“Trans people avoid and do not have a decent access to healthcare because there is a stigma. They were often discriminated against and verbally violated,” said Kittinun Daramadhaj, a lawyer and the President of the Rainbow Sky Association of Thailand talking about factors that hinder transgender people getting healthcare services in Thailand.
Several studies have shown that transgender people in Thailand are more likely to face discrimination and barriers in healthcare than their cisgender counterparts. A qualitative report from UNDP suggested that Thai Trans, specifically women, are affected by ingrained prejudice from healthcare staff, which affects their “healthcare-seeking behaviour.” Many more Trans men and Trans women also came forward and shared their experiences of being disrespected and discriminated against in healthcare, including the use of pronouns with which they do not identify, being gossiped about or labelled, being made fun of, being asked questions irrelevant to their health and some people disrespecting their privacy.
“There are many issues. For example, on our healthcare card, we do not want to be identified as ‘Miss’. During the history examination, there are also questions like ‘Why would you want to undergo [gender affirming] surgery?’, ‘Have you undergone the surgery yet?’ or ‘Did your parents say anything about it?’ These questions objectify us and invade our privacy,” a Trans man said while sharing his experiences in an interview with BBC Thai.
Kittinun said, however, that discrimination is just one of the four main factors that hinder Thai transgender people from getting access to decent healthcare services. Other factors are financial limitations, facility management and the lack of awareness about Trans and LGBTQ+ health, which do not only limit but shun them from their access to healthcare.
Complicated procedures lead to higher costs
Gender affirmation procedures for Trans people can range from changing pronouns, taking hormones to various degrees of surgery. Before taking any hormones or undergoing gender affirming surgery, transgender people have to take a psychological test. After the surgery they have to maintain hormones, go through many blood tests regularly and face several physical health risks, such as kidney and liver issues or mental health issues, such as depression. Each step of the process is not affordable for most people.
In some cases, one’s whole life savings are used up, and that still may not be enough, especially when taking hormones and hormone consultation from certified healthcare providers, in which many transgender people find suitable for their gender affirmation. Some buy hormones and take them without any medical consultation, leading to even greater health risks from misuse and dosing errors.
Centralisation of the facilities
Currently, there are a limited number of health clinics for transgender people in Thailand and most of them in Bangkok and other large cities.
The Rainbow Sky Association has five clinics, which provide free hormone consultation in Bangkok, Had Yai, Nakhon Sawan, Ubon Ratchathani and Chonburi. In Bangkok, there are transgender clinics in major hospitals, like King Chulalongkorn Memorial Hospital and Ramathibodi Hospital and at 16 other public health services centres, according to a project called ‘Pride Clinic’, led by Bangkok Governor Chadchart Sittipunt.
Despite the progress in Pride Clinics, where consultations about hormones, sexually transmitted diseases (STIs) and psychotherapy, Thailand needs to do more work on decentralising these facilities to other areas while pushing for welfare for transgender people.
Creating knowledge and understanding
In pushing for gender affirmation procedures to be part of state welfare, Kittinun stressed the importance of creating knowledge and understanding about gender, that these procedures are not “cosmetics or elective” but essential to their “identities of self”, and what it is like to be in a body that does not feel like yours.
He mentioned the two principles which would set the foundation for understanding and would serve as a strong argument for state supported welfare.
The first one is that transgenderism was removed from the international classification of diseases’ (ICD) list of ‘illnesses’ and their healthcare was brought back into the public health system, according to the World Health Organisation (WHO.)
“If we want legal interpretation to consider gender affirmation procedures as a “necessity”, we need to rely our argument, on the World Health Organisation’s International Classification of Diseases (ICD). We can refer to this to support the principle of necessity we are trying to raise. The WHO now accepts [gender affirmation as healthcare.]”said Kittinun.
The second principle lies in a basic human right to determine our own gender, despite being born with ones that are “not ours”.
“Determining our own identities has always been a basic human right… based on the idea of gender identity, which is one’s will…if we have this will, we can determine our own gender.” he added.
If these two principles are combined, he said that we can make gender affirmation procedures a necessary healthcare for Trans people and have them included in healthcare services under the National Health Insurance Act, section 5 paragraph 3.
He also emphasised that the major concept, which needs to be promoted, is human rights, to think of everyone as an equal individual with dignity. Once this concept is well-established in people’s minds, all LGBTQ+ rights will surely make their way to reality.
By Atikan Kulsakdinun
References:
https://ihri.org/wp-content/uploads/2021/09/คู่มือการให้บริการสุขภาพคนข้ามเพศประเทศไทย.pdf
https://www.aidsdatahub.org/sites/default/files/resource/undp-th-stories-stigma-2020.pdf
https://www.thaipbs.or.th/news//content/310779
https://www.nhso.go.th/news/3995
