Factors associated with a meaningful life for transgender women in India: implications for social work practice

Factors Associated with a Meaningful Life for Transgender Women in India: Implications for Social Work Practice Dr. S. Rama Gokula Krishnan 1 1. Faculty & PhD Supervisor, School of Social Work St. Joseph’s University, Bengaluru, India Email: [email protected] (ORCID0000-0002-6914-530X) Dr. Neeta Gerosa Pereira 2 2. Faculty, Department of Psychology & Counselling St. Joseph’s University, Bengaluru, India (ORCID0000-0002-9460-8396) Nirmal Joseph Das 3 3. PhD Scholar in Social Work St Joseph’s University, Bengaluru, India (ORCID-0009-0003-5600-5820) Alan Potter 4 4. Assistant Professor, Department of Social Work The American College, Madurai, India (ORCID0000-0002-6800-0627) This is an original manuscript of an article published by Taylor & Francis in SOCIAL WORK IN MENTAL HEALTH on 24/12/2024, available at: https://doi.org/10.1080/15332985.2024.2446156 Abstract The aim of this study is to measure the level of meaning in the lives of transgender women in India, apart from describing their daily challenges. A total of 127 trans women from four states in India took part in this study. The Meaning in Life Questionnaire was used to measure the level of meaning. The majority of the respondents had a low presence of meaning in their lives. Two case studies included in the full paper provide an even greater insight into the systemic barriers preventing respondents from leading meaningful and satisfying lives. Keywords: Meaningful Life, Transgender, Meaningful life, Social Work Practice, India. Introduction Sadly, the exclusion of sexual minorities begins at school (Elia & Eliason, 2010), and in a world where there is increasing discussion on the importance of inclusion and equality of opportunity for all, it is deeply disturbing to note that more than 70 countries in the world today still continue to criminalize, in one way or the other, the lives of the Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) individuals (McIntosh, 2021). In India, the transgender community continues to live on the margins of society and faces stigma, apart from socio-economic and educational exclusion (Pandya & Redcay, 2021). The 2011 census of India has noted that there are 4.88 million transgender individuals, of whom some are involved in cross-dressing and changing their names, whereas others also undergo medical treatment to fully transition from their sex assigned at birth (Arvind et al., 2022). Irrespective of the group to which they belong, transgender women are denied of the dignity and respect that every human deserves, by the virtue of being born human, and as a result, they also miss out on educational opportunities. In one recent Indian study on the transgender community for example, it was found that the single largest majority of the respondents had only a secondary level of school education (Bhattacharya & Ghosh, 2020). This automatically puts transgender women on a path of economic disempowerment. It also reduces their scope for securing white-collar jobs, and many are left with no other option but to engage in sex work (Ganju & Saggurti, 2017) or beggary (Saria, 2019). Both of these professions are unfortunately looked down upon in Indian society, although certain significant gains have been made to help provide some recognition to sex work as a profession. Recently, the Supreme Court of India has recognized sex work as a profession (Chowdhury, 2022). Yet, sex work in India is not entirely legal. According to the Immoral Trafficking (Prevention) Act in India, sex work can only be carried out privately and not in brothels. Furthermore, soliciting is deemed illegal as well (Swathisha & Deb, 2022). This semi-legal nature of sex work in the country has led to members of the transgender community, many of whom are engaged in sex work, being victimized repeatedly. They often face financial exploitation at the hands of law enforcement authorities as well as thugs, partly due to a paucity of legal measures to protect them from such harassment and exploitation (Virupaksha et al., 2016) and partly due to the trans-apathetic nature of society (Bahadur & Kumar, 2016). Disempowerment of Transgender Women in India Apart from the lack of legal support, the other major issue is the scantiness of medical and psychological support for transgender women. Since public hospitals in India do not conduct free gender re-assignment surgery, some transgender women are forced to opt for a traditional but highly risky and painful form of transitioning called Dai Nirvan, which involves the removal of the male genitals in a non-hospital setting (Singh et al., 2014). There have also been reports of urethral closing as a side effect of this non-medically approved and dangerous form of transitioning (Singh et al., 2014). Furthermore, almost two-thirds of the transgender population in India do not have access to treatment for sexually transmitted infections, and about 14.5 percent of transgender women in India are infected with the Human Immunodeficiency Virus (HIV) (Ming et al., 2016). These factors could be adversely impacting the mental health of the members of the transgender community since physical health and mental health are known to be closely related. Additionally, in one recent study, it was discovered that the pandemic had a greater negative impact on the mental health of transgender youth than cisgender youth (Hawke et al., 2021). Even before the pandemic struck the world, transgender women in India were suffering due to social exclusion and they continue to do so. It is worth considering the possibility that this social exclusion could impact their self-esteem (Shaikh et al., 2016) and mental health in general. One of the hallmarks of poor mental health in a community is the suicide rate, which among transgender women, is very alarming. It is estimated that the suicide rate among transgender women in India is 31 percent with about 50 percent of transgender women attempting suicide at least once before their 20th birthday (Virupaksha et al., 2016). Moreover, the notion that the mental health of transgender women deserves greater attention is supported by a recent meta-analysis of several studies on this matter. The meta-analysis revealed that there is indeed a higher prevalence of mental health disorders among transgender women than the general population (Pinna et al., 2022). This calls for a deeper investigation into the mental health of transgender women in countries such as India in particular, where there is a tremendous gap between the need for mental health services and their availability for the general population (Lahariya, 2018). If even the typical cisgender individual in the country is struggling to access mental health services, one can only imagine how out of reach these services are for a