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Sexual and Reproductive Health Rights in South Asia: Challenges and Policies

Natasha Israt Kabir

Freelance Researcher, President, and Founder of BRIDGE Foundation

Adjunct Faculty, Department of the Law and Justice, Jahangirnagar University, Bangladesh

Online Version Published: 30 December 2016

© 2016 South Asian Youth Research Institute for Development (SAYRID). This article is licensed under a Creative Commons Attribution 4.0 International License (CCBY).

Abstract

This paper examines the challenges of sexual and reproductive health rights in South Asia and puts forth some policy recommendations. Whenever we are discussing the role of state and society, it clearly follows the article 23 of the international covenant.1 The question is whether we are clearly concerned about the fact that sometimes protection of family does not include protection of the rights of the individuals as far as their sexual rights are the agendas to be considered. Sexuality is as much a part of right, indicator of being fully human and fully alive as needing food and water to live. It is the element of the joy of being alive, and its meaning is more elaborated than biological need: it encompasses spiritually, human nature and social culture.2

Keywords: Sexual Reproductive Health Rights; Sexual Minority; Symbolism; Transgender; South Asia

1. Introduction: How to define sexual and reproductive health rights?

The definition itself is complicated, and still now we are under the darkness to accept it as a form of rights regarding gender, race, age, people and another marginal criterion, to make choices and implement the decisions based on their sexuality and reproduction, provided that they follow the rights of others. It must be inclusive that follows the right to access to information, availability of the information and utility services to support these choices and promote sexual and reproductive health (SRH) in an effective manner.3

SRH rights are a relatively new concept. The Cairo conference in 1994 first recognized the reproductive rights as a whole entitled with the International Conference on Population and Development (ICPD). Previously reproductive health was mostly emphasized on the family planning, birth control, low birth rate and safety of the mothers and motherhood to check and balance the population. The definition of SRH agreed in the conference paved the way towards a more broad and comprehensive definition, and for recognizing reproductive health in the context of human rights and the right to health. This included rights to sexual health and showed the light on problems and diseases as well as positive experiences around pregnancy and parenthood, sexuality, and relationships. The key outcome of the conference was a program of the universal declaration to recognize the action by the year 2015. This Cairo declaration also shaped the other platforms like in 1995 World Conference On Women in Beijing, China.4

Concepts of gender are socially constructed, reinforced, and potentially challenged via public discourses including those of mainstream media. Media serve “as instrumental sites for regulating the boundaries of gender and sexual identities.” Granting that media are not monolithic and polysomic interpretations of discourses allow media consumers subversively “to read against the grain,” mainstream media are nonetheless part of the larger hegemonic power structure. The power of media lies in their ability to embed normative discourses, including those that are struggling to be accepted as normative (Moscowitz, 2010: 24-39).

1.1 What about the universal access?

There is still now the necessity of having a universally accepted definition of what is meant by ‘universal access to SRH services.’ WHO has to broaden the definition, which includes services and utility of the health related with prevention of birth, diagnosis of the causes, counseling for the parents, treatment and care services.5

1.2 What does the accessibility define while discussing the rights-based approach to access means?

The rights-based approaches give us broader perspectives while discussing the population growth interlinked with the economic, environmental factors as well as to understand the necessity and rights of each and every individual.The women’s protest at the broader level and Beijing conference and Beijing plus played a major role. The pressure and the lobby groups who are consisted along with the excluded and marginalized genre and prone to be more victims finally came under attention, having access to health facilities and rights. This came about largely as a result of the women’s rights movement, culminating in the Beijing conference, and consolidated by the work of other RSH related excluded and vulnerable groups and the stakeholders of the treatment as well. A rights-based approach means as well as providing to SRH services and information, paying attention to sexuality and sexual rights of different groups.

