Once in the provincial capital, the non-binary person from Montreal set up camp in a park near the Régie de l’assurance santé du Québec and hasn’t eaten since.

Alexe Frédéric Migneault is on hunger strike to pressure the RAMQ to include the “X” option for the third gender in Quebec’s health insurance cards. This is the culmination of more than two years of effort to create an alternative to the traditional “M” or “F” identifiers for men and women.

“I will strike to show them that it is urgent, that we cannot wait forever,” Alexe Frédéric Migneault said by phone. I would encourage them to act as quickly as possible.”

Adding the “X” designation would be more than just a gesture and, in his opinion, would help protect members of Quebec’s non-binary community and ensure medical records reflect accurate information. “It’s a health issue, physical health, mental health, (for) the entire community involved.”

Although Quebec began allowing non-binary gender markers on birth and death certificates last year, the Régie de l’assurance santé has not yet implemented this option on its cards, which are required to access publicly funded health care.

In addition to the “M” and “F” symbols on the cards, the Régie includes a code corresponding to the gender of Quebecers in the unique numbers of its health card.

In a press release, RAMQ said its health insurance cards and numbers are critical to ensuring that diagnoses, treatments and care are “assigned to the right person.” She added that Quebec’s Health Ministry is currently analyzing the implications of introducing a third gender designation in the province’s health and social services network.

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This is the fourth time that Alexe Frédéric Migneault has gone on hunger strike to force progress on this issue. His last strike in September ended when the Health Ministry confirmed it would eventually introduce the option of gender “X”.

This time, Alexe Frédéric Migneault has no plans to call off his strike until his health insurance number is changed and his health insurance card does not indicate “X” as his gender.

Water, sports drinks and vegetable broth are his only foods.

Transgender activist Céleste Trianon says Quebec is the only province that does not issue gender-inclusive identification documents. She says she has been in contact with Alexe Frédéric Migneault and has been following his efforts for almost two years.

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Other provinces allow non-binary gender markers on driver’s licenses, health insurance cards or government-issued photo IDs. Since 2019, the federal government has offered the “X” option for citizenship certificates, passports, permanent residence cards and other travel documents.

Ms Trianon says the designation is an essential element of recognition for non-binary people and its absence leads to discrimination.

“All Canadians have an identity,” said Céleste Trianon. All Canadians deserve to be able to assert their identity, not the one the government forces on them.”

The Quebec Secretariat for the Status of Women says the RAMQ participates in an interministerial committee responsible for creating guidelines on gender and sexual characteristics for provincial government agencies. The Secretariat, which oversees that committee, says guidance will be available soon, but has not given a date.

“I think the only real obstacle we face right now is indifference,” said Alexe Frédéric Migneault.