Photo: Shrouded in Mystery — Roehan Rengadurai

Transgender Inclusive Development

Experience from sanitation projects in South Asia

In its April 2018 issue, the Waterlines Journal is publishing an article documenting efforts to include transgender people in sanitation programmes in South Asia. It focuses on equitable access to toilets. It provides an introduction to transgender identities in South Asia, case studies of trans inclusion in sanitation initiatives from India and Nepal, and advice for practitioners, including recommendations that are both specific to sanitation, and of general relevance to practitioners in other fields.

What do we mean by the term transgender or trans?

The term transgender is commonly used but often knowing what it does (and does not) encompass can be difficult. The World Health Organization defines transgender people as:

Persons who identify themselves in a different gender than that assigned to them at birth. They may express their identity differently to that expected of the gender role assigned to them at birth. Trans/transgender persons often identify themselves in ways that are locally, socially, culturally, religiously, or spiritually defined (WHO, 2012).

Third gender is a term commonly used in South Asia but should not be taken as a regionally equivalent term for transgender. Cisgender is a term for people whose gender identity matches the sex that they were assigned at birth. Gender identity terminology is not static; it varies across cultures and between generations.

Listen to the experiences and calls to action of transgender people from across Asia and the Pacific in this video from the Asia Pacific Trans Network:

An often-marginalised minority

Throughout the 20th century, gender diversity was widely was widely pathologized, stigmatized, and often criminalized in many countries across the globe. While legal recognition, de-pathologization, and the recognition of transgender people as rights-bearing citizens is advancing in many countries, transgender people continue to face social, legal, and political discrimination, disenfranchisement, and violence in many countries as well as ‘high levels of stigma and discrimination’. Transgender people are often pushed ‘to the margins of society’ restricted to a ‘narrow range of often exploitative, underpaid and insecure jobs’. Their gender identity will often intersect with issues of race, class, and religion to exacerbate vulnerability and marginalization.

Why is transgender inclusion a priority for Water, Sanitation and Hygiene practitioners?

It is estimated that 0.3 per cent of the adult population in Asia and the Pacific may be transgender (Winter 2011). Thats between 9 and 9.5 million people. In other countries estimates of the adult transgender population are around 0.6 per cent in the United States (NCBI 2011) and 1.2 per cent of adolescents in New Zealand. The 2011 Indian Census counted 487,000 transgender people (MOSPI 2011), but this is widely thought to be an underestimate.

The Water, Sanitation and Hygiene community is focusing upon the 2030 global ambition of access to adequate and equitable sanitation and hygiene for all.

However great or small the number, the reality is that their access to adequate sanitation and hygiene, among other things, is often denied or made difficult. As Catarina de Albuquerque, the former Special Rapporteur on the human right to safe drinking water and sanitation, summarized ‘the use of public bathrooms, which are often sex-segregated, has been associated with exclusion, denial of access, verbal harassment, physical abuse and sometimes even the arrest of transgender and intersex individuals’.

As the former UN Secretary-General Ban Ki Moon said,

‘There are 17 Sustainable Development Goals all based on a single, guiding principle: To leave no one behind. We will only realize this vision if we reach all people regardless of their sexual orientation or gender identity’.


The Waterlines article includes case studies focusing upon efforts to include transgender people in sanitation initiatives in India and Nepal. The case studies have focused on improving the rights, well-being, and access to safe sanitation for third gender people, transgender women, and transgender men in South Asia.

In Nepal, transgender people have been visible in society and texts for centuries. However, the last 10 years has seen increased movement towards more legal recognition and protection, driven by LGBT rights advocates. On a sanitation front, some useful work has been undertaken by INGO Practical Action in partnership with the local NGO Environment and Public Health Organization (ENPHO), funded by DFID (now complete), to incorporate trans-inclusion into their ODF focused sanitation work in Gulariya Municipality. A public toilet constructed in the bazaar, close to the police office and the district hospital, was made with a separate facility for men, women, and an additional cubicle for third gender people. The initiative was prompted by local discussions with third gender individuals who had mentioned their challenge in using either men’s or women’s facilities. For some third gender individuals, the provision of third gender facilities was important not only for their access to sanitation, but also as a means of publicly recognizing and affirming their identity and their existence.