2. Bangladesh

A common oversight is recognizing that the suppression of Sexual Reproductive Health Rights (SRHR) is directly interlinked with serious societal problems such as poverty itself, hunger, malnutrition. HIV, AIDS and teenage pregnancies were excluded, and marginal groups are more vulnerable. Especially, I am talking about the sexual minority group which are included with Lesbian, Gay, Bisexual and Transgender and especially in Bangladesh context who are known as transgender and in Bengali or as the common South-Asian term the” Hijra.” The different perspective of showing light on them came to our notice when Bandhu Social Welfare Society (BSWS) at first pioneered this initiative of organizing Hijra Pride. The Ministry of Social Welfare and UNAIDS collaborated along with this initiative.6

While discussing with the Executive Director of BSWS Shale Ahmed as he clearly pointed that generation of fund is the crucial and hardest part to implement it and the thing is at the end it is not the sole responsibility of Bandhu only to promote this idea and implement soon in the future as it is only the beginning of where Bandhu started along with the partner organizations. “Until now, the crisis is increasing regarding the advocacy of HIV/AIDS including knowledge sharing, as the education ratio is very low among the Transgender/Hijra being socially excluded.

The concern is effort must be joint and altogether to address the alarming issue for the sexual minority otherwise, this parade for pride will be symbolism only in pen and paper.Attitude towards sexuality issue is a challenge. Manifestation occurs through different issues; like HIV/AIDS. Aside from going to work, hijras usually do not have any access to any social engagement. Mr. Ahmed further added that even though it was positive that law enforcement agency and especially police helped us as we must say Ms. Mili Biswas the Additional Police Commissioner helped us all the way as well as ministries stated by the executive director of BSWS. However, the hard and crucial fact is regarding negotiation and SRHR, the transgender and marginalized community are excluded in policy making and implementing. Whereas we have seen that acknowledging Hijra’s, it is one of the greatest achievements where third gender was regarded a part of gender identity in November 2013, and that is a milestone which has been decided by the government of Bangladesh. As this pride was to commemorate the day of third gender recognition for Hijra community, apparently, it was a huge success, but the question lies, ”What Next?”.

Based on the Hijra pride the “Dhaka Declaration 2014″ gave us clear messages regarding creating awareness, grooming of the community, identification, constitutional rights, advocacy efforts and incorporation of Hijra issues. We must not exclude them in formal education curriculum and create an opportunity to eliminate the discriminatory laws against the sexual minority where accelerating civil society movement can pave the way. None other than social campaigns, mobilization and effective participation can strengthen effort towards sensitizing family members where Ministry of Social Service and Ministry of Health can jointly initiate the project to address the SRHR.

Media sensitization can play the strongest role to promote their right based issues where advocacy efforts will be made for incorporating the issue of sexual minority communities in the government sector program for Child and Maternal Health. Here both the print and broadcast media can play an effective role. However, the question which is repeatedly hammering is that just only recognition and parade for their pride to be recognized cannot alone sort out those issues to be regarded. The declaration as well, must be under action and soon be implemented where monitoring and follow-up are required.

3. Nepal

Nepal has so far been issuing passports under two categories— male and female, codifying them as ‘M’ and ‘F,’ respectively. Though the government decided to issue passports to sexual minorities with their identity, it will be an uphill task for those who do not have citizenship certificates under ‘O’ category to get passports under that category. The first citizenship certificate under “O” category was issued in 2011 after a Supreme Court verdict. “Citizenship certificate should be converted into ‘O’ category before applying for such a passport,” added Shrestha. However, the existing Citizenship Act does not have a provision to change the details of citizenship card, a lawsuit demanding a provision to change one’s gender on citizenship (Pandey 2015).

4. Sri Lanka

Despite having the highest literacy rate in South Asia, the transgenders in Srilanka are also fighting for their rights. They are the targeted people, who face the discrimination that starts from their home; being the victim of domestic violence and later being the continuous victim of sexual violence.7 They are not well accepted and recognized for the rights of accessibility into the job, other social and health facilities and identity documents based on social, economic and the health services, i.e. marriage, hygienic facilities, depression, property, unemployment, and adoption. They have become the group who does not have any access to the housing, treatment for sexually transmitted diseases, excessive use of hormone pill, tobacco and alcohol (Nathaniel 2015).

