Another Battle for Bodily Autonomy in Trans Youth

On February 10, 2021 the Alabama Senate Health Committee voted to criminalize transgender medicaltreatment for minors. With an 11-2 vote, the committee approved Senate Bill 10 (SB-10), a bill that will “outlaw puberty blocking medications and gender-affirming care for minors.” On March 3, the Alabama Senate passed this legislation, and it is currently awaiting Governor Kay Ivey’s approval. SB-10 empowers the legal system to prosecute clinicians and pharmacists with felony charges if they prescribe medication or provide treatment to aid in the transitional processes of minors. Bill sponsor Senator Shay Shellnutt (R-AL) claims that “minors are too young to be making this decision.” The Senator has also admitted that he’s never interacted with a trans teen before submitting the bill. Opponents of the SB-10 refute Shellnutt’s claim by acknowledging this decision is between the medical care provider, the patient, and the patient guardians. As such, SB-10 infringes on the private rights of parents to care for their children with necessary and proper interventions. Shellnut has mentioned that hormonal treatment and other transgender interventions cause long term issues and that a child is not mature enough to be making such a permanent decision. Shellnut’s claims are false; the effects of hormonal drugs that are puberty blockers are reversible. Also, when evaluating long term effects of gender reassignment surgeries, doctors prefer to wait until the patient is at least 18 years old before they perform the surgery.

A person holding a sign with a metaphor describing gender.
Source: www.mindfulword.org

Doctors must take the Hippocratic Oath which defines their ethical conduct and moral reasoning. There are two main tenets of the Oath: “benefitting the ill and protecting patients against personal and social harm and injustice.” Not only does SB-10 force doctors to dishonor the Hippocratic Oath, but it is also medically harmful to the patient pursuing care and prevents them from confiding in their medical care team. Dr. Marsha Raulerson says it will “take away child’s confidence in trusting doctors with their thoughts and to talk candidly.”

Healthcare providers are only one pillar of the support system for patients wishing to transition. So, when healthcare providers are unable to provide care to these young individuals, it can harm their mental and physical wellbeing and contribute to gender dysphoria. Adolescent and young adult years are incredibly formative. It’s in these years that young people thrive and when they are in need of a lot of support and care. When their support systems and adequate healthcare is taken away “adolescents can feel alone, stigmatized, and undervalued”. Rejection, discrimination, and stigma during these formative years can put young adults at a higher risk of mental health disorders such as depression and anxiety. The aforementioned mental health disorders can lead to the usage of addictive substances like drugs and/or alcohol, and suicidal ideation. These factors contribute to significant health disparities within the LBGTQ+ community. It’s vital the care they receive is given without stigma and affirms the patient’s sexuality and gender identity, but this care cannot be given with government intervention that holds traces of transphobia.

Protestors gathering against the transgender military ban legislation.
Source: www.britishherald.com

Gender is a very dynamic concept, and there is no binary. It is up to the individual to choose their identity. Gender reassignment treatments and procedures are one way to reaffirm and respect an individual’s choice. LGBTQ+ youth deserve to know that they are respected and that they deserve quality healthcare and treatment. Healthcare providers should not be prevented from fulfilling their responsibilities. They should be able to provide quality care and treatment for their patients. If they can’t, they should be able to refer the patient to a doctor who can provide adequate healthcare. This is not the first time SB-10 has been passed to the full Alabama Senate. It was passed all the way up to the Governor in 2020 to be signed into action and is only back on the table due to COVID-19 complications. Advocacy is an important aspect of healthcare, and providers should be willing to advocate the most for marginalized communities. It is important to lift barriers to care for these groups, instead of continuing to make healthcare inaccessible.

A separate companion bill (HB-391) is currently in the Alabama House. This bill would restrict transgender students from participating in school athletics with the gender they identify with. Lawmakers that support the bill claim that it protects fairness for female and “keeps them from having to compete against transgender athletes who were born male.” The biggest difference to make right now is to call Alabama Senate representatives and tell them the harms these bills will cause to LGBTQ+ youth and to the healthcare providers that try to help them.

India’s Relationship with the Third Gender

Simran, 30, walks through Bandra in Mumbai to ask tourists for money so she can pay her Guru. Photo by Sara Hilton for The New York Times

What is the Third Gender?

