Revisiting Transgender Healthcare system in India

What is normal and what is not, is always pre-defined by the society and whoever doesn’t come under the banner normal are often rejected from getting incorporated in the society. Gender identity is what holds preferential importance in the community and whoever do not correspond to the sex assigned at birth is looked at differently in the public. Elaborately stating, these people who falls under Transgender group has much less freedom in every aspect even in the field of healthcare system.

Transgender forms a part of gay, lesbian, queer community along with those who were assigned as male and now are female and vice versa. In India, its not easy to make a estimation of third gender group due to societal stigma, but in 2011 census for the first time laid an estimation of trans population nearly about 4.8 million. India has a long history when it comes to transgender people, as before 2011 there were a lot of atrocities committed to this community. Them getting recognised as human beings is a relatively new conception and it quite obvious their healthcare facilities aren’t much accessible yet. This is a huge problem; it can be stated that they constitute a much part of the population in India and even outside and it might have a negative impact.

The transgender community in India, also known as Hijras, Aravanis, or Jogappas, has existed since the dawn of civilization. They held significant ceremonial and spiritual functions and were historically recognised as a separate gender category. Discrimination, stigmatisation, and marginalisation, however, are now commonplace in modern society. Different manifestations of this prejudice include denying access to school, having few job possibilities, and receiving poor healthcare. They frequently hesitate to get the appropriate medical care because of the stigma associated with their gender identification.

In India, the legal system governing transgender healthcare and rights has seen considerable changes in recent years like the NALSA decision where transgender community’s fundamental rights were constitutionally protected while acknowledging them as ‘third gender’ under India law. Followed by this, there was another Transgender Persons (Protection of Rights) Act, 2019 which fully uphold the welfare, defend the rights of transgender people, and outlaw discrimination against transgender people. Despite recent legal developments, transgender people in India still don’t have full legal protections or acknowledgment. Transgender people are increasingly being marginalised and are unable to get healthcare due to a lack of sufficient legal recognition.

Transgender people in India experience major healthcare disparities, which are frequently caused by stigma, discrimination, a lack of knowledge among healthcare professionals, and exclusionary healthcare legislation. These obstacles prevent them from receiving high-quality medical care and worsen their current health disparities. Transgender people frequently experience stigmatisation in the healthcare industry as well as other facets of their lives. Healthcare practitioners may refuse to serve transgender patients, treat them disrespectfully, or even physically abuse them as a result of negative attitudes, biases, and prejudices. This ultimately might lead to a hostile environment deterring transgender people from obtaining necessary medical care.

There was a case shared by the founder of Civilian Welfare Foundation where it was a herculean task for the doctors to admit a transgender individual to a male or female ward who met with a train accident. This shows the reality of the backwardness of the facility provided at the hospital. At another incident there were a trans woman, namely Anushri Banerjee, 22 year old, was gang raped and even faced with neglected behaviour at the hospital. Due to this, many trans people hide their identity like in one case there was a trans who hide her identity to get treated for her kidney ailment. Besides this there was a study stated that the Trans people are more vulnerable to HIV, but they do not get access to adequate and appropriate medical facilities. One of the main reasons of this is the medical professionals not having enough idea or education on this particular aspect. Like in another case, a trans after being gang raped was asked by the doctor that how can she even be raped and failed to prescribe HIV prevention medication after such unsolicited questions. In several cases doctors simply deny even to examine trans community people besides not having separate ward for them.

There are even cases where it was seen that instead of doctors themselves, nurses were compelled by doctors to write a prescription for transwomen. In one study conducted by Hamsafar Trust found that many doctors were not comfortable touching transgender patients and maintained minimal contact with them. Along with this, doctors have a very wrong perception about trans community sleeping with several partners. Moreover, they are vulnerable to double discrimination from the doctors if for real they tests positive for HIV. Like in a case, transwomen namely Aher had fallen prey to taunts not only from doctors for testing positive for HIV but also from male who pass sexual comments and female wards in hospitals who feel disgusted to have trans people around them. Chairperson of Chennai based research agency centre for sexuality and health research policy stated that while a transwomen undergoing sex change operations are was forced to dress up like man simply for admitting in the male ward.