5. Key Background, Analysis, and Data

Underpinning this work toward the realization of Convention to Eliminate All Forms of Discrimination Against Women (CEDAW) and Barbados program of Action (BPOA) is the full regime of international human rights instruments, including the UN Charter. These embody non-discrimination as a core principle and require that human rights be guaranteed for everyone without discrimination because they are indicated in a non-exhaustive list including race, color, sex, language, religion, political or another opinion, national or social origin, property, birth or another status. “Other Status” has been interpreted to include sexual orientation and gender identity by the decisions and general comments of multiple monitoring bodies of human rights treaties and political, human rights bodies.

Young and older transgender people are also at a heightened risk of poverty, violence, and homelessness. Additionally, this often goes unreported due to fear of reprisals against violence, or threats to confidentiality, especially in small and rural communities. Where civil society groups are advocating for systematic change in Asia- Pacific, there are also many state and non-state actor blockages, harassment and sometimes legal obstacles placed in the way of such social organizing.

6. The Range of Violence, Abuse, and Discrimination Includes

Transgenders are targets of violence, beatings and other forms of physical abuse from the law enforcement; being victims of “hate crimes’, sometimes attacked and murdered on the streets, ill-treatment, ejection from, denial of entry to and bullying in schools. Fear of violence and discrimination lead to young people leaving school, limiting education and subsequent employment opportunities. Lack of access to sick and dying partners in hospitals and in private homes, denial of and discrimination in employment, including in hiring and firing, ejection from or denial of access to housing, discrimination in and denial of health and other social services, fears of breaches of confidentiality and other policies create climate risk and have people not accessing health and other social services as a result. Denial of Asylum when proof of well–founded fears of persecution exists; they always become the regular subjection or verbal abuse.

Denial of legal registration of NGOs and networks working on related issues, active harassment of non-governmental organizations and networks working on related issues. Lack of Support, non-inclusion through to active harassment by mainstream civil society and social movements; media stories that are discriminatory or inflammatory. Other non-recognition and restriction on freedom of speech, association, and movement. These kinds of abuse affect health, education, employment, housing, economic opportunity, and healthy environments. It also worsens already limited economic opportunities and poverty. Being young and having limited access to decision making in one’s relationships and wider societies increase still more the risk of social exclusion.

6.1 Accordingly, Key Messages Include

Upholding the right to non-discrimination is essential to achieving the right of the third gender to development, justice, autonomy, dignity, security, equality, health, and wellbeing, education, housing, and employment, economic, trade, finances and more. Governments can take active steps to change social, political, traditional, cultural, religious attitudes and beliefs that perpetuate discrimination by sexual orientation, gender identity, and expression. Current development planning and policy implementation in most countries do not adequately take into account experiences of people marginalized because of sexual orientation, gender identity, and expression; there must be more resourced data collection and commitment to addressing groups that are still rendered invisible within the CEDAW, Beijing POA, MDGS and Post 2015 analysis. Attempts to criminalize transgenders in some countries, and ignoring old and archaic laws in others, have already increased high risks of violence, discrimination, and marginalization. Non-state actors, such as family and community members, as well as religious, traditional and other authorities, are sometimes responsible for perpetrating abuse and must be held accountable about relevant state and international human rights obligations.

7. Key Background, Analysis, and Data

Underpinning this work toward the realization of Convention to Eliminate All Forms of Discrimination Against Women (CEDAW) and Barbados program of Action (BPOA) is the full regime of international human rights instruments, including the UN Charter. These embody non-discrimination as a core principle and require that human rights be guaranteed for everyone without discrimination because they are indicated in a non-exhaustive list including race, color, sex, language, religion, political or another opinion, national or social origin, property, birth or another status. “Other Status” has been interpreted to include sexual orientation and gender identity by the decisions and general comments of multiple monitoring bodies of human rights treaties and political, human rights bodies. Helen Clark clearly stated

