On 15 April, 2014, the Supreme Court of India directed the Centre and state governments to grant legal recognition of their identity.
Following this direction, a transgender policy was implemented soon by the Kerala government making it the first state in the country to have a transgender policy in place.
The acclaimed transgender policy of 2015, according to the Social Justice Department, was intended to solve the problems of transgenders.
Through the efforts of the government and non-governmental organisations, the social stigma as well as the social conditions of transgenders in Kerala may have improved. However, the situation is far from perfect.
One of the crises the government transgender employees face is the lack of paid leaves and delay in reimbursement after their gender-affirmation surgeries.
Gender affirmation surgeries are a series of procedures that help a transgender individual transition into a self-identified gender.
According to transgenders, the surgery requires a minimum of two months to undergo, as well as adequate rest post the process.
However, the Kerala government currently has no provision for paid leaves for an individual who undergoes the surgery. Most transgenders have to take unpaid medical leaves and wait for long periods to get a partial reimbursement of the surgery fee.
South First spoke to Sudheesh (name changed), a transgender employee of the Kerala government.
According to him, a transgender person already requires numerous leaves for undergoing hormonal treatment.
In addition to such leaves, when they are asked to take unpaid leaves during their surgeries, it acts as an extra burden.
“As a transgender, for hormone treatment and for undergoing surgeries, I will need a lot of leaves. But a government employee only gets 20 casual leaves a year. For medical leave, we don’t get paid. For a transgender, even for top surgery, the doctors prescribe three weeks of rest. If we do bottom surgeries, the doctors recommend rest for at least two-three months. This becomes too difficult and puts a lot of burden on us,” explained Sudheesh.
He also opined that similar to maternity leave for females, the government should consider providing leaves for transgenders so that they can undergo the procedure.
Include gender affirmation surgery under insurance
The Kerala government provides insurance to all of its serving employees through the Medisep scheme.
According to the Medisep website, the scheme provides insurance coverage to all serving employees of the state government, including the Kerala High Court, who are covered under the existing Kerala Government Servants Medical Attendant Rules [KGSMA Rules, 1960] and pensioners.
However, the important requirements for transgender individuals — like counselling, treatment for hormonal imbalance, and gender affirmation surgeries — are not included in the insurance coverage.
For Sudheesh, who has to also take care of his family, losing a few months’ wages can inflict heavy damages. Adding to the crisis is the long delay in getting reimbursement for the surgeries from the government.
“I did my gender affirmation top surgery in April 2021, and received a partial reimbursement in March 2022. I did it by taking a loan from a bank. The cost of the surgery was around ₹20 lakh since I underwent the procedure at a good hospital, and the government reimbursed up to ₹5 lakh,” he said.
Anil A, a queer ally who has been working in the area for decades, told South First that the government hospitals in the state do not have the facility to do gender affirmation surgeries.
Since there was a lack of government hospitals, reimbursement provided by the state — ₹2-5 lakh — was not adequate.
“Primarily, government hospitals do not have the facilities for transgender individuals to undergo the surgery. The facility is only available in multispeciality private hospitals like Amrita and Aster Medicity, where it is very expensive. Moreover, the government provides an amount between up to ₹5 lakh for a transman and ₹3.5 lakh for a transwoman,” said Anil.