Why in news?
Discussions around transgender rights have brought gender‑affirming care to the forefront. Activists and medical professionals are urging the government to ensure that transgender and gender‑diverse persons have access to supportive services. Many argue that such care is a necessary part of the right to health and dignity.
Background and history
Gender‑affirming care refers to a range of interventions – social, psychological, medical and legal – that help individuals live in a gender that aligns with their sense of self. Historically, people whose gender identity differed from the sex assigned at birth faced stigma, discrimination and legal barriers. In India, the Supreme Court’s 2014 NALSA judgement recognised transgender persons as a third gender and affirmed their fundamental rights. The Transgender Persons (Protection of Rights) Act 2019 prohibits discrimination and allows self‑identification. However, medical and social support remains limited and often expensive.
Forms of gender‑affirming care
- Social interventions: Allowing people to use names, pronouns and clothing consistent with their gender. Creating safe spaces in schools, workplaces and public facilities.
- Psychological support: Counselling to address stress, anxiety and depression resulting from gender dysphoria and social stigma.
- Medical care: Hormone therapy and gender‑affirming surgeries provided by trained doctors to those who desire them.
- Legal and institutional support: Simplifying procedures for changing gender markers on identity documents and ensuring access to healthcare, housing and employment without discrimination.
Need for gender‑affirming care in India
Studies show that transgender persons have higher rates of depression, anxiety and suicide attempts compared with the general population. Access to gender‑affirming care improves mental health outcomes, reduces self‑harm and enhances quality of life. It allows individuals to participate fully in society and exercise their constitutional rights. International organisations, including the World Health Organization, classify gender‑affirming care as medically necessary rather than cosmetic.
Barriers and consequences of inadequate care
- Limited services: Few hospitals offer gender‑affirming procedures. Waiting lists are long and costs are high.
- Financial constraints: Many trans persons work in the informal sector and cannot afford private healthcare. Public health insurance schemes rarely cover gender‑affirming procedures.
- Policy gaps: The Transgender Act lacks specific guidelines for healthcare providers and insurance companies. Doctors often have little training in gender‑affirming medicine.
- Stigma and discrimination: Trans persons face hostility from families, employers and even medical staff, discouraging them from seeking care.
- Unsafe alternatives: In the absence of safe medical options, some individuals resort to unregulated hormone use or surgeries by unqualified practitioners, risking complications.
Way forward
- Integrate care into public health: Include gender‑affirming services under schemes such as Ayushman Bharat. Create dedicated clinics in government hospitals.
- Training and guidelines: Develop curricula for doctors, nurses and counsellors. Issue standard treatment protocols to ensure safe and ethical care.
- Community partnerships: Engage transgender organisations in designing services, conducting outreach and monitoring quality.
- Policy reform: Simplify legal processes for name and gender changes. Mandate insurance coverage for gender‑affirming procedures.
- Research and data: Collect data on trans health to plan services and measure outcomes.
- Public awareness: Conduct campaigns to reduce stigma and educate society about gender diversity.
Conclusion
Gender‑affirming care is a matter of dignity and human rights. By integrating it into the public health system and addressing social prejudice, India can ensure that transgender persons lead healthy and fulfilling lives.