or eliminate sexual function and pleasure. It is widely considered a human rights violation.

Dr. Marci Bowers, a gynecological surgeon who does gender-affirming genital surgeries and restorative surgeries for female genital mutilation survivors, told PolitiFact that gender-affirming surgeries do not amount to genital mutilation — the two are entirely different.

“Transgender surgery is done with full consent of the individual,” Bowers said.

Female genital mutilation is usually forced on girls younger than 15 in nonmedical and unsterile conditions. Gender-affirming surgeries, however, are performed in hospitals by trained professionals, and are rarely performed on people younger than 18, said Bowers, president of the World Professional Association for Transgender Health. When gender-affirming surgery is performed on minors, it is “only under the most severe conditions of gender dysphoria,” she said.

Bowers also noted the difference in how the two procedures affect women’s sexual functionality — such as the ability to have sensation or orgasm. Gender-affirming surgeries “are generally quite elegant surgeries that leave the individual fully functional versus (female genital mutilation), which robs a woman of functionality,” she said.

Mariya Taher, co-founder of Sahiyo, an organization working in Asia to end female genital mutilation, agreed with Bowers. Taher told PolitiFact her organization “strongly” believes that gender-affirming health care does not equate to genital mutilation.

“We are saddened to see the two issues are being conflated” and that female genital mutilation “is being used as a guise to target and harm trans youth and gender-diverse individuals” Taher said.

Additionally, representatives from the End FGM network in both the U.S. and Europe told PolitiFact that female genital mutilation and gender-affirming surgeries are not the same.

Moritz: “The combined value sales of sex reassignment surgeries and pharmaceutical products in 2018 was $2.94 billion. By 2022, that figure had rose to $4.18 billion.” 

We are unsure how Moritz arrived at those numbers; he offered no evidence backing them up and did not answer our inquiries. 

We found a few publicly available market research reports, which are often commissioned by investors deciding whether to invest in a given industry. But it is difficult to assess the reliability of these reports without knowing the methodology behind them, and estimates can vary widely, said experts.

Carlson made a broader assertion that profits are driving transgender health care: “Transgenderism, it didn’t happen by accident,” he said. “Some people are profiting from it.”  

None of the 2022 reports we found for the U.S. market added up to $4.18 billion, but some got close. Grand View Research, for example, values the U.S. sex reassignment hormone therapy market at $1.6 billion and the U.S. sex reassignment surgical market at $2.1 billion in 2022. 

These values can be calculated using a combination of insurance data, federal and state data, and information directly from medical providers, explained Stephen Parente, professor of finance at the University of Minnesota Carlson School of Management. But for procedures not reimbursed by insurance, getting accurate estimates might prove more challenging. Coverage of health care services for transgender people can differ by state and health plan, according to HealthCare.gov.

“Most types of health care, including gender affirming care, involve multiple types of providers of goods and services — e.g., drugs, visits, procedures, hospital stays, etc.” said Melinda Butin, health economist and professor at Johns Hopkins Bloomberg School of Public Health. “For this reason, it is hard to assess how much is spent on specific categories of care in sum.”

The market size can vary depending on what is included in a given estimate, said Supriya Munshaw, associate professor at Johns Hopkins Carey School of Business. Is it just surgery or is the hospital stay included? What about complications? How do they determine what mastectomies are gender-affirming and which are done for breast cancer?

“How are you actually calculating the number?” said Munshaw. “It might differ in different research reports.”

The U.S. health care market is large to begin with, totaling $4.3 trillion in 2021, according to federal data on national health expenditures. A market of billions is a “sizable market” from an investment perspective, Munshaw said, but “it doesn’t mean that if something is profitable that the healthcare industry is pushing it.”

PolitiFact Researcher Caryn Baird contributed to this report.

North Carolina Democrats are criticizing Republican-approved election maps that they argue are unconstitutionally lopsided.

The state’s Republican-controlled legislature in October approved maps that are expected to reduce the number of North Carolina Democrats in Congress from seven to three or four. New legislative maps are also expected to enable Republicans to maintain majorities in the state House and Senate.

State Rep. Eric Ager, D-Buncombe, said on the House floor that the redrawn maps were created by someone who’s not accountable to the public.

“This map was drawn entirely in secret by an Ohio consultant, as my colleagues have pointed out, with taxpayer dollars,” Ager said on Oct. 24.

Is that accurate? For the most part, yes. 

Contacted by PolitiFact, Republican leaders didn’t dispute Ager’s claim. However, they did point out that North Carolina legislators on both sides of the aisle have a history of spending taxpayer dollars on independent redistricting consultants and of drawing maps out of the public eye.

