Gender Transition Services for Hijras and Other Male-to-Female Transgender People in India: Availability and Barriers to Access and Use

Abstract

. This qualitative investigation explored access to and use of gender transition services by hijras and other male-to-female transgender people in the public and private hospitals in 7 Indian cities. We conducted 7 focus groups (n = 42 participants) and 30 in-depth interviews with a purposive sample of hijras/transpeople and 22 key informant interviews with service providers. Findings reveal a near-absence of gender transition services in public hospitals. Lack of free sex reassignment surgery (SRS) in public hospitals and the prohibitive cost of SRS in private hospitals seem to be the key reasons behind why some hijras/transpeople go to unqualified medical practitioners for surgery or undergo Dai Nirvan, a traditional but risky method of removing male genitalia practiced within the hijra communities. Similarly, unwillingness among qualified medical practitioners to prescribe hormone therapy compels many hijras/transpeople to self-administer hormones. The lack of national guidelines on gender transition services and ambiguous legal status of SRS mean that even qualified medical practitioners are hesitant to perform SRS. Findings highlight the need to provide free or affordable gender transition services in public hospitals, to develop national guidelines on gender transition, and to equip health care providers to provide technically and culturally competent gender transition services.