In April of 2014, the Supreme Court of India formally recognized the existence of a third gender. There is no formal definition of the third gender in India. People who identify as neither man nor woman are commonly referred to as Hijra or transgender. The Hijra have been subject to discrimination, harassment, and persecution for their genderqueer self-identification. Along with the queer community, Hijras have been targeted by law enforcement and government officials under Section 377. This law was used to criminalize any queer sexual acts and has been used to justify discrimination and mistreatment of the LGBTQ+ community since its enactment in British colonial era India.

What Is the History of the Third Gender In India?

Although the Hijra have been subject to much hate and discrimination in recent times, this has not always been the case. Hijras were well-respected and revered in ancient India. In fact, Hijras play important roles in many Hindu religious texts. One such text talks about the life of Lord Rama, one of the most virtuous Hindu heroes. At some point, Lord Rama was banished from his kingdom. After being banished, he told his followers that the men and women should wipe their tears and leave him. All of the men and women left. However, a group of people known as the Hijra remained standing before him. They were neither men nor women and refused to leave until Lord Rama returned fourteen years later. This community was praised for showing such loyalty.

Hijras also held religious authority and important court positions and administrative roles in Mughal era India. Believed to have the ability to bless, many would seek out Hijras for blessings during important religious ceremonies.  In ancient India, the Hijras were a community that was respected for being extremely loyal and were well trusted enough to be given important religious and governmental roles. This begs the question. If Hijras played an important role in ancient Indian society, then why are Hijras ostracized and persecuted in modern India?

Why Is the Third Gender Ostracized Today?

The answer is due in large part to the British colonization of India. When the British took over direct rule of India and absolved the British East India Company, government officials sought to enforce their western ideas and beliefs on Indians. Lawmakers accomplished this goal by enacting moral laws that banned anything that western society viewed as unclean and dirty. This included the creation of Section 377 of the Indian Penal Code which made illegal any “unnatural offenses” that were deemed “against the order of nature.” From when Section 377 was implemented in 1858 to when it was recently deemed unconstitutional on 6 September 2018, Section 377 was used as justification to mistreat and punish Hijras, queers, and the LGBTQ+ community.

The western concept of hating and marginalizing anybody who was not straight and cisgender took hold in Indian society. The Hijra community was forced from a well-respected role as pillars of religious and governmental society to being social outcasts. This social exile is responsible for the socioeconomic and medical difficulties that Hijras face. Hijras are prone to being economically challenged because of the stigmas that they face. They are denied educational opportunities, jobs, and discriminated against in every area of their lives.

What are the Social, Economic, and Medical Problems Caused By Lasting Social Stigmas?

Despite gaining their independence from Britain in 1947, India has only recently begun to make progress on removing legislation that has been used to attack the Hijra and LGBTQ+ population. The many decades of subjugation stretching back generations have left a mark. Many of the hateful western views towards LGBTQ+ people have become deeply ingrained in India’s culture. Even with many public relations campaigns along with a growing group of supporters, the vast majority of Indians still are against Hijras. Many Indians don’t respect Hijras worth. Hijras are often called to come to auspicious events such as marriages and child-births for blessings. Many Indians view the Hijras as bringing good luck and warding off evil spirits. Yet because of widespread discrimination, the majority of Hijras are forced to beg for money since they are barred from most employment opportunities. Due to this, some of the common means of living for Hijras are begging, dancing, and prostitution.

Open employment discrimination has run rampant because of the lack of workplace protections and discrimination laws that are not comprehensive or well-enforced. Continued police harassment has also burdened the Hijra community. Many police officers have jailed and imprisoned the Hijra community over offenses such as begging, prostitution, and having queer sex. This community has had to resort to such practices because of the refusal to integrate Hijras into the economy. Yet despite not being able to find work, Hijras are attacked even more for trying desperately to survive in a society that has practiced institutionalized, pursued, and encouraged harmful policies towards this community since colonial times.

In addition to facing issues with getting employed, Hijras also have difficulties receiving access to basic medical care. There have been many unfortunate instances of medical malpractice against Hijra people. The Civilian Welfare Foundation is an NGO that conducted studies on the medical problems faced by the transgender community. The study found that the majority of doctors are not educated on gender identity issues and that a transphobic stigma is ingrained amongst medical professionals which is responsible for the lack of proper medical care for Hijras.