“Human beings cannot benefit from development progress if their lives are defined by inequity, exclusion, and policies which treat them as less than equal. This is true of all people who encounter marginalization and injustice, whether they be women living under laws which fail to provide equal status in all spheres of life, or persons of any gender who are ostracized because of their ethnicity, class, sexual orientation, or gender identity.”8

Sexual and Reproductive Health and Rights are critical for equality, development, and peace as high lightened in the 4th World Conference on Women held in Beijing in 1995 to their sexuality, that includes the crucial factors of the sexual and reproductive health rights which is free from any types of coercion, discrimination, deprivation and all sorts of violence. Sexual and reproductive health services should be freely available and accessible to all without discrimination, through the primary health care system, and provided in a way that respects human rights, including the rights to privacy, confidentiality, informed consent, bodily integrity. Legal, policy, financial and social barriers to access to sexual and reproductive health services should be addressed and overcome.

7.1 How broad is the context of sexual & reproductive health & rights

SRH policy and access to services are heavily influenced, often negatively, by socio-cultural and political factors in the local and international context, which is mainly influenced by the government, policymakers, and religious aspects and how it is influencing others regarding economic budget cut and financial planning as well.

7.2 Socio-cultural factor

Socio-cultural factors are crucial in determining the nature of sexual relationships, sexuality, and sexual behavior, and in a broader sense, how it is going to be the norm of practice across the society, family, and country. Issues of sex and sexuality are taught in a wrong manner from childhood in South Asia which is rather known as taboo in most cultures. It leads to a reluctance to discuss and address sexual health problems. It also leads to the stigma of those who do not conform to socially accepted norms of behavior. This, in the long run, in turn, reduces access to SRH services by these groups.

7.3 Gender Vs Ungender norms

The societal projection among people; to show that men are macho, where everything is legalized, and they can even stalk girls or women; start from home and even in the cultural aspects of film, media, and social media as well. Is it not obvious that women are supposed to be passive, quiet, fragile and vulnerable, and transgenders are repressed and oppressed while producing and cultivating stereotyping ideas about making all of them vulnerable in different ways to SRH problems and inhibiting access to services? The film, media, and literature who are supposed to be more vocal for them, instead inflict those ideas among the common people.

7.4 Political factors

Nowadays SRHR has become the most crucial part of politics which is determined by socio-cultural and economic perspectives including religion.The policy makers are mostly the male even though it has become a common practice where children and women affairs ministry must be under the female minister.Most of the policies are less concerned about sexual health and systematically deprive the people from having the implementation of global and universal policies.9 However, there are examples of social movements, especially in India, where the community has managed to push issues onto the political agenda and helped to achieve increased access to services, for example on issues such as HIV/AIDS, and sexuality.

7.5 Stigma and Marginalization

This is compounded by the fact that it is often hard for marginalized groups to lobby for increased access, for example, the government in Nepal has attempted to shut them down. It is the fact that transgenders in South Asia are often stigmatized and marginalized as well as inequity in access is there to be addressed. Generally, in South Asia, the norms are all consisted along with the common concepts of sex and sexual relations, which are usually heterosexual and within marriage.

7.6 HIV Risk among Transgenders

The transgenders are in most of the cases deprived of health facilities and in most of the cases, they are engaged in earning livelihood by being sex workers and that is last resort to earn money. The income generation activities and lack of inclusion-based policies do make them more vulnerable towards sex work and being vulnerable to sexually transmitted diseases without any prevention (Godwin 2010).10

7.7 Legal and Human Rights Context of South Asia

There are some recent examples of protective and enabling laws, most notably in Asia and the Pacific. Many constitutions in Asia do have specific clauses for non-discrimination based on sex including Indonesia, Bangladesh, Sri Lanka, and Thailand. Furthermore, through precedent-setting court cases, the governments of India and Nepal have been obligated to provide sexual minorities a life guaranteed by non-discrimination (Herbst 2008:1-17). Even as early as 1990, the Nepal Treaty Act included the following language:

