BARRIERS TO TRANSGENDER HEALTH CARE IN PAKISTAN

Abstract

he term “transgender” refers to a spectrum of individuals who express gender in ways that deviate from the gender binary. It includes transsexuals, crossdressers and others.1,2 In Pakistan, the state of being a transgender presents a serious challenge to the traditionally established binary systems of nature/culture, man/woman, masculinity/ femininity and sex/gender. Even transgender community were given their identity as citizens of Pakistan in year 2009.3
Whereas the transgender persons suffer significant health disparities.4,5 Real or perceived stigma and discrimination within biomedicine and the health care provision in general may impact transgender people’s desire and ability to access appropriate care. The situation of the community is worse because they are left ignored and isolated without the survival facilities, education, employment opportunities, identity crisis or even the conformity from the dominant social class.3
National health services of Pakistan should include rigorous determination in the health care system to provide adequate care for transgender in the country. There is need to know the mechanism through the knowledge and biases of medical work force across the spectrum of medical training with regard to transgender health care. With these studies we can validate and propose potential solutions to address the identified gaps.
Whereas the situation in other developing countries including those belonging to African and Asian regions is not good. In developed countries the situation is found to be much better. However, reported data shows that transgender people even in developed world face various kinds of discrimination especially in health care situations. The federal government of USA does not have laws specifically for protecting transgender people from discrimination in employment, housing, healthcare, and adoption. U.S. President Barack Obama had issued an executive order prohibiting discrimination against transgender people in employment by the federal government and its contractors.
While in Pakistan there was no specific law for the transgender, however, a Senate committee had approved a bill in December 2017 for full legal protection to transgender people. It will provide a relief to transgender people for their health care and other facilities. Further, National Assembly of Pakistan approved the final Bill as Act called the Transgender Person (Protection of Rights) Act, 2018 on 18 May 2018.6
There is need to assess the perceptions and knowledge of the heath care provider workforce to provide medical care to transgender. Barriers may include fear of stigma associated with providing transgender medical care. Barriers may also include bias in the structure of clinics, forms, and electronic medical record systems in addition to gaps in knowledge and bias among support staff. Identification of solutions to the gaps is needed, which are not solely a lack of knowledge.
The degree to which third party payer policy impedes access needs to be determined. Determination of change needed to overcome the financial barrier to care is also required. It is necessary to evaluate other barriers including societal stigma, mental health issue among patients, and socioeconomic issues. Finally evaluation of strategies to overcome these barriers is a must to address the matter.