Advocacy for Dedicated Health Policies for Transgender Individuals Post-Gender Affirming Surgeries

There is a recognized need for separate policies, acts, and programs to address the transition and complications following gender-affirming surgeries.

Members of the sexual and gender minority community, particularly those who have undergone or desire gender-affirming surgeries, have complained that health services provided by health service delivery bodies under the Ministry of Health and Population do not adequately address post-surgery transition infections and complications, demanding separate policies, acts, and programs.

Participants at the program titled 'Our Community, Our Responsibility,' organized in collaboration with the Blue Diamond Society at the central office of the Family Planning Association of Nepal (FPAN) in Pulchowk on Wednesday, stated the necessity for a separate 'Hormonal Clinic' in government health facilities. Currently, there is no confirmed data on the number of 'transgender' individuals.

They stated, "If there were a 'Hormonal Clinic' facility in government hospitals, the risk of health problems arising after gender-affirming surgery would be reduced. Lack of 'hormonal balance' causes 'anxiety.' Sometimes, 'infections' also occur. A 'Hormonal Clinic' is necessary to address such problems. The medicine for 'hormone balance' should be free."

FPAN stated that the workshop was organized with the aim of addressing the problems, infection management, and complications that arise, especially for groups within the sexual and gender minority community who have undergone gender-affirming surgeries.

At the program, Sharmila Dahal, Chief of the Family Planning and Reproductive Health Branch, Family Welfare Division, Department of Health Services, discussed that the Safe Motherhood and Reproductive Health Act includes provisions for reproductive health services for all individuals, clarifying that the Act does not discriminate against anyone.

She said, "The demand from the sexual and gender minority community is for 'hormonal' services, which cannot be operated without immediate policy and regulation changes; the regulations must specify at which level of hospital or service center such services should be operated. Advocacy from the community has not yet reached this level. Awareness and advocacy from you are necessary at the policy-making level. The government will always provide support and cooperation in this matter. Furthermore, there are two factions within this community. Please come together. One group supports one issue, and another group opposes it. This makes it difficult for the government to work, and if you unite, the problems become easier to solve."

Dahal, Chief of the Family Planning and Reproductive Health Branch, informed that she deeply understands the problems of the sexual and gender minority community and stated that she will always work for the protection of health and rights. She added, "Although 'hormonal' services cannot be started immediately, we will definitely hold further discussions with the Family Planning Association on what can be done to address post-surgery infections and complications."

At the program, Dr. Pravin Shakya, Executive Director of the Family Planning Association of Nepal, discussed that the sexual and gender minority community has its own specific health problems, stating that the association has been providing support to the extent of its capacity, will continue to do so in the future, and that providing such support is their responsibility. He said, "However, due to the lack of clear policies and regulations on many issues, obstacles arise in program implementation. For these various reasons, the association could not operationalize the 'Hormone Clinic' service."

Executive Director Dr. Shakya mentioned that the issues of sexual and gender minorities are common issues including social, economic, political, cultural, and technical aspects, and stated that these will be addressed at the policy level. He urged, "I request the Blue Diamond Society and participants to present the personal hardships of those facing problems and those who have come out in society in a message-oriented manner with data, as this can make policymakers more sensitive, and advocate with the government and policymakers accordingly. I advocate for your rights by presenting the example of how the law on abortion gained recognition because data and personal stories were presented strongly."

At the program, Manisha Dhakal, Head of the Blue Diamond Society, complained that problems, infections, and complications arise after gender-affirming surgery, and they face stigma and discrimination when they go to hospitals or service centers for treatment. She said, "When problems, infections, and complications appear after gender-affirming surgery, we face stigma and discrimination when we go to hospitals or service centers for service. We are your citizens, and we expect respect and service as citizens. When a woman or man openly seeks services like facial or body hair removal, there is no stigma or discrimination, but when our community seeks the same service, questions arise, and discrimination occurs. We are your citizens; please do not discriminate or look down upon us in service."

Participants at the program openly presented their experiences, stating the compulsion to seek services abroad, which involves financial difficulties. They also requested that the government understand that problems arise not from taking 'hormones' but from taking them without a doctor's 'prescription.' The participants said, "Looking in the mirror brings disgust, seeing the mismatch between oneself, the soul, and the body; we are living as if dead; we are citizens of this country, and we wish to live proudly like others."

At the conclusion of the workshop, the FPAN announced that participants highlighted important issues arising from group work and decided to submit a detailed report soon to the Family Welfare Division under the leadership of the Family Planning Association.