The Burdened Body: Using a Well-Being Lens to Explore Lived Realities of Accessibility and Quality of Transgender Healthcare in India

Transgender identities remain a site for both discursive debate and contention in the personal and political domains in India. Based on a qualitative study using a phenomenological model of inquiry, this chapter explores trans health through probing into questions of availability, accessibility, acceptability, and quality of healthcare being availed of by trans people in India, drawing on the experiences of 40 trans persons, including transmen, transwomen, and persons of non-binary gender identities. The chapter documents barriers to accessing healthcare that include infrastructural and geographical constraints, limited healthcare provider knowledge and competencies, unequal patient-practitioner relationships, and the cis-normative healthcare system overall. The chapter identifies links between the nature of healthcare being availed and trans-specific behaviors of conforming, rejecting, negotiating, and affirming their identity through accessing healthcare. Participants described tolerating lower quality of care, visual conformity to birth gender to prevent discrimination, disclosure of identity to access appropriate forms of healthcare, avoidance or delay in accessing healthcare, and sourcing alternative solutions to healthcare, including self-care that could be risky. Both the socio-economic positionality of trans persons seeking care, as well as the belief systems of practitioners, contributed to skewed power dynamics between them. The trans narratives documented are a reminder of how trans identities are not expressions of sickness but non-conformity to current dominant social norms around gender and its manifestation across healthcare. This chapter calls for a holistic model of trans healthcare modelled on social prescribing that addresses the underlying causes of patient’s health and well-being issues, as opposed to simply treating their symptoms.