NO, ONE CENTRE OF EXCELLENCE IN TRANSGENDER CARE IS NOT ENOUGH

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THE CONTEXT: The All-India Institute of Medical Science (AIIMS) recently announced its plans to open a Centre of Excellence for transgender healthcare in 2024.  

ABOUT THE CENTRE OF EXCELLENCE:

• The centre will be established at the Burns and Plastic Surgery department of the institute.
• The move comes after a collaboration with the Ministry of Social Justice & Empowerment, the National Aids Control Organization (NACO), and the Ministry of Health and Family Welfare (MoH&FW).
• It aims to not only deliver holistic care but become the seat of learning in the subject of Transgender Health under one roof and save patients from the hassle of running from one OPD to another.
• The institute has already been conducting gender-reassignment surgeries and aims to offer surgical, endocrinology-related, and psychiatry services.

ISSUES FACED BY TRANSGENDERS

• Discrimination: Transgenders face discrimination in employment, educational institutes, and within families which severely affects their overall wellbeing. They often face difficulty in property inheritance or child adoption. Because of being socially marginalised they are compelled to take up menial jobs despite good qualifications or forced into sex work. They face issues with the accessibility of even basic amenities as public toilets and public spaces.
• Inadequate access to healthcare: 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. 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.
• Issue of legal recognition of gender: There are issues of legal recognition of gender in India. Certain documents in India, such as the passport, still do not have the provision of transgender as a gender marker. They are often forced to identify with a gender with which they are not associated despite Transgender Persons (Protection of Rights) Act, 2019 which allows the community the right to self-perceived gender identity.
• Against NALSA judgement: 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.

STEPS TAKEN BY THE GOVERNMENT

• NALSA v Union of India (2014): The community was first given legal recognition in India in NALSA v Union of India(2014). The NALSA case judgement led to the recognition of transgender people as the ‘third gender’ by the Supreme Court of India. It affirmed that the fundamental rights granted under the Constitution will be equally applicable to them, and gave them the right to self-identification of their gender as male, female or third gender.
• Transgender Persons (Protection of Rights) Act, 2019: The Act aims to stop discrimination against a transgender person in various sectors such as education, employment, and healthcare. It also directs the central and state governments to provide welfare schemes for them. It re-emphasised the role of governments in holistic healthcare services to the community as providing sex reassignment surgery, counselling services 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: The Rules have been made under the Transgender Persons (Protection of Rights) Act, 2019. The rules seek to recognise the identity of transgenders and prohibit discrimination in the fields of education, employment, healthcare, holding property and use of public services and benefits. It 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.
• National Portal for Transgender Persons: It would help transgenders in digitally applying for a certificate and identity card from anywhere in the country, thus preventing any physical interaction with officials.It will help them track the status of application, rejection, grievance redressal, etc. which will ensure transparency in the process.

THE WAY FORWARD:

• Increase in number of centre of excellence: One centre of excellence 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.
• Transgender-Inclusive Policies:There is a need to frame transgender inclusive policies by sensitizing the legal and law enforcement systems. It will increase their chance to be included in policies formulation and increase their public participation.
• Financial Security: There is a need to ensure financial security among transgenders to mainstream the community in the society. For example, liberal credit facilities and financial assistance must be ensured to start up their career as an entrepreneur or businessman.
• Sensitization and awareness:There is a need to increase awareness and sensitise the legal and law enforcement systems towards the challenges of the community. This requires a concerted effort from all stakeholders, including the transgender community, the government, civil society, and religious leaders.

THE CONCLUSION:

Transgenders face various disadvantages in the Indian society. Therefore, state along with civil society must develop effective measures and also there should be efforts in sensitising the society and increasing awareness for fostering a sense of respect and acceptance for transgender community.

PREVIOUS YEAR QUESTIONS

Q.1 Discuss the desirability of greater representation to women in the higher judiciary to ensure diversity, equity and inclusiveness. (2021)

Q.2 “Micro-Finance as an anti-poverty vaccine is aimed at asset creation and income security of the rural poor in India”. Evaluate the role of Self-Help Groups in achieving the twin objectives along with empowering women in rural India. (2020)

MAINS PRACTICE QUESTIONS

Q.1 What are the roadblocks in improving the status of transgenders in India? Highlight some major government initiatives related to their empowerment.

Q.2 Despite the constitutional safeguards and special legislation, transgenders are historically marginalized and disadvantaged groups in accessing healthcare in India. Comment.

SOURCE: https://indianexpress.com/article/opinion/editorials/aiims-transgender-care-centre-conversion-therapy-unscientific-practices-9054488/