The transgender community has been part of India’s social fabric for centuries, but decades of policy neglect pushed many into poverty and inadequate health care. 

The Supreme Court formally recognized trans people as a third gender in 2014, yet state-level services developed slowly. Telangana opened India’s first dedicated trans clinic, the Mitr Clinic, in 2021 with support from the U.S. Agency for International Development and Johns Hopkins University. Jharkhand State has now ordered all government hospitals and medical colleges to establish dedicated outpatient units for transgender patients.

People for Change, an LGBTQ organization, spent the past year mapping gaps in trans health care across Jharkhand. Its surveys of 100 trans residents in five districts found limited access to gender-affirming care, hormone therapy, dermatology, and mental-health services. The group followed this survey with a May 2025 consultation in Jamshedpur, an industrial town in Jharkhand, that brought together clinicians and community leaders to outline a feasible outpatient model. 

Those findings were presented to Health Minister Irfan Ansari in June, backed by input from allied organizations and more than 50 trans leaders. The process helped inform the state’s decision to introduce dedicated trans outpatient departments in all government hospitals and medical colleges.

People for Change, which played a central role in shaping the policy, noted that government hospitals in Jharkhand still face infrastructure and resource gaps. Even so, the group said the order reflects a clear policy commitment to creating dedicated trans health services.

If Jharkhand’s trans outpatient departments system functions as planned, it could become a regional model for states with comparable gaps in public health access. 

Government data from the 2011 Census — the latest official count to identify an “other” gender category — lists 13,463 trans residents in Jharkhand, alongside sizable populations in neighboring states: 40,827 in Bihar, 30,349 in West Bengal, 22,364 in Odisha, 18,489 in Chhattisgarh, and 137,465 in Uttar Pradesh. Though likely underreported, these figures underscore the scale of need across eastern and central India.

“The decision to start dedicated transgender OPDs (outpatient departments) is not just an administrative step — it is a statement of inclusion, a recognition that the transgender community deserves discrimination-free, dignified, and responsive healthcare. When the government takes such a deliberate step, it sets a tone for systemic change,” said Souvik Saha, founder of People for Change. “It creates an official entry point for transgender healthcare.”

“For the first time, transgender persons will have a recognized and respectful space within the public health system,” added Saha. “That itself is a major shift. It signals to doctors, nurses, and administrators that transgender health is a priority. This leads to sensitization, accountability, and the gradual improvement of attitudes within hospitals.”

Saha told the Washington Blade the policy is likely to trigger broader improvements, noting that once a service is formally notified, budget allocations, training, infrastructure, and staffing typically follow. He said the move could strengthen the system gradually, “step by step.”

“We are realistic: we know improvements won’t happen overnight. But we are also optimistic because the state has already shown genuine leadership and empathy by issuing this order,” said Saha. “And since Jharkhand is celebrating its 25th year of formation, this decision reflects the state’s intention to move towards greater equality and social justice.” 

“For the transgender community, this is not just a service — it is dignity. It is visibility. It is inclusion,” he added. “And with the government, civil society, and community working together, we believe this will lead to meaningful and lasting change in the years ahead.”

Saha told the Blade that the dedicated transgender outpatient will operate within existing government medical colleges and hospitals in Jharkhand and will be staffed by current medical and paramedical teams, with no separate funding required at this stage. He said the policy does not call for separate wards or beds, but for clearly designated outpatient spaces for trans patients. The service, he added, will be run by existing staff who will receive training and orientation as needed.

“At this moment, the specific operational details are still being discussed with the government of Jharkhand. However, what is clear is: the OPD will function as a dedicated space within the hospital, not limited to a specific day,” said Saha. “Transgender individuals will have access to focused, discrimination-free services through this dedicated space. The clinic will run through existing hospital systems, with linkages to psychiatry, dermatology, endocrinology, and other departments when required.”

“This structure allows the government to start services immediately without needing new construction, new staff positions, or separate budget lines,” he added. “It is a practical and efficient first step, making the service accessible while keeping the doors open for: future budget allocations, specialized staffing, expansions into gender-affirming services, and strengthened infrastructure. The government’s intent is very clear: to ensure dignified, equitable, and discrimination-free healthcare for the transgender community. This order is a strong beginning, and operational details will continue to evolve through collaborative discussions between the government, hospitals, and People for Change.”

Saha acknowledged that taboos, misinformation, and stereotypes about the trans community persist in Jharkhand and in many other states. However, Saha said there are encouraging models at which to look. 

He pointed to Kerala and Chhattisgarh, which have introduced sensitization programs and begun integrating trans-inclusive practices into their public health systems. These examples, he noted, show that when health departments invest in training and awareness, attitudes shift and services become more respectful and accessible.

“In Jharkhand, People for Change has proposed a similar approach. We have formally recommended to the government that civil surgeons, chief medical officer, doctors, nurses, and other hospital staff be trained on gender sensitization and transgender health challenges. This includes understanding gender identity, psychological needs, respectful communication, medical protocols, and ways to ensure discrimination-free services,” said Saha. “The encouraging part is that these proposals are already being discussed in detail with the government of Jharkhand. The government has shown strong intent through the issuance of the transgender OPD order, and training health professionals is naturally the next crucial step.”

Saha noted that it remains unclear whether trans people will be recruited into government health roles, saying it is too early to make any definitive statement. He explained that recruitment requires separate processes, policies, and approvals, and the current order does not address new staffing or the creation of government positions.