Maps drawn mostly in secret

North Carolina legislators kicked off their redistricting efforts in September, holding three community hearings across the state. Members of the public were invited to offer input on how new congressional, state Senate and state House maps should be drawn. On Oct. 18, Republican legislative leaders released drafts of maps they’d created behind closed doors. It’s unclear whether the suggestions made in the public hearings had any influence on the final maps.

Democrats in the state House and Senate were allowed to propose amendments to the maps, and they did. But Republicans rejected most of the Democrats’ suggestions.

Lawmakers tweaked the maps slightly before approving them the week of Oct. 24. But they didn’t change proposed district lines in ways that would significantly affect the Republicans’ odds of winning races in 2024. 

In each of the three finalized maps, 95% of the census blocks remained in the same district where they were first introduced, according to an analysis by Peter Miller, a senior research fellow at the Brennan Center for Justice.

This year’s redistricting process stands in contrast to how the maps were drawn in 2019 and 2021. Those years, Republican legislative leaders drew lines on a terminal that displayed their actions in a way that could be viewed by the public. Some Republicans touted that redistricting process as the most transparent in North Carolina history. State Rep. Destin Hall, R-Caldwell, later acknowledged that during the 2021 process he consulted privately drawn maps.

Republican legislators said that Democrats have also drawn election maps behind closed doors.

In response to questions about Ager’s claim, the office of Republican House Speaker Tim Moore cited a 1991 letter that then-state Rep. Art Pope wrote to the U.S. Department of Justice. Pope, a Republican, complained about the Democratic majority’s secretive redistricting practices, saying redistricting committee leaders “made no effort to build a consensus and opposed all alternative proposals and amendments that they had not previously agreed to in private.” That December, the U.S. Department of Justice ruled that the Democrats’ plan violated the federal Voting Rights Act. 

How consultant was paid

In the redistricting process, each legislative chamber is responsible for drawing its own maps. Then, after some negotiation, the chambers reach an agreement on final maps. The state Senate didn’t hire an independent consultant to help draw its proposed maps, said Lauren Horsch, a spokesperson for Republican Senate Leader Phil Berger. 

The state House, however, spent taxpayer funds on an outside consultant, Hall confirmed to PolitiFact. Hall, a Republican, is a chairman of the House Redistricting Committee.

House Republicans have an outside law firm, Nelson Mullins Riley & Scarborough LLP, representing the chamber on redistricting matters. The firm hired Blake Springhetti, an independent consultant from Ohio, to help with redistricting, Hall told PolitiFact.

“Our outside law firm engaged the expert and paid the expert, and as is customary in any law firm/client relationship, we then compensate the law firm using state funds, including reimbursements for expenses,” Hall said in an email. “The expert has been paid approximately $174,000, which is well in line with other expert fees in redistricting cases.”

The payment arrangement has been customary in North Carolina for decades, Hall said. He said his office informed House Democrats on Aug. 23 that they could also use state funds for redistricting experts.

House Minority Leader Robert Reives, D-Chatham, received that notice but declined to use funds for that purpose, his office told PolitiFact.

It “seemed a waste to hire outside experts on maps the Republicans never would have considered,” Todd Barlow, Reives’ chief of staff, said in an email. “Additionally, the NC House maps used in 2022 were blessed by the courts, passed on a bipartisan vote, and still legal. They could have been used again. That’s different from the NC Senate and Congressional maps which had to be redrawn.”  

North Carolina’s Supreme Court ruled last year that state and congressional boundaries used in the midterm elections were tainted by partisan bias and needed to be redrawn. Barlow also pointed to the fact that Republican state senators — unlike their House colleagues —  drew their maps this year without hiring an outside consultant.

Legislators have used public funds on independent consultants over the years. Between 2021 and 2022, Republican legislative leaders spent about $2.9 million in an unsuccessful defense of election maps that were ultimately thrown out and ordered to be redrawn, WRAL reported. Legislators previously paid the late Tom Hofeller, a former redistricting chairman for the Republican National Committee.

Democrats acknowledged have in the past used public funds on outside redistricting consultants, too. Legislative Republicans previously allocated $25,000 to Democratic caucuses in the House and Senate so they could hire outside counsel, according to Senate Minority Leader Dan Blue’s office. 

Democratic legislators also hired an outside consultant, Leslie Winner, in 1991. Gerry Cohen, former special counsel for the North Carolina General Assembly, told PolitiFact he believed she had been paid with public funds. Former legislator Toby Fitch, who led the House’s redistricting effort that year, told PolitiFact in a phone interview that he couldn’t remember how Winner was paid.

Our ruling

Ager said the state House of Representatives’ new election map “was drawn entirely in secret by an Ohio consultant, as my colleagues have pointed out, with taxpayer dollars.”

The maps were adjusted slightly after being drawn in private. Public funds were used by House Republicans to hire independent redistricting consultants, a common practice by legislators on both sides of the aisle. 

The statement is accurate but needs clarification or additional information. That’s our definition of Mostly True.