Introduction
Transgender health in India remains a critical yet often overlooked issue. Despite legislative
progress, the transgender community continues to face significant health disparities, driven
largely by societal stigma, lack of access to healthcare, and widespread discrimination.
Addressing these challenges is crucial to building an inclusive healthcare system that caters
to the needs of all citizens, regardless of gender identity.
Who Are Transgender Individuals?
Transgender persons identify themselves in a different genderthan that assigned to them at
birth. They are further subcategorized into Trans-woman and Trans-man. Transgender
community includes Kinnar, Hijras, Eunuchs, Kothis, Aravanis, Jogappas, Shiv-Shakthis etc.,
who have been a part of Indian society for centuries.
The Demographics of the Transgender Community in India
Indian Census has never recognized third gender i.e. Transgender while collecting census
data for years. But in 2011, data of Transgender’s were collected with details related to their
employment, Literacy and Caste. In India, total population of transgender is 4,87,803
according to census 2011. The largest transgender communities reside in Uttar Pradesh,
Andhra Pradesh, Bihar, West Bengal, and Tamil Nadu. Despite this large presence,
transgender individuals remain among the most marginalized groups in India. The main
problems that are being faced by the transgender community are of discrimination,
unemployment, lack of educational facilities, homelessness, lack of medical facilities. The
other fields where this community feels neglected are inheritance of property or adoption of
a child. They are often pushed to the periphery as a social outcaste and many may end up
into high-risk professions such as sex work, begging and dancing. A staggering 62% of
transgender individuals are engaged in sex work, which further compounds their health
risks.
Health Problems Faced by Transgender Individuals
Trans people worldwide experience substantial health disparities and barriersto appropriate
health care services that keep them from achieving the highest possible health status.
Among other health disparities, trans people are significantly more likely than the general
population to be targeted for violence and harassment, to contract HIV. The prevalence of
HIV among the Indian transgender population is the second highest across all risk population
groups. Mental health issues are another critical concern, with a significant percentage of
transgender individuals attempting suicide orsubstance abuse. The community also faces
non-communicable diseases (NCDs), nutritional deficiencies, and sexual violence,
particularly those engaged in sex work.
Challengesin Healthcare Utilization
Transgender face discrimination even in the healthcare settings accessing quality healthcare
services, whether general health needs or specific to their gender needs. Often, healthcare
providers rarely had the opportunity to understand the sexual diversities and they do not
have adequate knowledge about the health issues of sexual minorities. Thus, transgender
people face unique barriers when accessing public or private health services. This includes:
inappropriate use of pronouns; verbal harassment by the hospital staff and co-patients; and
lack of healthcare providers who are sensitive to and trained on providing treatment/care to
transgender people and even denial of medicalservices Beyond the discrimination they face,
low health literacy and the absence of health insurance further hinder their ability to seek
care. This lack of access and support leads to poorer health outcomes and contributes to the
cycle of marginalization.
Government Initiatives and Policies
In recent years, the Government of India has launched several initiatives to improve the
status of transgender individuals. In April (2014), India’s Supreme Court recognized
transgender people as ―The Third gender along with male and female. The Transgender
Persons (Protection of Rights) Act, 2019, provided a legal framework for the protection of
transgender rights. In 2021, Ministry of Social Justice and Empowerment launched SMILE
(Support for Marginalized Individuals for Livelihood and Enterprise) scheme which includes a
sub-scheme ‘Comprehensive Rehabilitation for welfare of Transgender persons.’ Initiatives
like the Garima Greh Scheme (2021) under SMILE scheme offer shelter and support for
transgender individuals. Garima Greh’s have been geotagged for the convenience of
transgender community to easily locate the shelter homes across the Country. Also,
inclusion of transgender persons under Ayushman Bharat-PMJAY in 2022 provides free
medicalservices, including sex reassignment surgeries.
Tamil Nadu has been a pioneer in supporting transgender rights. Tamil Nadu was also the
first state to form a transgender welfare board in 2008 with representatives from the
transgender community which provides free sex reassignmentsurgeries, housing, education
scholarships, and income generation programs to transgenders in the state. Kerala, too, has
established a comprehensive transgender policy in 2015 focused on healthcare access,
mental health counselling, and substance abuse treatment. After 2015, 17 states of India
introduced welfare policies for transgender people.
Recommendationsfor Improving Transgender Health
Tackle Stigma and Discrimination: Addressing the stigma and discrimination
transgender individuals face is essential to improving their health outcomes.
Include Transgender Health in Medical Curriculum: Educating healthcare providers
on transgender health needs is key to creating an inclusive healthcare system.
Expand Accessto Transition Services: Public hospitals should offer free or affordable
transition services, with clear national guidelines on transgender health.
Empower Transgender Communities: Ensuring that transgender individuals have
access to accurate health information and services can improve their health-seeking
behaviour.
Increase Research on Transgender Health: More research is needed, particularly
focusing on transgender men and their unique health challenges.
Conclusion
Addressing transgender health is crucial for promoting equity and inclusivity in healthcare.
Ensuring their access to comprehensive and respectful healthcare can reduce health
disparities, improve their quality of life, and promote social acceptance. Moreover,
recognizing transgender health needs is vital for upholding human rights and fulfilling India’s
commitment to universal health coverage for all citizens.
By:
Dr. Mehak Singla
