Gender identity is a perception of one’s own internal sense or innate knowledge of gender that is determined by the individual alone. The individuals whose gender identity differ from the physical sex assigned at birth are known as transgender individuals. Transgender has evolved into an umbrella term covering trans men, trans women & some identifying as neither male nor female, or both, often described as non binary or genderqueer. There are many other different ways to categorise transgenders. Despite the presence of non conforming gender identities for antiquity, transgender individuals face multiple forms of oppression and discrimination in society.
There is a looming misconception that trans health refers only to the health concerns involving anatomical conditions. According to WHO, health is a state of complete physical, mental, and social well-being and not merely the absence of a health condition. Not only an undistorted access to holistic healthcare but also socio economic determinants of health such as entitlement to legal protection, public awareness, enhanced capability through education and employment come under the purview of trans health. This essay focuses on status of transgender community through the lens of healthcare.
Inclusive Transgender Laws and Economic Development
The Supreme Court Nalsa Judgement of 2014 ruled that transgender individuals have the right to recognize themselves as male,female or the third gender and enjoy all the fundamental rights. Further, the Transgender Persons (Protection of Rights) Act, 2019 prohibits discrimination against transgender in different areas including healthcare – ‘the denial or discontinuation of, or unfair treatment in, healthcare services’(Ministry of Law and Justice, 2019). Recognition of rights is a crucial step towards an inclusive society but not much has changed for the marginalised group on the ground.
Globally, to evaluate the relationship between LGBT inclusion and economic development, a quantitative indicator “Global Index on Legal Recognition of Homosexual Orientation” (GILRHO) has been developed. (Badgett M, Rodgers Y, Waaldijk K, 2019) The regression analysis reveals a clear positive relationship between the legal index and per capita GDP globally for the full sample of 132 countries for 45 years. According to the findings, on average, a country has $2065 more in per capita GDP for each additional index point(additional human right) of the GILRHO. The theoretical underpinnings behind the research includes human capital approach, capability approach, post materialist values and strategic modernization.
Socio – Economic Identity
Most of the transgender individuals are trapped in a vicious cycle of discrimination and deprivation. The community is largely excluded from society and as a result, from economic opportunities. According to a study conducted by the National Human Rights Commision, 92 percent of transgenders are deprived of the right to participate in any form of economic activity in the country. They are excluded from getting proper education, about 50-60% have never attended school. 96% of transgenders are denied employment opportunities. Some of them are rejected despite being qualified. This forces them into acute poverty and engagement in sex work, begging or other low paying jobs as a means of livelihood consequential to unacceptance of gender incongruent behaviour. In India, it is estimated that upto 1.7% of GDP is lost in one year due to bigotry and exclusion of LGBT community. The loss of labour productivity and output because of employment discrimination and the loss of life years due to early death, disability, improper healthcare could generate costs of up to US$ 31 billion.
Health Issues and Associated Barriers
The socio-economic status of transgenders debars them from accessible, affordable and indiscriminate healthcare. Transgender individuals are 49 times more prone to contracting HIV than others. Engaging in unsafe sex work makes them more susceptible to STIs. They are recognised as a ‘core high risk group’ with 8.82% HIV prevalence rate by India’s National AIDS Control Organisation(NACO). Their treatment gets delayed due to multiple factors. There is a severe lack of awareness related to STIs. The ones who do seek health services face multiple challenges. One is lack of medical professionals with adequate knowledge of sexual diversities. Discrimination by health providers deeply impact their mental health. Some common instances are deliberate use of male pronouns for transgender women, verbal abuse and harassment by staff and hesitation of other patients to get treatment at the same place as transgenders.
Many transgender individuals seek Sex Reassignment Surgery(SRS). Unfortunately, the public hospitals largely fail to provide such facilities. Only a few hospitals in Tamil Nadu and Kerala have emerged by setting up clinics exclusively for sex change surgeries and trans health. These services are provided at an affordable rate. However, most of the transgender individuals find only private care accessible, nevertheless unaffordable . As SRS is a cosmetic surgery, it also falls outside the purview of insurance policies that may reduce costs. As a result they resort to alternatives like castration (chemical or surgical removal of sex glands) which may cause complicated health problems.
Access to acceptable healthcare is a fundamental right of every individual. The root cause of absence of healthcare catering to the needs of transgender community is layers and layers of stigma. STDs, sex work and transphobia lead to double or triple stigmatisation. It robs them of their capabilities, leaves them financially weaker and marginalised thereby making access to even general healthcare services a far fetched idea for most of the community. Poor socioeconomic status is a major barrier to enrollment in health insurance schemes. They lack awareness and ability to pay premiums as a consequence of exclusion from education and employment opportunities.
Progressive Steps
Steps must be taken in the direction of empowerment of transgender community by building more inclusive institutions. Medical training must transcend the binary sex system. As medical professionals get equipped with understanding mental and physical needs of transgender individuals, it will normalise treatment procedures. Social welfare schemes must be introduced addressing the needs and providing a safety net to the community. States like Odisha, Manipur, Kerala, Maharashtra, Chandigarh, and Chhattisgarh have formulated welfare policies and schemes for trans-persons which include free SRS facilities in select government hospitals and HIV sero-surveillance clinics to address sexual health needs of trans people.
However, Kerala is the only state, which has implemented a comprehensive transgender policy after conducting a survey to map the issues of trans people in the state. It sets an example for other states to adopt policies and procedures for indiscriminate health access to the community. Equity in healthcare cannot be achieved by targeting the health practices alone. The path to inclusiveness in society involves all aspects of development like gender rights, schooling and employment. Moreover, as the economic costs of transgender prejudice are huge, it becomes imperative to target equity in education and employment opportunities by creating awareness, provision for social entitlement, liberal credit facilities, establishing helplines for guidance etc.
Tanya Gautam, is a third-year student of Economics at IP College for Women, DU.
References
- Badgett M, Rodgers Y, Waaldijk K, (2019) The relationship between LGBT inclusion and economic development: Macro-level evidence. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0305750X1930069
- Desai, R., (2019) What a Transgender‑Friendly Health Care System Would Look Like. Retrieved from: https://theswaddle.com/what-a-transgender-friendly-health-care-system
- National Human Rights Commission, (2018), Country assessment on human rights in the context of sexual health and reproductive health rights. Retrieved from: https://nhrc.nic.in/sites/default/files/sexual_health_reproductive_health_rights_SAMA_PLD_2018_01012019.pdf
- Sethi, S., Barwa, M. (2018), Transgender health and their rights in India. Retrieved from: https://www.researchgate.net/publication/328718852_Transgender_Health_and_Their_Rights_in_India
- UnAids, (2014), The economic costs and development impact of exclusion of LGBT people. Retrieved from: https://www.unaids.org/en/resources/presscentre/featurestories/2014/march/20140314homophobia
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