From Data to Dignity: What the SAHAJ Study Reveals about Trans Rights and the New Trans Act 

Across India, trans and gender-diverse persons continue to fight a dual battle, for legal recognition and for the right to live with dignity. In Gujarat, the recent SAHAJ–Foram Foundation study on Transpersons’ Access to Sexual and Reproductive Health and Rights (SRHR) offers critical data-driven insights into this struggle. Rooted in feminist research principles and led by community voices, this study provides a mirror to the gaps of our health and governance systems, all of which are likely to deepen with the new Transgender Persons Act, 2026.  

As we inch closer to the 2030 deadline of the commitment to the Sustainable Development Goals (SDGs), especially SDG 3 on health and SDG 5 on gender equality, this research raises a stark question: who counts as “everyone” in leave no one behind?  

A Feminist Framework of Participation and Validation  

The research is significant not only for what it found, but for how it was done. The study was initiated through consultations with trans representatives who identified the SRHR questions they wanted answered, and it remained community-validated at the stages of design, interpretation, and dissemination.  

 Twenty-four in-depth interviews across Ahmedabad, Surat, and Vadodara surfaced voices spanning trans men, trans women, and Hijra communities. Each story reflected how systemic exclusion from SRHR services compounds other forms of economic and social marginalisation.  

A Landscape of Denial: What the Data Says  

“I had not thought I would face so many problems… I could not find a single home in this city. People were like – Are you transgender? No, no, we can’t give you the house. There was a lady – a landlord. She refused me. I asked her Why are you refusing me? I am willing to pay you what you are asking for. She said, If you stay here, others like you will come. …It was very hard for me. These problems do exist. You cannot find a house; you cannot find a job.” (R22, 21-year-old TW) 

The insights from Gujarat mirror patterns visible across India: systemic gaps in access, information, and respectful care.  

• Access to Gender-Affirming Healthcare: Only three districts in Gujarat- Ahmedabad, Vadodara, and Surat, offer gender affirming treatments through public facilities. For most of the state’s trans citizens, essential surgeries and hormone therapies remain inaccessible, unaffordable, and poorly communicated.  
• Knowledge Gaps and Inadequate Information: Trans and Hijra respondents often learned about treatments from peers, not doctors. Misinformation about surgical options, hormone side effects, and aftercare was rampant, revealing the inadequacy of the medical system to provide accurate, affirming guidance.  
• Economic Implications: Gender-affirming surgeries cost between ₹2.4 and ₹5 lakh (2500 to 5000 USD), far beyond the reach of most participants, pushing several trans women into obscure work to finance medical transitions.  
• Discrimination across Institutions: Violence by family, rejection from schools and workplaces, and denial of accommodation formed the backdrop of almost every life story. For many, accessing basic healthcare meant negotiating fear and humiliation.  
• Scarcity of Data: The study also highlights a deeper structural problem the near-total invisibility of trans health data in India’s official statistics. Without disaggregated data, trans persons remain unseen within “universal” health narratives, making rights-based policy interventions nearly impossible.  

The Promise vs. The Reality: Context of the New Trans Act 

The 2014 NALSA judgement had raised hope that India might move toward a rights-based understanding of gender identity, one anchored in self-identification, dignity, and non-discrimination. The new Transgender Persons Act, however, challenges that premise.  

The revised Act introduces a medical board into the process of legal recognition, replacing the rights-based self-identification principle. That shift matters profoundly. It moves authority over gender identity away from the person and toward the state and medical gatekeepers, creating a system where trans people must again prove who they are to be recognised.  

For a community already facing delays, cost barriers, and patchy access to care, this is not a neutral administrative change. It risks deepening exclusion by making legal identity depend on an overburdened health system, medical certification, and bureaucratic discretion. It also creates additional exposure to outing, stigma, and refusal, especially for people who already avoid disclosure in healthcare settings because of disrespect, misgendering, or privacy concerns.  

The SAHAJ study shows why this matters: Respondents were already navigating major barriers to accessing even basic and gender affirming care, including limited availability of services, lack of informed counselling, and poor aftercare. In that context, making certification more central is likely to intensify harm rather than expand rights.  

From a feminist policy lens, the issue is not simply whether a certificate exists. The deeper question is: who gets to define personhood, and what institutional power is being exercised over structurally excluded bodies? The research data shows that trans people are not asking for exceptional treatment; they are asking for systems that work, respect, and recognise them as rights-bearing citizens.   

This includes:  

• timely, affordable, and decentralised gender-affirming care;  
• trained providers who understand different trans identities and health needs;  
• privacy and non-discrimination in public hospitals;  
• comprehensive sexuality education in schools;  
• safe housing, education, and work opportunities;  
• and policy design that includes trans-led organisations at every stage.   

These are not “special interests”. They are the essential conditions for equal citizenship.  

What the evidence demands  

The study makes a strong case for policy action in four areas. First, healthcare must be decentralised beyond a few urban centres, with at least one equipped hospital or referral point in every district, including counselling and follow-up services. Second, providers need training on trans-specific health needs, including communication, confidentiality, hormone therapy, surgical aftercare, and reproductive health. Third, public systems must stop treating trans identity as a problem to be certified and instead recognise self-determination as the basis of dignity and access. Fourth, government and CSR programmes should fund trans-led, community-rooted support systems, because the study clearly shows how often NGOs become the only safe and affirming spaces available.   

The Act moves in the opposite direction. It expands state oversight over identity instead of expanding access to care and inclusion. That is why civil society concerns are so strong: the new Act risks creating more paperwork, more gatekeeping, and more vulnerability without addressing the real barriers trans people face. The evidence is already clear. What remains is the political will to act on it.