Response of Health Care System with regard to Gender Diversity & Intersectional Marginalities

Session Report 
Tanu Paliwal

A Four Week Online Certificate Training Course on Healthcare & Gender Equity: Emerging Dimensions, Policies, Impact & Way Forward was organized by the Gender Impact Studies Center (GISC), at the IMPRI Impact and Policy Research Institute, New Delhi and Center for Ethics (CFE), Yenepoya (Deemed to be University), Mangalore.

Day 3 of the event our last speaker Dr Aqsa Shaikh, Associate Professor, Community Medicine, Hamdard Institute of Medical Sciences & Research, New Delhi, delivered a presentation on “Response of Health Care System with regard to Gender Diversity & Intersectional Marginalities”.

Gender Diversity and Health

Dr. Aqsa Shaikh initiated the session by shedding light on the often overlooked issue of violence against men within homosexual relationships. Addressing the broader concept of gender diversity, she underscored the societal debates surrounding various aspects such as trans people in sports, gender reassignment surgeries, and the reservation for trans individuals.She emphasized the prevalent lack of understanding in society, leading to fear, judgment, and the manifestation of transphobia and homophobia.

Highlighting the intersectionality of gender identity, Dr. Aqsa emphasized that trans individuals face multiple layers of marginalization, including factors like religion, caste, and tribal identity. The discussion delved into the intricate connection between gender identity, sexual characteristics, sexual orientation, and healthcare provision. Drawing a distinction between trans and intersex individuals, she elucidated the healthcare interventions that often commence in the lives of intersex persons.

She advocated for recognizing the diversity within the trans community, dispelling stereotypes, and acknowledging the varied gender identities beyond the binary classification of men and women. While discussing the numerical representation of trans individuals, she pointed out the challenges in obtaining accurate census data, emphasizing the need for visibility in official records to allocate resources effectively.

She touched upon the educational challenges faced by trans individuals, with highlighting the high probability of bullying and abuse when entering schools. This often leads to limited educational opportunities, pushing many into traditional professions or marginalized roles. She chronicled the legal milestones in India’s recognition of trans rights, including the landmark NALSA judgment, the reading down of Section 377, and subsequent acts addressing trans issues.

Despite legal advancements, the pervasive challenges within the healthcare system got highlighted . The diverse landscape of healthcare providers, including registered medical practitioners, unregistered practitioners, and spiritual healers were discussed . Issues like conversion therapy and unethical practices still persist, presenting challenges for regulatory bodies like the National Medical Commission.

Dr. Aqsa critically examined the healthcare system’s response to trans individuals, shedding light on the lack of regulation for gender-affirming surgeries and the absence of standardized operating procedures. She narrated instances of trans people seeking medical interventions from unregistered doctors, leading to disastrous consequences, and emphasized the need for regulating bodies to oversee gender-affirming surgeries.

The discussion expanded to societal perceptions affecting trans individuals’ access to healthcare. Detailed the barriers faced by trans people in seeking healthcare facilities, including stigmatization, body image issues, and the lack of awareness. Mental health concerns within the trans community were also emphasized, the shortage of trained professionals in trans-inclusive healthcare got pointed out.

She highlighted the dearth of affordable healthcare options in rural areas, emphasizing the urban-centric availability of specialized services. The challenges continued into gender-affirming surgeries, with cases of unfortunate outcomes and a lack of regulating bodies overseeing the procedures. Dr. Aqsa presented a comprehensive picture of the complex issues surrounding trans individuals’ healthcare, touching on legal, societal, and medical dimensions.


Towards the conclusion, Dr. Aqsa proposed steps to address these challenges, including the need to decriminalize trans individuals, depathologize gender identity, revise blood donation guidelines, and demedicalize certain surgeries. She advocated for the creation of a medical board to evaluate the necessity of gender-affirming surgeries and stressed the importance of including gender-affirming care in essential healthcare services.

The session concluded with a question-and-answer round, highlighting the importance of ongoing discourse, legal advocacy, and policy changes to create an inclusive and equitable healthcare system for trans individuals.

AcknowledgementTanu Paliwal is a research intern at IMPRI.

Read also : Gender Implications of Health Policies 

Breaking Barriers: Integrating Gender Perspectives in Medical Education