“These people have been compelled to appear in the public life with the identity as determined according to their genital instead of their characteristics, and it is very important to rethink the state of affairs in the context of human rights and fundamental rights.We also should internalize the international practices in regards to the enjoyment of the right of an individual, changing world society and practices of respecting the rights of minority gradually. Otherwise, our commitment towards the human rights will be questioned internationally, if we ignore the rights of such people only on the ground that it might be a social stigma”.Recent court judgments have improved the legal environment for sexual minorities in other countries in the region and beyond including Pakistan, Philippines, Fiji, South Korea and Hong Kong SAR of China. However, non-discrimination for gender minorities has lagged with only the interim constitution of Nepal including language on non-discrimination for transgender people in Article 13 and Article 33 and 34 of their Interim Constitution’’ (Bhardawaj 2011).

Once you are a transgender, you will face discrimination from the birth and even after death. In some of the countries they do not even have access to religious rituals to be buried and in most of the cases are treated as unwanted and unaccepted.Not that these discriminations are mostly state sponsored but the state does not respond either in a positive way rather maintain a far distance and keep them more vulnerable to access to health facilities, basic rights of living and earning money with decent jobs and friendly environment. The recognition of being third gender could not ensure that till now.

8. Social Exclusion

For example, an ethnographic study of transgender people (hijra) in Bangladesh described their location at the extreme margin of exclusion, having no sociopolitical power. The investigators found that these deprivations were grounded in non-recognition beyond the male-female dichotomy (Khan 2008:127-41); (Khan 2009:441-51). Being outside this binary, hijras and many other transgender people around the world have experienced repeated physical, verbal, and sexual abuse (Lombardi 2001:89-101).

This abuse often takes place at the hands of those entrusted to protect civil society. For example, a non-governmental organization (NGO) in India has reported multiple episodes of hijras being arrested, beaten, and humiliated by police, and then being brought up on false charges. In one incident, a young hijra was gang-raped by ten men. Instead of arresting the perpetrator, the police arrested the victim, forced her to stand naked for seven hours while being beaten, kicked, and tortured by genital burning. It took a public hunger strike before the police force would register her complaint about the incident (Law 2011). This type of extreme social exclusion and discrimination has been found to diminish self-esteem and sense of social responsibility, thus making it difficult to ensure uptake of safer sex messages aimed at reducing HIV- related risks among transgender women. If we do focus on the current perspectives for the transgender women one of the factors to be considered as crucial is lack of the accessibility for the legal aid. That causes the ground for their identification cards including passports and another medium of verification, as well. It is more about gender rather than genetic make-up. If we take the case study of Latin America, as an example Colombia, the findings showed how they exclude the transgenders regarding having health care facilities. That is not the end; they are also denied to a national identity card as well as other verification cards. They have also been associated with indiscriminate arrests of transgender women and police brutality (Sanchez 2008).

Mental health issues are the factors that include some of the risk factors as well for the high level of risk regarding sexual practices among the excluded and vulnerable group, who are known as the sexual minority. That shows a clear credence for the role of the vitally important health outcomes (Reisner 2008: 501-13). While there has been some improvement in medical provider attitudes and knowledge over time, bias and lack of knowledge persists (Lurie 2005: 93-112). Providers’ attitudes towards transgender people are barriers to care and limit access to early testing and treatment for HIV (Rachlin 2008: 243-58) and (Sanchez 2009: 713-19). Lack of access to legitimate medical sources for transition-related care leads many transgender women to use and share syringes for illicit hormone and silicone injections, which may increase risks of HIV (Wallace 2010: 439-46).

