Ekta Arora
The term “transgender” is used to describe individuals whose innate sense of one’s gender, expression, or behaviour is not in alignment with the sociocultural expectations emerging from the gender assigned to them at birth, legally and medically. [1] The term “AFAB” is an acronym meaning “Assigned Female at Birth”; it describes individuals who were assigned female at birth based on certain characteristics of their bodies at birth.
While discrimination against transgender and AFAB individuals is prevalent in many facets of their lives, it is especially evident in the medical field. Organisations and medical professionals lack awareness and inclusivity. The cisgender binary narratives that underpin healthcare and policy frameworks overlook those who don’t readily fit in. This exclusion may negatively impact the health and general well-being of transgender and nonbinary individuals.
Understanding Health Concerns
Transgender people require specialised healthcare services in addition to regular health examinations. Many people seek gender-affirming services to feel more at ease in their bodies; however, a lack of insurance coverage and limited access to specialised care can make it difficult to obtain appropriate care. Transgender people are also more likely to contract HIV and other sexually transmitted diseases because of the frequency of sex work in their communities.
Furthermore, there is a higher prevalence of mental health disorders; transgender people face higher rates of discrimination and violence, increasing the risk of substance misuse and suicide. Regular health examinations are also a hassle since institutions are often not equipped or knowledgeable about transgender health needs and may not provide culturally competent care.
Difficulties in Accessing Care
Medical institutions often segregate spaces such as restrooms and registration forms based on binaries, which do not easily accommodate people who do not fit within those traditional gender categories. This gives birth to a system of cisnormativity that refuses to include trans people. Trans women have reported facing sexual harassment by the medical staff; some have even been denied care altogether.
A report of the 2015 National Trans Survey clearly states that more than 33% of transgender individuals reported at least one incidence of harassment by a healthcare provider in the prior year. [2] Many individuals report experiences of harassment by non-medical personnel, such as ward boys, security guards, other patients, and visitors. This discrimination and harassment can lead to transgender individuals avoiding seeking necessary medical care and resorting to home remedies and other alternative treatments. This can ultimately result in worsening health outcomes and increased healthcare disparities within the transgender community.
With regard to gender-affirming procedures, many people find it difficult to access these procedures due to their high costs. Doctors who specialise in sex reassignment surgery are frequently found in private hospitals. “The cost of SRS in private hospitals reportedly ranges from Rs 2 to Rs 8 lakh depending on the procedure. This does not include pre and post-operative care. The few public hospitals that provide such procedures do so only after considerable delays and there are issues of quality healthcare, several people told.” [3] Some also report being charged higher consultation fees, which adds to the overall financial burden of seeking gender-affirming procedures. Additionally, the lack of insurance coverage for these procedures further limits access for many individuals.
Cisnormative Medical Education
The discomfort experienced by trans people stems not only from the failure of individual medical practitioners but also from the failure of a system designed to neglect a group. Training programs and medical curricula often do not include transgender bodies and health. Doctors and other medical personnel are not sensitised or educated on the unique health needs of trans individuals. Many transgender people feel compelled to constantly educate doctors about their bodies, even though doctors are expected to have prior knowledge. When
treating transgender women, medical personnel disregard the gender-sensitive practices offered to cisgender women, resulting in feelings of discomfort and even harassment. This lack of education and sensitivity can lead to misdiagnosis, inadequate treatment, and overall poor healthcare experiences for transgender individuals. It is crucial for medical professionals to receive comprehensive training as well as awareness sessions on transgender health to provide quality care for all patients.
Government Policies Addressing Trans Healthcare
The Transgender Persons (Protection of Rights Act), 2019, meant to safeguard the rights of transgender individuals, has garnered significant criticism since its implementation, especially its provision for “certification of identity.” Under this, trans people are required to submit an application to their district magistrate, who will then issue a “transgender identity card.” Critics of this act contend that it undermines the principles of self-identification advanced by its predecessor, the NALSA judgment. The other medical benefits extended by the act are thus often accessible only by those who obtain this card, wrapped in the web of red tape. Regarding other medical benefits, like revising the medical curriculum or including provisions for gender-affirming surgeries in more hospitals, they remain severely under-implemented.
Another governmental policy, Pradhan Mantri Jan Arogya Yojana (PM-JAY), the largest health assurance scheme, aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalisation. It also stated that this scheme would cover transgender people, assisting with the costs of gender-affirming procedures. The problems with the “certificate of identity” also pose a barrier to accessing the benefits of this insurance scheme.
This scheme’s implementation for these procedures has also proven inadequate; it has faced issues with delayed claim settlements and low reimbursement. Furthermore, the budgetary allocation for trans people within this scheme is also disproportionate. Despite small appropriations, much of the funds earmarked for transgender assistance go unused. Between 2021 and 2024, just roughly 11% of the allocated funds were used.” [3] This lack of proper utilisation of funds highlights a systemic issue in the allocation and distribution of resources for transgender individuals. Policymakers must address these inefficiencies to ensure that all members of the community can access necessary healthcare services without unnecessary financial burdens.
References
- Monro S. Non-binary and genderqueer: An overview of the field. Int J Transgend 2019;20:126–31
- James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M.About the National Center for Transgender Equality[Internet]. 2016. Available from: https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf.
- https://www.health-check.in/health/ayushman-bharats-broken-promise-to-indias-transgender- community-950562
- Raghuram H, Parakh S, Tugnawat D, Singh S, Shaikh A, Bhan A (2024) Experiences of transgender persons in accessing routine healthcare services in India: Findings from a participatory qualitative study. PLOS Glob Public Health 4(2): e0002933. Available at: https://doi.org/10.1371/journal.pgph.0002933
- Dipika Jain, 2022, Right to Health and Gender-Affirmative Procedure in the Transgender Persons Act 2019 in India, Available at:
https://www.thieme-connect.de/products/ejournals/html/10.1055/s-0042-1749137 - Padmanabhan P. A Transgender Woman’s Death, and the Need for Urgent Revamp of Sex Reassignment Surgery. New Click. 2021 . Available at: https://www.thenewsminute.com/article/anannyah-s-story-isn-t-new-kerala-lacks-support-trans-pe rsons-undergoing-surgery-153592
About the contributor: Ekta Arora is a fellow at LPPYF Law and Public Policy Youth Fellowship 5.0 Fellow at IMPRI and is a student of political science at the University of Delhi. With a focused academic trajectory in public administration and public policy, she is particularly interested in how governance structures and institutional design shape the lives of people, especially those historically excluded from power.
Disclaimer: All views expressed in the article belong solely to the author and not necessarily to the organisation.
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Acknowledgment: This article was posted by Bhaktiba Jadeja, visiting researcher and assistant editor at IMPRI.
