No, one Centre of Excellence in Transgender Care is not enough

Transgender people are legally guaranteed equal access to healthcare. Yet, it is denied.

Written by Aqsa Shaikh

The All India Institute of Medical Science (AIIMS), New Delhi, recently announced its plans to open a Centre of Excellence for transgender healthcare in 2024. Transgender people have been historically discriminated against and marginalised — pathologised and labelled mentally diseased. They have been subject to unscientific and inhuman practices like “conversion therapy” by medical practitioners. The community lacks access to healthcare because of structural barriers like exclusionary infrastructure, lack of services and trained and sensitised healthcare workers.

The community was first given legal recognition in India in NALSA v Union of India (2014). The Supreme Court endorsed their rights as fundamental rights. The judgment directed central and state governments to ensure medical care for transgender people and cater to their mental, sexual, and reproductive health.

In 2019, Parliament enacted the Transgender Persons (Protection of Rights) Act that re-emphasised the role of governments in holistic healthcare services to the community — providing sex reassignment surgery, hormone therapy, counselling services, HIV sero-surveillance and mental health services. It also asked for a review of the medical curriculum and medical research that caters to transgender persons. Most importantly, it called for facilitating trans peoples’ access to hospitals and healthcare institutions.

The Transgender Persons Rules, 2020 added that state governments shall ensure the provision of separate wards and washrooms for transgender people in hospitals by 2022. It asked states to undertake the sensitisation of healthcare professionals and directed the publishing of an equal opportunity policy and notification of a complaint officer by every establishment. It also suggested that at least one government hospital in a state should provide safe and free gender-affirming surgery and related services.

Transgender people are legally guaranteed equal access to healthcare. Yet, it is denied.

State policies in primary and secondary healthcare have made no effort to ensure access for the community. Mental healthcare continues to be dominated by tertiary institutes that have failed to provide for gender-diverse people. When it comes to gender-affirming procedures, some private providers have stepped in to tap into the lucrative market of sex reassignment surgeries but government hospitals, including AIIMS, have largely stayed away. Under such circumstances, the plan to open a Centre of Excellence at AIIMS-Delhi is a welcome step. It, however, would fulfil some needs of some transgender people and should not be considered a panacea for all ills.

The Transgender Act makes it mandatory for a transgender person to undergo surgery to change their gender within the binaries of male and female. This is in contravention of the NALSA judgment, which states that any insistence on sex reassignment surgery for declaring one’s gender is illegal. There is a misplaced focus on tertiary care and surgical procedures. This is pushing transgender people to undergo surgery to get a binary gender marker. Certain documents in India, such as the passport, still do not have the provision of transgender as a gender marker. The aim should be to cater to felt needs for surgery rather than coercing people into it to gain legal recognition.

One centre cannot cater to the needs of transgender people across India. All government medical colleges and hospitals in India should provide gender-affirming services. This must be in addition to quality, inclusive, and accessible primary and secondary healthcare. Institutions aiming to be Centres of Excellence must comply with legal necessities like transgender-inclusive wards, washrooms, equal opportunity policy, and grievance mechanisms. The medical curriculum needs revision to serve the needs of gender-diverse people. We need more Centres of Inclusion providing essential healthcare at grassroots levels than Centres of Excellence at premier institutes.

The writer is associate professor, Department of Community Medicine, Jamia Hamdard

Courtesy : TIE

Note: This news piece was originally published in theindianexpress.com and used purely for non-profit/non-commercial purposes exclusively for Human Righ