9. Policy Recommendations 

As discussed in another paper in this series, sexual practices among transgender women including sex with another biological male are already criminalized in a large proportion of UN member states. However, even in countries where same-sex practices are accepted, homophobia still now exists and is prevailing. The discrimination and solidarity through rainbow parades are still now far behind the reality of actual discrimination in the developed countries. State, church-based faith groups and followers, as well as anti-LGBTQ groups, are always active to obstruct the progress. It is obvious and clear that without the full protection and mechanism you might not have access to the basic rights of employment, health, education and other social and economic benefits especially in the context of South Asia. Undoubtedly this group is treated as third class citizens for being the third gender until and unless they belong to a powerful and wealthy status or maybe in some cases, maintain a hide-out identity in front of the society.

10. Conclusion

The exclusion of the sexual minority has become a crucial agenda for all of us who are concerned to start reviewing scale up efforts, and if necessary, amend national health and population laws and policies to ensure that they are grounded in sexual and reproductive health and rights and eliminate barriers to access or laws that restrict access to essential sexual and reproductive health services for transgenders. Right now, we have to increase funding and budgetary allocations for SRH services as part of increased health and social spending overall, and ensure sufficient, dedicated resources including human, financial and material training of health workers and strengthening of supply chains, to enable the provision of safe and acceptable comprehensive sexual and reproductive health services.

The excluded sexual minority have to address the crucial part of restructuring donors and funding to support the provision of family planning services that are integrated within a large package of comprehensive SRH services must be there to ensure the sustainability. The necessity of establishing inter-sectorial coordination and collaboration for an integrated approach to the provision of sexual and reproductive health services to address the needs of all individuals, irrespective of gender, age, sexual orientation or gender identity, race, ethnicity is crucially and equally important.

The policymakers need to be more focused on the issues like the HIV status, marital status, employment, or on other grounds, increase equity in access to sexual and reproductive health services by addressing the social and cultural determinants, such as  gender, socio-economic class, caste/ethnicity and societal norms/practices.

The practitioners have to be focused more on how to embed the youth SRHR agenda in a wider multi-sectoral approach for youth development through linkages with education, vocational skill building, and economic programs should be emphasized as a back and forth. We need to review, amend and repeal discriminatory laws and policies about sexual and reproductive health and rights. In line with this, policies against stigmatization and discrimination of these people practicing their sexual and reproductive rights should be implemented. Laws and harmful practices that discriminate transgenders should be eliminated. We have to expand SRHR programming for the youth by recognizing and addressing the diversity of young people, especially groups that are marginalized.We need to integrate SRHR and HIV services to ensure that the larger SRH needs of the population are sufficiently addressed.

The educators in the mainstream education centers need to negotiate with the governments to ensure access to SRHR information and services, including SRHR policies for transgenders. We have to emphasize the perspectives based on the reduction of the unmet need for contraceptives through the provision of services that offer diversity in method choice, and that are provided in a gender-sensitive, non-judgmental fashion, responsive to the various needs of sub-populations and marginalized groups.

The much-required program for the reformation of contraceptive delivery programs should address the perspectives mentioned below: 

a) The excluded sexual minority have to meet acceptable and appropriate standards of care;
b) They need to adhere to the ethical considerations of informed consent and;
c) The included mechanism must uphold the fundamental rights of individuals seeking services.

Sustainability of the efforts to strengthen public health systems, strictly monitor, and regulate the functioning of public-private partnership by the government to ensure the SRH rights and needs of individuals are adequately met. We need an action to enhancing data collection on all issues within the domain of sexual and reproductive health rights that can aid future advocacy and action. 

References

Bhardawaj, K., and V. Divan (2011). A Legal and Jurisprudential Review of Select Countries in the SEARO Region: Bangladesh, India, Indonesia, Nepal, Sri Lanka, and Thailand, in Sexual Health and Human Right. I.C.O.H.R. Policy. WHO: Geneva.

Godwin, J (2010). Legal Environments, Human Rights, and HIV Responses among Men Who Have Sex with Men and Transgender People in Asia and the Pacific: An Agenda for Action,  APCOM: Bangkok

Herbst. J.H et al. (2008). “HIV Prevalence and Risk Behaviors of Transgender Persons in the United States: A Systematic Review, AIDS Behave,” 12 (1), 1-17

Khan, S.I, et al. (2008). “Not to Stigmatize but to Humanize Sexual Lives of the Transgender (Hijra) in Bangladesh: Condom Chat in the AIDS Era, J LGBT Health Res,” 2008, 127-141.