Meanwhile a case study from India, highlighted in the article, shows how transgender community leaders in Manipur are using access to sanitation as not just a goal in itself but also a means for furthering other forms of inclusion including economic inclusion and empowerment for transgender people. The trans advocacy group in Manipur decided to prioritize improving access to toilets in educational institutions, in workplaces, and in other public settings. Following reports of harassment from transgender students, the group prioritized creating some new third gender or transgender specific facilities, re-designating some existing facilities (as third gender specific or transgender specific facilities) and providing some gender-neutral toilets, to ensure that transgender individuals had an alternative option. Alongside provision of additional toilet options, the transgender community group prioritized awareness raising and education. Sensitization sessions were held with entrepreneurs, at vocational training centres, with government child protection officials, and with members of the media, and mass awareness events raised awareness of transgender people, discrimination, and transphobia. In parallel, community advocates were trained in storytelling techniques and managing a community-led blog to document narratives of socioeconomic exclusion as an evidence base for advocacy.

What these case studies highlight is the daily struggle to safely and regularly access public sanitation facilities that transgender people face. But this issue is not removed from the rest of their experiences as a transgender person and so any work that we do on inclusive sanitation must understand this and can help to provide a vehicle for wider inclusion.

Photo — APTN


  1. Always use appropriate and respectful language. For example, use the term transgender (or trans) as an adjective, for example, rather than as a noun. To help you do this engage with and respect the language local trans individuals and organisations use to describe their identity, their gender, and their pronoun.
  2. Recognize the diversity of transgender experiences, identities, aspirations, and requirements and the likely differences in perspective between generations. As with any work that seeks to support inclusion, we must to be aware of voices and perspectives that are frequently overlooked, for example transgender men, transgender youth or children, non-binary people, transgender people with a disability, transgender people from ethnic or religious minorities.
  3. Conduct consultations and discussions in a way that are context specific and avoids giving a platform to further discrimination. For example, discussions on whether to prioritize segregated facilities (i.e. separate men/women/third gender toilets) or instead provide gender-neutral facilities need to be context specific and focused upon exploring how the safety and dignity of all vulnerable groups can be improved. t the options consulted on should not inadvertently include an option to discriminate against transgender people or become a platform for harassment of an already vulnerable group.
  4. Understand the reality of transgender people’s lives and how that impacts on their priorities. Some people experiencing high levels of harassment and violence may be willing to compromise on using their preferred facilities in pursuit of short-term safety. A potential two stage question (untested) to understand the sanitation needs and aspirations of transgender people in South Asia could be: i) in your current circumstances, which toilets do you prefer to use (men’s, women’s, third gender, transgender, gender neutral); and ii) in a situation of improved acceptance and safety, which toilets would you prefer to use (men’s, women’s, third gender, transgender, gender neutral)?

“Nothing for us without us”

Efforts for transgender inclusivity need to bear in mind that heightened visibility of transgender individuals may increase risk of harassment or violence. The sensitivity of and variation to what will work in different contexts highlights further that it is essential in all cases to work with transgender people themselves to understand their realities and requirements (for sanitation or whatsoever) and then in designing the most appropriate solutions for their particular context. This is the only way to get it right and to ensure such efforts are really inclusive and effective, instead of inadvertently adding to the risks faced by transgender people.

Further reading:

  • The article, published on 23rd April, can be accessed from Waterlines, Volume 37, Issue 2 (April 2018)
  • Report on Addressing the Rights, Needs and Strengths of Fijian Sexual and Gender Minorities in Disaster Risk Reduction and Humanitarian Response is available here.
  • A style guide for writing about transgender people is available here.
  • A report documenting the legal recognition of transgender people in countries around the world is available here.
  • The Asia Pacific Trans Network produces a range of resources on transgender people in the Asia Pacific including this fact sheet on being trans in Asia and the Pacific. Find them here.
  • Blueprint for the Provision of Comprehensive Care for Trans People and Trans Communities in Asia and the Pacific. You can find that here.

What DFID is going on LGBT inclusion

DFID works in partnership with partners across government on LGBT rights and inclusion. We use the tools that we have to promote positive change from partner governments and to support LGBT groups in leading their own as they mobilise for change.

  1. We regularly assess partner governments’ commitment to human rights through the Partnership Principles — agreed principles for providing financial aid to countries.
  2. We work with the FCO to build support for LGBT rights internationally, working through institutions such as the UN, EU, Council of Europe and the Commonwealth.
  3. We raise concerns about LGBT rights at the highest levels. Whether this is done in public or in private is guided by the context.
  4. We fund specific programmes that support LGBT people, often using health as an entry point for raising awareness, tackling violence, harassment and exclusion, and challenging discriminatory laws.
  5. We fund work that can indirectly support LGBT rights, through strengthening the rule of law, improving access to justice, building capacity on human rights and supporting an enabling environment for civil society groups.

Find out more about what DFID is doing on WASH

Photo — APTN