Healthcare Limitations for Transgender and Non-conforming (TGNC) Persons in Pakistan

Abstract

Pakistan finds itself at a crossroads, struggling between legitimizing the identity of trans gender and non-conforming (TGNC) persons and the multivariate forces that hold back this progression. This can be observed when one seeks out census data on the khawajasira population – a respectful Urdu term for TGNC persons.1 Officially this number stands at 10,422,2 but various organizations advocating for TGNC rights state this number to be around 300,000 to 500,000.3 So while progressive changes, such as the Transgender Person (Protection of Rights) Act of 2018,4 have led to Pakistan recognizing khawajasira as a third gender, they are grossly underreported on the national census. This gives us an insight into the problems faced when it comes to their recognition into Pakistani society, often stemming from the stigma of their own social networks. This stigma illustrates the intersectional nexus of discrimination reflected in religion and politics, resulting in disapproval, marginalization, and social banishment.5 Religion is instrumentalized by predominantly religious and other non-state actors who condemn khawajsira identity and culture, which further propagates the status quo.6 As a result, much of Pakistan’s TGNC populations live on the margins of society, with an overwhelming majority experiencing institutionalized discrimination and physical attacks.5 The odds of subsequent engagement in high-risk behaviors such as survival sex, drug use, and even suicide increase dramatically.5 Due to this marginalization, TGNC persons defer their healthcare needs until absolutely necessary thus undermining their outcomes from illnesses that are otherwise preventable.7 Specific reasons include prejudice by healthcare professionals, inexperience with TGNC healthcare, and the lack of legislation protecting TGNC rights.