Barriers in access to healthcare services for individuals with disorders of sex differentiation in Bangladesh: an analysis of regional representative cross-sectional data

Alam Khan,Tarannum Naz,Md Ashiquazzaman,Md Imran Nur Manik,Moizur Rahman,Md Shariful Islam,Md Nuruzzaman Khan,Mostafizur Rahman,Aminur Rahman,Hazrat Ali,Mahmud Arif Pavel,Md Ibrahim Mollah,T M Fahad,Tanjeena Zaman

doi:10.1186/s12889-020-09284-2

Abstract

BackgroundWorldwide people in disorder of sex development (DSD) faces multiple barriers while seeking their social rights, particularly healthcare services. We aimed to explore the healthcare opportunities available to them, using patterns of healthcare utilization and difficulties faced by DSD population in accessing healthcare services in Bangladesh.MethodsData from a total of 945 DSD population and 71 medical staff were analyzed, collected from three major divisions (Dhaka, Chittagong, and Rajshahi) in Bangladesh during the period of January to December of 2017. A structured questionnaire was used to collect data via face-to-face interviews. Descriptive statistic was used to determine the frequencies of the visit by the DSD population in healthcare facilities as well as to analyze difficulties experienced by the DSD population in getting healthcare services. Multivariate regression analysis was used to explore the association between perceived barriers in getting healthcare services and failures of the DSD population to receive the healthcare services.ResultsPresent data revealed that around 80% of DSD population sought healthcare services from government healthcare facilities, where the overall success rate in getting healthcare services was less than 50%. The DSD population reported a number of reasons for failures in getting healthcare services, including non-friendly interaction by non-clinical hospital’s staff, non-friendly interaction by physicians, public fright as general people do not want to mingle with a DSD person, undesirable excess public interest in DSD individuals, and limitation of the treatment opportunities of hospitals to merely male or female patients. Among the stated reasons, the most frequently reported reason was non-friendly interaction by physicians (50.27%), followed by undesirable excess public interest in DSD individuals (50.16%).ConclusionDSD population in Bangladesh have limited access to healthcare facilities and facing multiple barriers to get healthcare services. Initiatives from the government and social organizations are important to ensure their access to healthcare services.

Highlights

Worldwide people in disorder of sex development (DSD) faces multiple barriers while seeking their social rights, healthcare services
It was found that most of the DSD population in Dhaka (90.2%), Chittagong (78.1%), and Rajshahi (81.2%) divisions live outside of their original parental home. They live together with other DSD population in groups named as Hijra sangha (Bengali language)/ DSD community (Fig. 1)
In Chittagong and Rajshahi divisions, proportions of the DSD population living with life partners were nearly similar, around 10% of the DSD individuals were live with their life partners

Summary

Introduction

Worldwide people in disorder of sex development (DSD) faces multiple barriers while seeking their social rights, healthcare services. Sex development disorders are considered as a heterogeneous group of abnormalities characterized by an incongruence of gonadal, chromosomal, and genital development [1, 2]. A study in Germany identified four times higher occurrence of the congenital disorder among newly born infants of non-German parents as compared to infants of German parents [14]. This is considered to be associated with greater rates of consanguinity in the migratory inhabitants, as they have the autosomal recessive inheritance of numerous conditions of DSD [14]

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