The trans and medical communities have a long, convoluted and not always friendly history.
Their relationship was further complicated when, amidst persistent protests from the trans community and various revisions, the Transgender Persons (Protection of Rights) Bill, 2019 was passed by the Lok Sabha on Monday, 5 August.
The Bill proposes to cement unalienable rights for trans people, and while this is a much needed step forward in inclusion one does wonder if the lack of clarity in the bill will render it simply a paper tiger (at best).
So What Does the Bill Promise for Healthcare?
First, the Bill explicitly prohibits discrimination in healthcare (among other aspects of life) but critics have long said that the Bill does not provide punitive/penal specifications on how it intends to do this.
It does, however, add that it is the government’s responsibility to provide health facilities to transgender people, “including separate HIV surveillance centres, and sex reassignment surgeries,” according to PRS Legislative Research.
For eons, medical institutions have studied the world in black and white, in strict binaries and seen those as fact. Simultaneously, our social world evolved and trans, non-binary and LGBTQ+ voices were heard more and so our definitions of gender, sex, sexual and gender expression blossomed beyond rigid binaries.
Re-education on trans bodies and their medical rights is something the community has been stressing, and it seems the Bill may have taken cognisance of this.
It reads that the government “shall review medical curriculum to address health issues of transgender persons, and provide comprehensive medical insurance schemes for them.”
There would also be a National Council for Transgender persons (NCT) that stresses social justice and health, with a union minister and minister of social justice, a secretary for social justice and other ministers. It will also have five members from the transgender community and five experts from non-governmental organisations.
Beyond the Surface: Much Left Unclear and Unaddressed
As a cis person, a lot of these measures taken seem to make big strides in the right direction.
Speaking to Ray, a trans person and law student friend of mine, quickly blew that illusion out of the window.
For example, of the NCT, she told me, “Many of the provisions in the Bill are interlinked and since health is a state subject, it only makes more sense to have State Commission on Transgender Persons in each state that is monitored or brought under the purview of the National Commission on Transgender Persons (instead of a Council as is there in the bill, which doesn't have much powers).”
“The Trans Bill talks about access but not free access to gender affirming medical care/procedures.”Ray
For a trans person getting a gender-affirming medical service, there is stigma, lack of access and often debilitating expense involved. Not addressing the issue of cost belies the fact that the trans bill does not acknowledge critical issues for the community.
On a deeper dig into the Bill, it seems to lack in clarity. For example, there isn't any single protocol for the medical community on trans healthcare as a whole.
The Bill needs to have clauses that include trans people in every sphere of healthcare, from re-drafting policies to ensuring sensitisation of all doctors. For example, Ray adds that, “The talk about medical care in the bill is only about SRS +hormonal therapy (only transition related issues) but it should include other procedures too. A provision for free surgeries in Government hospitals and insured surgeries in private hospitals is the way to go forward.”
“The bill turns an indifferent eye to the fact that new MBBS syllabus is to roll out in August this year and doesn’t acknowledge that with every delay, the medical fraternity is losing time to educate the lakhs of MBBS, BDS, nurses and several other medical students and interns about transgender persons and trans affirmative healthcare.”
The Bill also creates hierarchies within the community, in favour of those who fall or want to remain within the binary.
Although the bill has a separate definition for intersex, it still conflates with the definition of a transgender person, which further marginalises intersex people. Besides their specific healthcare concerns (forced ‘corrective’ surgeries) and punitive measures are not mentioned.
“It also does not have any penal provisions on 'conversion therapies ' etc as constituting malpractice, for example therapies or treatments that claim to ‘cure’ or ‘convert’ people,” adds Ray.
“Constituting malpractice amounts to becoming punishable under the law and could lead to the possibility of losing your practicing license. But this is not there in the bill.”Ray
Then, issues of fertility, IVF or surrogacy still remain unaddressed, as these still follow heteronormative ideas about parenthood and family.
Besides the provision that a mental health professional with verify gender dysphoria, there are no provisions for the care of trans people’s mental health. For instance, gender sensitivity training for mental health professionals and re-education is not mentioned.
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