The transgender healthcare gap: A pattern of stigma and struggle

Hospitals often fail to provide transgender individuals with adequate care, leading to their premature discharge with only minimal primary treatment. Photo: TBS

Every individual, regardless of caste, creed, class, race or gender, deserves to live in a society that fosters peace and harmony. This includes the gender-diverse community, an integral part of our societal mosaic. In Bangladesh, members of the community, locally lumped together as "Hijra," are a distinct sexual minority facing severe adversities. 

Despite the Bangladeshi government's recognition of them as "third gender" in 2013, significant legislative action to improve their conditions and safeguard their fundamental and political rights is still lacking.

Their struggle for legal recognition and equitable access to healthcare services continues amidst these challenges. While Bangladesh's medical system has seen advancements, the implementation of policies specifically aimed at improving healthcare for the transgender community remains insufficient.

In the healthcare sector, members of the hijra community confront significant barriers when seeking medical treatment. Upon arrival at hospitals, they are often greeted with unwarranted inquiries such as, "Why are you here, and who allowed you to enter this facility?" 

This treatment starkly contrasts the principles outlined in Human Rights Principle-17, which asserts the fundamental right to the highest standard of healthcare without discrimination based on gender. This principle mandates healthcare provision irrespective of gender, alongside robust protections against sexual violence, including forced marriage, rape and non-consensual pregnancy. 

It also emphasises the importance of providing access to reliable and affordable contraception, family planning services and comprehensive education on reproductive and sexual health for everyone, regardless of their gender identity.

Falling ill is an ordinary part of life, and typically, people seek medical attention from specialised physicians in hospitals. However, for gender-diverse individuals in Bangladesh, accessing necessary medical services presents a significant challenge due to the healthcare system's lack of inclusivity in their treatment. 

Society often marginalises them, leading to a widespread belief that they don't deserve the same medical care afforded to others. In Bangladesh, there are no healthcare facilities where they can receive adequate medical services without facing harassment. Their reception in hospitals is often unwelcoming, with many not even being allowed proper entry, let alone access appropriate medication.

The situation is particularly dire in some government hospitals, where medical staff can be openly hostile towards hijras and transgender people. These staff members may refuse to allow them to wait in common areas, believing that their presence might disrupt the hospital environment or affect its reputation. 

When they seek healthcare, they are frequently met with unequal treatment and stereotypical questioning, emphasising their devalued status in society due to their gender identity. Instead of receiving the necessary medical care, they often face indignity and disrespect from hospital authorities. This systemic discrimination highlights the urgent need for societal and institutional changes to ensure equitable healthcare access for all, regardless of gender identity.

From the moment they enter the hospital premises, they confront various challenges which manifest at every juncture of the medical service process. For instance, even at the ticket counter, transgender people, particularly hijras, often find themselves in a dilemma. 

Facing societal discrimination, typically in precarious financial conditions, they usually opt for government hospitals. However, these hospitals are structured with distinct lines for male and female patients. Still, no specific queue or counter is designated for gender-diverse people despite their recognition as a "third gender." 

Consequently, they are left with no appropriate place to queue, unable to align with the male or female lines. This lack of accommodation in the hospital's structure is a glaring example of their systemic challenges in accessing healthcare. 

Due to their unique biological characteristics, gender-diverse people in Bangladesh often face societal stigmatisation and exclusion. This marginalisation hinders their access to healthcare facilities, especially in government hospitals with shared wards. There are instances where transgender individuals urgently require emergency medical attention and need to be admitted to hospital beds or wards. Typically, these hospitals have separate wards for male and female patients, but they lack specific accommodations for transgender patients. 

As a result, when gender-diverse individuals require emergency medical care and are admitted to either a male or female ward, they frequently encounter unwelcoming attitudes from other patients, sometimes facing complaints. In such challenging circumstances, hospital authorities often fail to provide them with adequate care, leading to their premature discharge with only minimal primary treatment.

In instances where they do not receive adequate medical care, their frustrations sometimes escalate into vocal protests, leading to disorderly scenes in healthcare settings. This reaction often prompts medical professionals to provide care, albeit in a hasty and occasionally negligent manner, to discharge them quickly. Private hospitals offer a more accommodating environment with individual patient rooms, but the high costs associated with these facilities are prohibitive for the financially disadvantaged community.

Gender-diverse people form an integral part of our society, yet they endure societal stigma and neglect. Families, society and the state must recognise their responsibility to treat the community with respect and empathy, ensuring they have unimpeded access to healthcare services. Integrating the gender-diverse community into the mainstream of society and involving them in the nation's collective progress is essential for the holistic development of the community and the country.

Sketch: TBS

Md Arif Hossain is a graduate of the Department of Anthropology at the University of Dhaka. He is currently serving as a Research and Development Coordinator at  BRIHONNOLA. 

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.