Nafis Sadique Shatil
Across the world, LGBTQIA+ individuals continue to encounter significant challenges in accessing sexual and reproductive health rights (SRHR), often due to deeply rooted social stigma and systemic discrimination. While some countries have made strides in recognizing and protecting these rights, many still fall short in ensuring equitable healthcare for sexual and gender minorities.
A Personal Story from Nepal: Saroj’s Struggle
Saroj, a 24-year-old transgender man from Itahari, Nepal, has endured the societal rigidity of gender norms throughout his life. Assigned female at birth, Saroj knew from an early age that he identified as male. However, living authentically came with immense challenges.
Menstruation became a monthly source of distress for Saroj, not just physically but emotionally, as society framed it as “exclusively female.” Without access to gender-affirming surgery, Saroj navigated the pain and stigma in silence.
At 21, severe menstrual pain and heavy bleeding forced him to seek medical help. However, the experience was fraught with humiliation. From being ridiculed at the registration desk to dismissive comments from a gynecologist questioning his gender identity, Saroj left the health post without proper care.
“I felt like a spectacle. People stared, whispered, even laughed. The doctor taunted me, asking why I dressed like a boy if I was biologically female,” Saroj shared.
Beyond medical settings, Saroj faced judgment even when purchasing menstrual products, with shopkeepers mocking him for his identity.
Global Challenges: LGBTQIA+ Healthcare Disparities
Saroj’s story is not unique. Around the world, LGBTQIA+ individuals face numerous obstacles in accessing SRHR services:
- Lack of Inclusive Healthcare:
- In many countries, healthcare systems remain ill-equipped to address the unique needs of LGBTQIA+ individuals. For instance, in sub-Saharan Africa, widespread criminalization of homosexuality exacerbates healthcare access issues for queer individuals, with many fearing arrest or violence when seeking care.
- In the United States, the rollback of protections under the Affordable Care Act left many transgender individuals vulnerable to discrimination, especially in conservative states.
- Discrimination in Medical Settings:
- A 2022 report by the World Health Organization (WHO) found that LGBTQIA+ patients often experience judgment, verbal abuse, and denial of care in medical facilities.
- In India, transgender women seeking HIV treatment report frequent mistreatment, including being asked invasive personal questions unrelated to their health issues.
- Barriers to Gender-Affirming Care:
- Gender-affirming surgeries and hormone therapies remain inaccessible in many countries, either due to high costs or lack of trained professionals. In Nepal, for example, while some hospitals offer top surgery, bottom surgery is unavailable, forcing individuals to seek expensive and risky procedures abroad.
- Reproductive Rights Exclusion:
- LGBTQIA+ individuals often face restrictions in accessing reproductive services like IVF, surrogacy, and adoption. For instance, surrogacy is legal in countries like India but is restricted to heterosexual, married couples, excluding same-sex and transgender individuals.
- In Poland, which has some of the strictest abortion laws in Europe, lesbian and bisexual women often face compounded barriers when seeking reproductive health services.
- HIV and STI Vulnerability:
- Studies show that stigma and discrimination contribute to higher rates of HIV and sexually transmitted infections among LGBTQIA+ populations. In Latin America, HIV prevalence among transgender women is as high as 35 percent in some regions, yet access to preventive care remains limited.
Legal and Policy Gaps
Despite progressive legislation in some countries, implementation remains a challenge. For instance:
- Nepal: The 2015 constitution guarantees rights for gender and sexual minorities, including reproductive health rights. However, these rights often exist only on paper due to societal stigma and inadequate enforcement.
- United States: While several states have expanded Medicaid coverage for transgender healthcare, others have enacted anti-transgender legislation, restricting access to gender-affirming care for minors.
- Uganda: The 2023 Anti-Homosexuality Act criminalized same-sex relationships, driving LGBTQIA+ individuals further underground and cutting them off from essential healthcare services.
Global Recommendations for Change
Advocacy groups and international organizations have called for urgent reforms to address these disparities:
- Policy Revisions:
- Governments must amend laws to explicitly include the SRHR needs of LGBTQIA+ individuals, ensuring access to services like IVF, surrogacy, and gender-affirming care.
- Healthcare Training:
- Medical professionals need comprehensive training to provide empathetic and inclusive care. Programs like the UK’s Pride in Practice initiative have shown promise in improving LGBTQIA+ patient experiences.
- Financial Support:
- Subsidized insurance and government-funded healthcare programs are crucial for reducing the financial burden on LGBTQIA+ individuals.
- Data Collection and Research:
- Governments should invest in research to understand the specific SRHR needs of LGBTQIA+ populations, as recommended in Nepal’s 2023 Mitini Nepal report.
- Global Solidarity:
- International bodies like the United Nations must hold countries accountable for violating LGBTQIA+ rights and provide support for grassroots organizations advocating for change.
A Call for Action
Saroj’s experience serves as a microcosm of the global struggle faced by LGBTQIA+ individuals in accessing equitable healthcare.
“Healthcare is a fundamental right,” Saroj emphasized. “I hope governments and healthcare providers recognize this and work toward creating a system that respects and supports everyone, regardless of their gender or sexual identity.”
Around the world, LGBTQIA+ communities continue to fight for their rights, not just in legislation but in daily interactions with healthcare systems. Their voices demand action—a call to end discrimination and ensure that no one is left behind.