In addition to this, there are many healthcare professionals who are unaware of the health issues relating to transgender people. They might not have received the necessary training on the unique healthcare requirements and difficulties that transgender people encounter. On top of this, many healthcare systems do not clearly recognise gender identity, lack gender-neutral restrooms, gender-inclusive intake forms, which prevents them from providing tailored interventions and inclusive healthcare services. The lack of transgender-specific healthcare options in rural areas and smaller towns further exacerbates the discrepancies in healthcare that transgender people have to cope with. Due to this, even during pandemic of 2019, transgender community received minor attention, thereby vaccination wasn’t for them. It is unfair as they too are human beings and are also in proportionate number but still research on medical health and care regarding them is lagging. Moreover, it is stated that they are more vulnerable to HIV aids than common people but yet they do not get appropriate medical facility even on this particular issue.

To deal with such healthcare disparities, important steps needed to be followed. Like Educating healthcare workers on transgender healthcare which is essential for fostering inclusive workplaces. Topics like transgender lingo, gender identity and expression, healthcare inequities faced by transgender people, mental health issues, and the provision of gender-affirming care should be included in this course. Furthermore, transgender people frequently have special healthcare requirements, such as undergoing gender-affirming operations and treatments. By providing comprehensive transgender healthcare, including hormone therapy, gender-affirming procedures, mental health assistance, and preventive care specifically for transgender people, healthcare professionals can ensure accessibility. Gentle care is important too on the side of healthcare workers while dealing with the problems of transgender community as they feel safe to seek medical care only when they are accepted in their surroundings.

Government here has a very crucial role to play. They must look into the implementation of all the policies it gave sanction to. Indian government must provide sort of insurance coverage for hormone therapy, gender-affirming surgeries, mental health support and other related healthcare services. Also, it must look into boosting of legal protections where transgender people won’t be getting discriminated as in spite of laws on this aspect, discrimination still persists among this community. Along with this support organisations and non-governmental organisations (NGOs) are essential in providing healthcare and advocating for transgender people. They can help patients navigate the healthcare system and speak up for their needs and rights when they are in a medical setting.

In conclusion, there are severe gaps in health care for transgender people in India that need to be immediately addressed. We can start to remove the obstacles that prevent transgender people from receiving high-quality healthcare by putting the suggested initiatives, such as education and sensitization, policy changes, gender-affirming care, and community participation, into practise. Accessible and inclusive healthcare benefits both individuals and society as a whole, and it is not just an issue of human rights. It produces better health results, higher wellbeing, and a society that is more egalitarian. It is up to us all to push for change, raise awareness, and work towards a healthcare system that accepts and caters to the various requirements of every person, regardless of gender identification. We can only succeed with coordinated efforts.

References:

Datta, Sayantan. “Trans and Queer people in India should demand better health care.” Scientific American. July 21, 2021. Trans and Queer People in India Should Demand Better Health Care – Scientific American

Nikharthil, Deepak. “India’s healthcare systems persistently exclude LGBTQ+ people. This needs to change.” The Wire. October 31, 2021. India’s Healthcare Systems Persistently Exclude LGBTQ+ People. This Needs To Change. (thewire.in)

Shaikh, Aqsa. and Raghuram, Harikeerthan. “Discrimination against transpersons plagues India’s health care system. Its time to overhaul it.” Forbes. January 7, 2022. Gender Bias: Discrimination Against Transpersons Plagues India’s Health Care System. It’s Time To Overhaul It: Aqsa Shaikh, Harikeerthan Raghuram – Forbes India

Bansal, Govind. “making trans-gender healthcare a priority in India- journey towards social inclusion.” ResearchGate Vol 32, issue no 02 (June 2020): 324-329. DOI:10.47203/IJCH.2020.v32i02.004

Cicero, Ethan. “healthcare experiences of Transgender adults: an integrated mixed research literature review.” National Library of Medicine 42(2) (April 2020): 123-138. doi: 10.1097/ANS.0000000000000256

Adrika Sengupta

Intern, Asia in Global Affairs.

The originality of the content and the opinions expressed within the content are solely the author’s and do not reflect the opinions and beliefs of the website.