A recent performance audit by the Comptroller and Auditor General of India, the constitutional authority responsible for auditing government spending and administration, outlined severe human-resource and medicine shortages across Jharkhand’s public health system. 

Tabled in the state assembly in February, the report found that about 61 percent of sanctioned posts for medical officers and specialists were vacant, along with more than half of all staff-nurse positions and roughly four-fifths of paramedic posts. The audit also documented acute shortages of essential drugs in the hospitals it reviewed, with stock gaps ranging from 65 to 95 percent during the 2020-2022 period. The findings highlight the systemic constraints that the new trans outpatients will have to navigate.

Saha acknowledged that drug shortages remain a serious issue in government hospitals and said the concern is valid. Even so, he added that he is approaching the new outpatient policy with hope and confidence.

“The government of Jharkhand has made a historic and intentional decision by opening dedicated transgender OPDs,” said Saha. “When a government takes such a strong step of recognition and inclusion, it also shows the readiness to understand the specific health challenges and medication needs of the transgender community.” 

“As more transgender persons start coming to the OPDs and their health requirements become clearer through proper documentation and reporting, we are confident that the state will make every effort to ensure that essential medicines are available for them,” he added.

Saha said People for Change is also seeking support outside the public system. The organization has begun briefing civic service groups — including Lions Club, Rotary Club and Inner Wheel, international volunteer organizations that run local welfare and health projects — on the outpatient order and the community’s needs. According to Saha, several of these groups have indicated they may help trans patients with medicines and other essentials when prescribed by a doctor.

“So the effort is two-fold: the government is creating an inclusive health system and will be informed of the community’s specific medicinal needs through the OPDs. People for Change and partners are strengthening the safety net to ensure that transgender persons are never left unsupported,” said Saha. “We truly believe that this collaborative approach will ensure that transgender individuals receive the medication and care they deserve — with dignity, consistency, and compassion.”

“Every hospital may take a slightly different amount of time depending on internal readiness, but overall: The foundational work is already underway, Hospitals have started preparing their designated OPD spaces, And coordination is happening at the level of civil surgeons, medical superintendents, and hospital management teams,” he added.

The European Union’s top court on Tuesday ruled member states must recognize same-sex marriages legally performed in other member states.

The EU Court of Justice in Luxembourg ruled in favor of a couple who challenged Poland’s refusal to recognize their German marriage.

ILGA-Europe notes Polish authorities refused “to transcribe into the civil register a certificate of same-sex marriage concluded” in Germany “between a Polish citizen and a Polish-German citizen … on the grounds that Polish law does not allow same-sex marriage.”

The couple who lives in Poland brought their case to Polish courts. The Polish Supreme Administrative Court referred it to the EU Court of Justice.  

“Today’s ruling of the Court of Justice of the EU is of key importance not only for the couple involved in the case, but also for the entire LGBT+ community in Poland,” said the Campaign Against Homophobia, a Polish LGBTQ and intersex rights group, in response to the decision. “It clearly states that refusing to transcribe a marriage concluded abroad is incompatible with EU law. Therefore, regardless of the absence of registered partnerships and marriage equality, Poland must ensure the possibility of effective transcription.” 

“With this judgment, the CJEU clearly states that the recognition of marriage status is key to enjoying EU citizens’ fundamental right to freedom of movement across the EU,” added ILGA-Europe Advocacy Director Katrin Hugendubel. “The EC now needs to ensure that this judgment is implemented quickly by the Polish state and across the EU.”

Sixteen EU countries — Ireland, Portugal, Spain, France, Luxembourg, Belgium, the Netherlands, Germany, Denmark, Austria, Slovenia, Malta, Greece, Sweden, Finland, and Estonia — have extended full marriage rights to same-sex couples. Poland, Romania, Bulgaria, and Slovakia are the EU countries with no legal recognition of same-sex couples.

The Dominican Republic’s Constitutional Court on Nov. 18 ruled the country’s National Police and Armed Forces cannot criminalize consensual same-sex sexual relations among its members.

Human Rights Watch in a press release notes the landmark decision struck down Article 210 of the National Police’s Code of Justice and Article 260 of the Armed Forces’ Code of Justice.

Police officers and servicemembers who engaged in same sex “sodomy” faced up to two years or one year in prison respectively. Human Rights Watch in its press release said the provisions violated “constitutional guarantees to nondiscrimination, privacy, free development of personality, and the right to work” in the Dominican Republic.

“For decades, these provisions forced LGBT officers to live in fear of punishment simply for who they are,” said Cristian González Cabrera, a senior Human Rights Watch researcher. “This ruling is a resounding affirmation that a more inclusive future is both possible and required under Dominican law.”

Consensual same-sex sexual relations have been legal in the Dominican Republic since 1822, more than two decades before it declared independence from neighboring Haiti.

The Armed Forces Code of Justice had been in place since 1953. The National Police Code of Justice took effect in 1966.

Anderson Javiel Dirocie de León and Patricia M. Santana Nina challenged the policies in court.

“This decision marks a decisive step toward ensuring that these institutions, as well as any public or private body, adapt their rules and practices to guarantee that no person is discriminated against or sanctioned for their sexual orientation,” said Santana in the press release.

Dominican law does not ban discrimination based on sexual orientation or gender identity in employment, education, housing, and other areas. The country’s constitution defines marriage as between a man and a woman.

James “Wally” Brewster, who was the U.S. ambassador to the Dominican Republic from 2013-2017, is openly gay. Religious leaders frequently criticized him and his husband, Bob Satawake.

Brewster in a text message to the Washington Blade said the Constitutional Court ruling is “important.”