Khan, S.I, et al. (2009). Living on the Extreme Margin: Social Exclusion of the Transgender Population (hijra) in Bangladesh Health Population Nutrition. 27( 4),441-51.

Lombardi, E.El (2001). Gender Violence: Transgender Experiences with Violence and Discrimination, Journal of Homosexuality. 42(1):,89-101.

Law, G.C.o.H.a.t (2011). Selected Submissions from the Global Commission on HIV and the Law – Asia-Pacific, Caribbean, Eastern Europe & Central Asia and Latin America, in Regional Dialogues, U.H.A.Practice, UNDP: PortofSpain, Trinidad. http://www.msmagazine.com/winter2010/condomsarrest.asp.

Lurie, S (2005). Identifying Training Needs of Healthcare Providers Related to Treatment and Care of Transgendered Patients: A Qualitative Needs Assessment Conducted in New England. International Journal of Transgenderism,8 (2-3), 93-112.

Moscowitz, Marc. L(2010). Gay Marriage in Television News: Voice and Visual Representation in the Same-sex Marriage Debate, Journal of Broadcasting & Electronic Media”, Web of Science ®. Taylor & Francis Online, ,54(1), , 24–39.

Nathaniel, Camellia (2015).”Seeking Equal Rights.”, The Sunday Leader.

Pandey, Lekhanath”(2015). “LGBT to Get Passports under ‘O’ category, The Himalayan Times

Reisner, S.L, et al. (2008). A Mixed Methods Study of the Sexual Health Needs of New England Transmen Who Have Sex with Non-transgender Men. AIDS Patient Care STDS. 501-13.

Rachlin, K, et al.(2008).Utilization of Health Care among Female-to-male Transgender Individuals in the United States.Journal of Homosexuality 54 (3), 243-58.

Santis, J.P. De(2009).HIV Infection Risk Factors among Male-to-female Transgender Persons: A Review of the Literature Associates Nurses AIDS Care. 20( 5),362-72.

Sanchez, Riascos, V.P, et al. (2008). ID Cards That Reflect Gender Identity Can play a role in Reducing Vulnerability of Transgender Sex Workers (MOAD0305,), in XVII International AIDS Conference, IAS: Mexico City. In Most Settings around the World, It Is Legally and Financially Prohibits.

Sanchez, N.F, et al. (2009). Health Care Utilization, Barriers to Care, and Hormone Usage among Male-to-female Transgender Persons in New York City. American Journal of Public Health, 99 (4), 713-19.

Wallace, P.M (2010).Finding Self: A Qualitative Study of Transgender, Transitioning, and Adulterated Silicone. Health Education Journal,69. (4), 439-46.

Endnotes

[1]. Article 23 of the International Covenant on Civil and Political Rights 1966 recognizes that the families are fundamental group units of society and are entitled to protection by society and the state. “The Family is the natural and fundamental group unit of society and is entitled to protection by society and the state. http://arrow.org.my/wp-content/uploads/2015/04/SRHR-in-the-Post-2015-Agenda_Policy-Brief_2014.pdf

[2]. However, sometimes protection of family does not include protection of the rights of the individuals insofar as their sexual rights are concerned. Sexuality is as much a part, if not more, of being fully human and fully alive as needing food and water to live. It is the essence of the joy of being alive, and its meaning is far broader than biological processes: it encompasses spiritually, human nature and social culture. http://www.ohchr.org/EN/ProfessionalInterest/Pages/CCPR.aspx 

[3]. Simply defined, sexual and reproductive health rights are the right for all people, regardless of age, gender and other characteristics, to make choices regarding their sexuality and reproduction, provided that they respect the rights of others. It includes the right to access to information and services to support these choices and promote sexual and reproductive health (SRH). https://assets.publishing.service.gov.uk/media/57a08c2940f0b64974001036/LitRevie

