The Supreme Court of India recognized transgender as a third sex in 2014, but not much has changed for the community.
On Monday, in a historic move, the World Health Organisation (WHO) announced that it no longer classifies transgender people, who identify as the opposite gender to the one they were born with, as mentally ill. Yep, finally.
In a new catalogue that WHO released on Monday, the change was announced as part of its new International Classification of Diseases (ICD-11). Known variously as Gender Identity Disorder (GID) or gender incongruence, GD has now been added to the category of ‘conditions related to sexual health’.
The new catalogue, which still needs to be approved by UN member countries, will be introduced at the World Health Assembly in May 2019 and is slated to come into effect from January 2022.
Not ‘Disorder’ but ‘Variation’
Being a transgender was so far categorized under ‘mental, behavioural and neurodevelopmental disorders’. The move could prove to be monumental for the LGBTQ community, especially transgender persons who have historically been segregated as ‘mentally ill’.
Listing gender incongruence under ‘conditions related to sexual health’ would do much to dispel the prejudices and stigma attached to it since it would no longer remain a ‘disorder’ that needed treatment or institutionalization, but rather establish it as a variation in the spectrum of sexual identity.
Traditionally, GD was treated with psychotherapy, hormone therapy which includes injecting patients with estrogen or testosterone, depending on their incongruence (known popularly as ‘puberty blockers’) and surgery. However studies have found that children being treated for GD often reach a ‘resolution’ of their problems without actually ‘transitioning’. Declassifying GD as a mental disorder that needs a cure may help queer children to better understand and express their sexuality.
What Happens in India?
Despite the SC order, the community continues to face discrimination and humiliation at various levels, including healthcare.
In 2017, Anirban Kundu, a transperson from Kolkata, was injured in a road accident but denied treatment at a hospital due to their gender. In 2014, another transperson, Saikat, lost their life after being denied treatment in West Bengal.
There are countless such cases, both reported and unreported. Studies have shown that doctors may often have apathetic attitudes towards transgender persons who may have faced sexual violence.
According to a 2017 report in Scroll, a transwoman who had gone to a doctor after being raped had been asked “how can you be raped?”
Such incidents are not isolated or area/culture specific. Transphobia is a global concept and the medical fraternity is as much party to it as the rest.
“In India, very few people experiencing gender incongruence actually seek any help for it. There is hardly any awareness and what people is known is shrouded in stigma. Declassifying it from a mental disorder would encourage more people to seek help,” said Dr. Achal Bhagat, a practicing psychiatrist based in Delhi.
But while the WHO’s decision is expected to create international discussion and pressure on member nations to work toward a better understanding of gender in terms of health and education policies, it by no means ensures such action.
“The difficulty is how society responds to transpersons and this includes those in the medical community who suffer from similar biases. Those biases are unlikely to change with just a change in listing,” Dr Bhagat said.
Actor, dancer and transgender activist Laxmi Narayan Tripathi feels only education and sensitization can lead the way.
“The WHO recognising that gender incongruence is not a disorder is great news. But it will hardly be enough in bringing about any real change in attitudes of doctors and hospital staff that often are the source of discrimination,” Laxmi told News18.
Laxmi said that real change can be brought only when doctors are better educated and sensitized in matters of gender. "Medical education needs to tackle these issues at an academic level that is in medical colleges as part of course curriculums, as well as practitioner level. And this can only be done by our own government and society, not the WHO,” Laxmi said.