Why India Needs Urgent Access to Gender-Affirming Care

Gender-Affirming Care is vital for the dignity, mental health, and inclusion of India’s transgender and gender-diverse communities.

Gender-Affirming Care (GAC)

Syllabus: Vulnerable Sections (UPSC GS II)
Source: The Hindu

Context

A recent article highlights the urgent need for Gender-Affirming Care (GAC) in India. It stresses that GAC is vital for ensuring the mental health, dignity, and inclusion of transgender and gender-diverse persons.

What is Gender-Affirming Care (GAC)?

Definition:

Gender-Affirming Care refers to medical, psychological, and social services that help individuals align their gender identity with their physical and social lives.

Forms of GAC:

Social Interventions: Use of correct names, pronouns, and inclusion in schools, workplaces, and official documents.
Psychological Support: Counselling and peer networks to manage gender dysphoria and mental stress.
Medical Care: Gender-Affirming Hormone Therapy (GAHT) and surgeries to modify secondary sexual characteristics.
Legal and Institutional Support: Inclusion of affirming practices in healthcare and education systems.

Note: The World Health Organization (WHO) classifies GAC as medically necessary, not elective or cosmetic.

Need for Gender-Affirming Care in India

High Mental Health Burden: Over 31% of trans persons have attempted suicide, nearly half before age 20 (India Mental Health Survey, 2024).
Proven Health Benefits: GAC reduces depression and suicidal thoughts (JAMA Network Open, 2023).
Right to Dignity: Under Article 21, access to healthcare is a part of the right to live with dignity.
Social Inclusion: Enables self-acceptance, reduces stigma, and enhances workplace participation.
Public Health Priority: Recognized under the Transgender Persons (Protection of Rights) Act, 2019, as essential for equality and inclusion.

Barriers to Gender-Affirming Care in India

Limited Medical Infrastructure: Lack of trained endocrinologists and absence of national treatment guidelines.
Financial Constraints: Surgery costs ₹2–8 lakh; hormone therapy costs ₹50,000–70,000 per year.
Policy Gaps: Poor implementation of Ayushman Bharat TG Plus and low awareness among hospitals.
Social Stigma: Discrimination in hospitals, workplaces, and families discourages care-seeking.
Unsafe Alternatives: Many resort to self-medication with unprescribed hormones, causing serious health risks.

Example: Reports from Hyderabad and Mumbai show cases of hormone misuse due to absence of supervised clinics.

Consequences of Inadequate GAC

Severe Mental Health Impact: Denial of care leads to depression, anxiety, and suicidal behaviour.
Social Isolation: Exclusion from education and jobs perpetuates poverty and homelessness.
Health Risks: Unregulated hormone use causes organ damage and hormonal imbalance.
Data Gaps: Lack of transgender-specific data in NFHS and NSSO excludes them from welfare schemes.
Human Rights Violation: Denial of GAC undermines equality, autonomy, and constitutional rights.

Example: A TISS (2023) study found that 65% of trans youth face rejection from healthcare providers.

Way Forward

Integrate GAC into Public Health: Include under Ayushman Bharat and provide free or subsidized services.
Training and Sensitization: Introduce gender-sensitivity modules in medical and nursing education.
Community Partnerships: Work with trans-led NGOs for outreach and counselling.
Legal and Policy Reform: Frame national GAC guidelines and inclusive insurance policies.
Data and Research: Conduct national surveys to inform evidence-based policies.
Awareness Campaigns: Promote understanding to dispel myths and reduce stigma.

Example: Tamil Nadu’s gender clinics and Kerala’s Transgender Cell are successful state models.

Conclusion

Gender-Affirming Care is not a privilege but a medical and human right.
Ensuring its accessibility and affordability is essential for mental health, dignity, and equality.
A rights-based and inclusive health approach can make India a true leader in gender justice and wellbeing.