[4]. Reproductive rights were first officially recognized at the International Conference on Population and Development (ICPD) in Cairo in 1994. Before this, reproductive health programming had focused on family planning, fertility control, and safe motherhood, having emerged from concern about population control. The definition of SRH agreed in Cairo moved beyond this, and was notable for being broad and comprehensive, and for placing reproductive health in the context of human rights and the right to health.

http://www.tigurl.org/images/resources/tool/docs/2649.doc 

[5]. Relating to antenatal, perinatal, postpartum for the mothers and newborn care and Family planning services including infertility and contraception? Right now, it is important to ensure the elimination of unsafe abortions, prevention, and treatment of STIs, HIV/AIDS, RTIs, cervical cancer, etc. Promotion of healthy sexuality should be the primary concern to be added. https://assets.publishing.service.gov.uk/media/57a08c2940f0b64974001036/LitRevie 

[6]. Bandhu Social Welfare Society (BSWS) jointly with Ministry of Social Welfare and UNAIDS, therefore, organized Hijra Pride 2014 to commemorate the day of third gender recognition for Hijra Community with the graceful support of its development partners at divisional and central level. Some community-based organizations including Sustha Jibon, Shomporker Noya Shetu, and Rupbaan collaborated with BSWS to make this event a huge success, but the question is what next and who will be the next torchbearer? http://www.bandhu-bd.org/hijra-pride-2014/ 

[7]. The transgender persons are more often deprived of fundamental rights though they are human beings. They face a range of social and legal issues such as having to have identity documents without gender recognition avoid sex-segregated public restrooms and other facilities, having to accept dress codes that perpetuate traditional gender norms and to face barriers when they need appropriate health care. In Sri Lanka, they have been extremely exposed to various kinds of discrimination including domestic violence, family discrimination, sexual harassments, educational limitations, the right to employment, legal inequality, and harassments from law enforcement authorities. As a result, their livelihoods are severely affected. http://articles.urnotalone.com/Seeking+Equal+Rights/?16727 

[8]. UNDP Administrator Statement on the International Day for the Elimination of Homophobia and Transphobia (IDAHOT). http://thepoc.net/index.php/undp-administrator-statement-on-international-day-ag 

[9]. Political factors are themselves often influenced strongly by the socio-cultural context at national & international levels. As previously mentioned, the international policy context is clear on issues of reproductive health (ICPD program of action) (less so on sexual health). However, there is a general lack of national & international political will to act to implement international policy. In many countries, systems are not in place for the population to demand accountability of the government to provide quality services, and there are limited opportunities for civil society groups to participate in policy debates. However, there are examples of where social mobilization has managed to push issues onto the political agenda and helped to achieve increased access to services, for example on issues such as HIV/AIDS, and sexuality. https://assets.publishing.service.gov.uk/media/57a08c2940f0b64974001036/LitRevie

[10]. In the few places where epidemiological data on transgender women is gathered, they demonstrate disproportionate risk for HIV. The difference in HIV prevalence between studies using laboratory markers and those with self-report only suggest that many transgender women may not be aware of their HIV status.  

https://assets.publishing.service.gov.uk/media/57a08c2940f0b64974001036/LitRevie    

Author (s) Biography

Natasha Israt Kabir is a freelance researcher, president and founder of the BRIDGE Foundation. She teaches at the Department of Law and Justice in the Jahangirnagar University, Bangladesh. She serves as Charles Wallace Trust Fellow, UK and US State Department alumni as well. Her research area covers Colonialism & Asiatic Mode of Production, Nationalism, South Asia, Peace & Conflict Resolution, International Politics, Contemporary International Relations, Culture & Economy, Energy Security, Environment, European Integration, Diaspora, Government & Politics, World Affairs, Regional Cooperation, Foreign Policy and Disaster Management.

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Sexual and Reproductive Health Rights in South Asia: Challenges and Policies by South Asian Youth Research Institute for Development (SAYRID) is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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