A group of doctors and community activists came together on Tuesday to stress the need for uniform guidelines in India for sex reassignment surgery (SRS) for transgenders, which is lacking now.
A combination of factors, including financial barriers and lack of healthcare providers (psychiatrists and surgeons), result in the community members succumbing to crude methods of sex reassignment, they said.
In the wake of this, a group of experts, including doctors from NIMHANS, Victoria and M.S. Ramaiah hospitals, social activists, and members of Ondede and Swatantra (sexuality minority organisations), at a national-level workshop here on Tuesday, held discussions to frame guidelines on SRS. The workshop was held in NIMHANS.
The participants, who deliberated upon the need for separate guidelines for such surgeries, decided to set up a committee of experts and adopt a resolution demanding that such surgeries should be done free in government hospitals and at subsidised rates in private hospitals.
Representatives from the community from North-East, Maharashtra, Puducherry, Kerala and Telangana, who attended the workshop, shared their experiences, especially challenges faced by the community members in proving their identity.
Suresh Bada Math, chief of Community Psychiatry and Telemedicine in NIMHANS, said in many regions across the world, an individual’s pursuit of SRS is often governed, or at least guided, by documents called Standards of Care (SoC) for the Health of Transsexual, Transgender and Gender Non-conforming people. “The most widespread SoC in this field is published and frequently revised by the World Professional Association for Transgender Health (WPATH, formerly the Harry Benjamin International Gender Dysphoria Association). However, we do not have any guidelines or rules in India,” he said.
Counselling needed
Asserting that any person, who wished to undergo SRS, should get psychiatric counselling for at least two years before the surgery, the doctor said this is important as the person should be mentally prepared for gender change.
D. Muralidhar, professor in the Department of Psychiatry Social Work in NIMHANS, said although discussions on framing guidelines started way back in 2012, nothing concrete has emerged. Pointing out that only West Bengal had some guidelines, the doctor said Karnataka’s guidelines could be the basis for a national policy document.
Akkai Padmashali, convener of the workshop, said the National Legal Services Authority had said that the ambiguous legal status of SRS should be clarified. “The authority had also said that gender transition and SRS services (including proper pre- and post-surgery/transition counselling) should be provided free of cost in government hospitals. We will reiterate this in the resolution that we will adopt and submit to the government soon,” she added.
Jayna Kothari, legal expert; Ramakrishna and Venkatesan Chakrapani, medical experts from Chennai; Virupaksha, consultant psychiatrist in M.S. Ramaiah Hospital, and Prashanth, psychiatrist in Victoria Hospital, spoke.
Nearly 50 surgeries at Victoria Hospital
The State-run Victoria Hospital has been doing sex reassignment surgeries for the past four years and nearly 50 such surgeries have been conducted so far, said K.T. Ramesh, Head of the Department of Plastic Surgery.
“We had been doing only mastectomy (breast reconstruction) till last year. Now, we have started doing vaginal reconstruction. However, we need more legal guidance from the government to take this forward,” the doctor said, adding that the hospital gets cases from across the country.
“As most of them got admitted in special wards, the surgery cost went up to ₹15,000. The same will cost over ₹1.2 lakh in a private hospital,” he said.
