We are a few of the more than 100 Washington pediatricians, family doctors and nurses who oppose I-638’s new sex inspection requirements. The initiative is a government mandate forcing us to conduct medically unnecessary and potentially harmful tests on elementary, middle and high school girls. This includes genital exams, and genetic or hormone tests, as a new part of sports physicals. 

I-638, officially known as the Defending Equity in Interscholastic Sports Act, is part of a coordinated and thinly veiled political attack on all girls, not just vulnerable transgender children. As The Seattle Times editorial board wrote in their opposition to I-638 : it “would send Washington back to the days of ‘femininity certificates,’ when amateur women athletes, including Olympic athletes, had to carry proof that they had passed visual exams and chromosome testing that proved they were women.”

Under I-638, sponsored by MAGA megadonor Brian Heywood’s Let’s Go Washington, any girl from elementary to high school who wants to play sports would be forced to provide medically verified proof of their sex as a new part of sports physicals just for girls. Boys are exempt. It prohibits parents from using birth certificates, and Section 3(2)) states that, to be in compliance, doctors must subject girls to examinations of their “reproductive organs,” or make parents pay for expensive genetic or hormone testing. Insurance will likely not pay for these expensive genetic and hormone tests because they are not medically necessary to diagnose, treat or manage a specific health condition.

Washington students currently remain fully clothed during sports readiness exams, and exams focus on cardiovascular, musculoskeletal and neurologic systems. But I-638 would change that, potentially even requiring pelvic exams, which are medically unnecessary for sports, and can emotionally and physically harm young girls. The American College of Obstetricians and Gynecologists says there is no medical reason for a pelvic exam for girls younger than 21, unless the patient has other health concerns. 

The initiative is so poorly written that its sponsors have even said they wish they had written an initiative with more clarity on how it would be implemented. There is no explanation of when and how the government will enforce these rules, who can conduct sex inspections or what evidence will be required during genital, hormone or genetic tests.

It could be used to demand that girls as young as kindergarten or girls who participate in nonathletic activities like e-sports prove their sex to a stranger. I-638 is clear about only one thing: The government gets to make personal decisions for our patients and their parents.

Nearly 150,000 school-age girls across Washington state do not have a regular doctor — this is especially true for low-income, rural and immigrant girls, and girls of color — and would be subject to genital examinations by strangers. The American Academy of Family Physicians says sports physicals should take place “not in a group setting,” but many families depend on free large group sports physicalswhere girls could face greater embarrassment and trauma from invasive genital inspections. 

By requiring girls to undergo invasive inspections, I-638 would decrease participation, robbing girls of the physical, social and emotional benefits that sports provide. More than half of teenagers experience anxiety or depression. In the midst of a youth mental health crisis, the last thing we should do is put up barriers to healthy and social activities.

I-638 would force us to violate an ethical code to do no harm to our patients. That’s why we are joining the WA State PTA, WA State Nurses Association, Planned Parenthood Alliance Advocates, the League of Women Voters, and thousands of parents and teachers across the state in urging voters to vote No on I-638.

Grace Shih: MD, is a physician, reproductive health specialist and professor in the Department of Family Medicine, University of Washington.
Glenna Martin: MD, MPH is a family physician in Seattle. She sits on the board of Pro Choice Washington.
Caitlin Blau: DO, is a family physician in Bellingham.
Sam Doyle: ARNP, is a nurse practitioner at Fred Hutchinson Cancer Center and a UW teaching associate of Medicine and Pulmonary, Critical Care and Sleep Medicine.

I’ve worked with survivors of child abuse for over a decade. I can attest that confidentiality, privacy and having safe adults to turn to are crucial for abuse disclosures. For many children experiencing abuse or harm at home, a trusted adult at school may be the only person who recognizes that something is wrong and can help connect them with support.   

Initiative 001 (IL26-001)), on your November ballot, would remove commonsense record protections for victims of child abuse. The changes it makes would allow abusers who have been accused of, or even charged with raping, beating or otherwise harming their child to access their victims’ social work and counseling records, putting these vulnerable kids in more danger. 

It’s hard to see how anyone would want to remove safeguards designed to protect children. The backers of this initiative are playing politics in order to distract voters from the real issues families are facing, like rising costs. It’s important for voters to get the facts, not just the campaign narrative that I-001 backers are pushing. 

I-001 would put children at greater risk by discouraging them from seeking help at school. While most parents are loving, sadly child abuse is more widespread than most realize — there are more than 100,000 reports of abuse each year in Washington. Children are often afraid to report abuse, or don’t know what is happening to them is abuse. Under I-001 even fewer students facing abuse, including child sexual abuse, would seek help from trusted adults at school. We should not force schools to hand over sensitive information about kids to their abusers, but that’s what it does. 

I-001 is so poorly written that it actually removes parents’ rights. As The Seattle Times editorial board pointed out in its opposition to this initiative, I-001 repeals Washington’s parents’ rights laws and replaces them with language taken nearly verbatim from Louisiana. 

The state attorney general’s analysis found that I-001 removes parents’ guarantee of “immediate notification” when their child is a crime victim and replaces it with a much weaker standard of notification. “If a student is the victim of a serious crime at school, parents should not have to wait to find out and any delay could cause further harm to the student,” says former Snohomish County Sheriff John Lovick, now a state senator.

Delayed notification only adds to a child’s trauma and can prevent them from getting immediate help and support from loved ones and professionals. If a student is the victim of a serious crime at school, parents should not have to wait to find out.   

Forcing schools to release students’ counseling and other records puts already vulnerable children in danger of further abuse. While it is understandable that most parents want to know what is happening with their kids in order to help them, the fact is that some parents abuse or kick out their child if they find out they are LGBTQ+. In fact, 40% of LGBTQ+ homeless youth were forced out of their homes because of their identities, putting these youth at higher risk for sexual assault.   

I-001 does the opposite of keeping our children safe. That’s why organizations across the state, including the Washington State PTA, the League of Women Voters, Washington State Nurses Association, more than 100 doctors and medical care providers and Planned Parenthood Alliance Advocates are opposing I-001. 

No matter what your political affiliation, you can protect children from increased risks of harm by voting no on this ill-conceived initiative that would remove vital protections for youth to disclose abuse and get help from trusted adults. 

Roshelle Cleland: is public policy director at the Washington State Coalition Against Domestic Violence and Sexual Assault.

Just hours after after the CEO of the Stonewall National Museum, Archives & Library warned elected leaders against withholding support for institutions like his, Broward County did exactly that.

The resignations came within 24 hours of each other and amidst allegations of censorship by their own party.

> Fear of arrest and stigma are causing people to go into hiding, to avoid HIV testing and treatment, and deterring lawyers from representing them.