The study highlighted the stories of Saikat and Anushri. Saikat was a transgender patient who died from lack of treatment following a train accident. The reason is that doctors could not decide whether to admit her to the male or the female ward. Anushi was gang-raped by several men and sought medical treatment. However, doctors refused to treat her because she was transgender and even denied her access to anti-HIV medication. These two stories highlight the dangerous impact that social stigmas have on our society. In addition to facing persecution and discrimination daily, Hijra people are at risk for bodily harm and even death from bigoted doctors and nurses who are not trained to deal with gender identity issues.

Fear of the social stigmas for being associated with the transgender community is a major reason why many doctors try to avoid seeing Hijra patients and why some outright refuse treatment altogether. Adding on to social fears, healthcare professionals have been hesitant to treat Hijra people because of the risk of criminal prosecution under Section 377. Up until the recent 2018 Supreme Court decision, it was illegal to commit queer sexual acts as well as to aid and abet these acts. There have been cases of individuals being arrested simply for selling condoms to Hijra and queer people. The lack of proper medical care and access to safe sex talks and practices has led to an HIV rate amongst Hijras that is 100 times the national average. Doctors fear Hijra patients because they are misinformed and believe in multigenerational social stigmas. Hijra patients fear doctors because of the risks of being mistreated and harmed by substandard or complete refusal of medical care. This toxic mutual distrust can only continue to harm the Hijra community.

Rithika, 23 and Ammu, 21, live with their Guru in the Koliwada area of Mumbai. Photo by Sara Hylton for the New York Times.

What Are the Recent Successes For the Hijra Community?

There are some recent successes that have helped the Hijra people. The Right for Transgender Persons Bill drafted in 2014 and passed in 2016 has been a major milestone in protecting the Hijra community. The law declared many forms of discrimination against Hijras to be illegal and banned the forcing of Hijras to beg or to leave their homes. Other benefits include the creation of a committee that focuses on helping Hijra pursue education by giving access to scholarships and textbooks among other needs. The bill has also allowed for Hijras to be recognized as socially and economically disadvantaged which qualifies Hijras for benefits from India’s Affirmative Action program. However, there are downsides to the bill as well. Hijra people have to go through a district screening process to receive their third gender certification and ID cards. This approach can lead to refusal of benefits to Hijras based upon the decision of a committee without oversight and comprised of people not trained in gender identity issues.

Also occurring in 2014 was the landmark Supreme Court decision that officially recognized the existence of the third gender. This has allowed for Hijras to opt for third gender classification on official legal documents such as driver’s licenses and passports. The decision has also signified acceptance of the Hijra community’s existence by a government that has continuously sought to marginalize those who aren’t cisgender. However, this decision has also come up short in addressing the many problems Hijras face. Third gender IDs, while motivated by good intentions, do not address many basic rights. When getting married, transferring property, or adopting children there are only cisgender ordinances in place. This means that Hijras cannot get married, cannot leave behind property for their kids, and cannot adopt kids that desperately need good homes while being recognized and identifying legally as the third gender.

Another recent Supreme Court decision that has increased the rights of Hijras happened in 2017. The court declared that the Right to Privacy was a fundamental right to all individuals and enacted protections for the privacy of Hijras’ sexual orientations. This will go a long way toward helping prevent socioeconomic and medical discrimination.

In addition to legal successes, there have also been gains in societal acceptance and integration of the Hijra community. In 2017 India accomplished many firsts. Joyita Mondal became India’s first third gender judge, Tamil Nadu became India’s first Hijra police officer, Natasha Biswas became India’s first third gender beauty pageant winner, and Kochi Metro Rail Ltd. became India’s first government-owned company to provide bulk employment to Hijras. There are plenty more Hijra success stories out there which are a sign of widespread societal change. There is hope that the social stigmas that have plagued the Hijra community will soon be fully erased.

It is clear that Hijras face many challenges in modern times. Widespread social stigmas and discrimination against this community were promoted for generations. It is also clear that such large problems take a long time to fix. However, if legal efforts and public relations campaigns are continued then India can one day become a society that fully embraces and supports all people regardless of sexual or gender orientation.