Opinion How India can become the vishwaguru for transgender healthcare
Under Trump 2.0, there has been an unprovoked assault on transgender rights in the US. The world is looking to India's healthcare systems to provide affordable and dignified services for transgender peoples
A special health camp organised for transgender people in Pune. (Express file photo by Arul Horizon) 
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A primary agenda of the Trump administration is the erosion of transgender rights. Soon after taking office, the US president issued an executive order declaring that the federal government would recognise only two sexes — male and female — as unchangeable, impacting federal IDs like passports. Another executive order banned federal funding for gender-affirming care for transgender individuals under 19 years of age, depriving them of vital life-saving services such as puberty blockers and hormone replacement treatments. Trump also reinstated a ban on transgender individuals serving in the military and on transgender women and girls from participating in women’s sports in federally-funded schools. He even mandated that transgender individuals be housed in detention according to their sex assigned at birth, posing significant risks of physical and sexual violence.
As if this didn’t cause enough damage, USAID operations, a strong supporter of many transgender healthcare initiatives, including in India, have been shut down pending review, leaving many transgender employees jobless and beneficiaries of these services helpless without an alternative. This change has had global repercussions. In India, the Mitr Clinic, supported by USAID and serving hundreds of transgender clients with essential services like mental healthcare and transition-related medical services, has been shut down. The US, once a global leader in transgender rights and healthcare, has suddenly become a dangerous place for transgender people to live in and access healthcare.
This development is undoubtedly disastrous. Within this tragedy, however, lies an opportunity for India. Transgender rights in India are legally protected, thanks to the 2014 NALSA vs Union of India judgment and the Transgender Persons (Protection of Rights) Act of 2019. India is one of the few countries that legally recognises more than two genders. The law mandates anti-discrimination measures in education, employment, housing, and access to public spaces and offices for transgender persons. It also supports transgender individuals seeking sex reassignment surgery, promising at least one government hospital providing these services per state. A couple of years ago, Ayushman Bharat announced the Ayushman Bharat TG Plus card, offering a package of Rs 5,00,000 per person for transgender individuals to access any inpatient medical care, including gender-affirming services. It, however, is yet to be implemented.
While Indian doctors are considered among the best in the world, the provision of transgender-friendly services in India remains sub-optimal. Much of this stems from the lack of transgender care competencies in medical and healthcare professional courses. On the insistence of the Madras High Court, the National Medical Commission removed homophobic and transphobic content from medical curricula and included some LGBTQIA+ competencies. A Centre of Excellence for Transgender Healthcare has been initiated at AIIMS, New Delhi. Still, the number of gender affirmation surgeries happening in our public healthcare system is just a handful, while the private sector is inundated with demand for the same by a growing pool of clientele who need these life-saving services and are willing to pay for them. Contrast this with Thailand, which performs one of the highest numbers of transgender surgeries in the world. There is no reason why India cannot become a hub for such procedures.
India boasts of a cultural and societal acceptance of sexual and gender minorities, a constitutional and legal framework for providing transgender healthcare services, a strong network of community-based organizations advocating for transgender health and rights, capable doctors who can be trained in providing highly skilled services, a burgeoning private healthcare sector, and a friendly medical tourism policy.
As the US and some European countries impose restrictions on gender-affirming services, the world is looking to India for its healthcare systems to rise and shine in providing quality, affordable, and dignified healthcare services for transgender individuals. In this challenging time, with anti-trans legislation being enacted in many countries, India can be a beacon of hope for transgender individuals seeking affordable and quality healthcare.
To make this possible, we need strict implementation of the Transgender Persons (Protection of Rights Act) 2019 and Rules 2020, inclusion of transgender healthcare services in medical curricula, training of in-service doctors in highly specialised transgender surgeries, professional guidelines for providing these services, a conducive medical tourism policy catering to transgender clientele, strengthening of services in the public healthcare system including the Ayushman Bharat TG Plus scheme, and improved passport, visa, and document-change policies. The budget for transgender issues in India has been dismally low and needs a significant increase, with an enhanced role for the health ministry to cater to the healthcare needs of transgender people.
The time has come for India to put its policies into action and create an ecosystem that cares for transgender persons who need life-saving gender affirmation services. With proper policy and action, India can truly become a vishwaguru for transgender healthcare.
The writer is associate professor, Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Delhi
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