transgender individual who is socially excluded and harassed by several groups in society. What is interesting is that, despite all these hurdles, the transgender community in India has not allowed itself to be entirely bogged down by its struggles, and the community still continues to exist and grow. In other words, there are signs that indicate that the community has managed to retain its resilience, especially at the micro level despite all the odds that have been stacked against them (Ganju & Saggurti, 2017). This resilience could originate from a deep sense of meaning and purpose, and this meaning and purpose in life are known to help reduce stress and promote mental well-being (Ostafin & Proulx, 2020). This aspect deserves more attention and investigation, especially in the context of transgender women in India, so that new and relatively unexplored factors could be identified and promoted to help improve the mental well-being of transgender women who are in great need of care and support. Meaning in Life In simple terms, meaning in life refers to people’s belief that their lives are significant beyond the temporary situation they are in (Steger, 2009). This construct, though not new, has gained increased attention from researchers in the past two decades (Morgan & Farsides, 2009; Glaw et al., 2017; King & Hicks, 2021). It is important to note that meaning in life is not a replacement for mental health or mental well-being as a construct. Rather, it is to be perceived as a component or cause of mental well-being (Steger et al., 2006). The challenge, however, lies in measuring it and after several decades of research into this line of thought, researchers have managed to develop accurate tools for measuring meaning in life. The purpose of the present study is twofold-to measure the level of meaning in life among a group of transgender women in the city of Bengaluru as well as those living outside the city and to identify the specific factors that are associated with the meaning in life among the members of the community. Bengaluru, which was formerly known as Bangalore, is the capital city of the state of Karnataka in India and is also known as the Silicon Valley of India due to the large presence of tech companies (Guttikunda et al., 2019). Apart from these two objectives, the researchers also aim to identify other challenges faced by members of the transgender community in India. Methodology Universe and Sampling A significant challenge in this area of research is the accessibility of respondents. The members of the transgender community experience social exclusion and stigma in the country (Jose & V., 2014), and as a result, they are a hard-to-reach population. Since a sizable number of the members of the transgender community are engaged in begging and sex work in small settlements to make ends meet (Nuttbrock, 2018), data were initially collected from 10 settlements in Bengaluru city, the capital of the State of Karnataka. A total of 151 members of the transgender community were living in these settlements. Out of these, 68 respondents met the inclusion criteria and were willing to be part of the study. These 68 respondents then referred other potential respondents from other states in India (Tamil Nadu, Andhra Pradesh, and Kerala) and data from another 59 respondents who met the inclusion criteria from these other states were collected. Thus, data were collected from 127 respondents in total. The motive behind collecting data from respondents from multiple states was to ensure greater diversity in the sample. Inclusion and Exclusion Criteria Only those respondents who were 18 and above, those who openly identified themselves as transgendered women, and those who were willing to be part of the study were included. Women who could not understand English were excluded from the study as the interview schedule was in English. Tools of Data Collection A self-prepared interview schedule was used to collect data from the respondents. The interview schedule had three parts. The first half of the schedule contained questions regarding the socio-demographic, economic, and other basic details. The second part of the schedule contained items that have been found to be associated with meaning in life in other studies involving cisgender individuals. These included statements that measured the level of optimism, feelings of loneliness, being a giver, taking care of children, praying, listening, sleeping, reading, and meditating (Baumeister et al., 2013). The second part also included statements regarding different forms of violence, as transgender women do experience different forms of violence on a regular basis (Dutta et al., 2019). Finally, there was an item on harassment by law enforcement authorities for practicing sex work or begging (Ganju & Saggurti, 2017). The responses or all of the items in the second half of the interview schedule were measured on a five-point Likert scale with the responses ranging from strongly agree to strongly disagree. The third half of the interview schedule comprised of a standardized scale to measure meaning in life among the respondents. This scale has a total of 10 items with two dimensions of meaning in life (Steger et al., 2006). The first dimension measures the presence of meaning in the respondents’ lives, while the second dimension measures the search for meaning, that is, the extent to which the respondents are searching for meaning and understanding in their lives (Steger et al., 2006). The responses are measured on a seven-point Likert scale with 1 representing the responseabsolutely untrue and 7 representing the response-absolutely true. While items 1, 4, 5, 6, and 9 constitute the sub-scale-presence of meaning, items2, 3, 7, 8, and 10 make up the search for meaning sub-scale. A higher score in each of the sub-scales represents a higher score in both dimensions, that is, meaning in life and the search for meaning. The researchers chose to adopt this particular scale as it is one of the most reliable measures of meaning in life that are currently available (Steger et al., 2006). As far as the scoring of the scale is concerned, the author of the scale has set 24 as the cut-off score for each sub-scale and this cut of value is used as a proxy to determine whether the respondents have scored high or low in each of the sub-scales (Steger, 2010). Furthermore, the researchers conducted a reliability test and discovered a Cronbach’s Alpha value of 0.811, indicating that the scale is in fact reliable (Taber, 2018). Each interview took about 20 minutes. The collected data were entered into PSPP, a free data analysis software (Sto. -Tomas et al., 2019), and stored on a password-protected computer. Analysis of Data A percentage analysis was carried out to describe the characteristics of the respondents, the level of meaning in their lives, and to shed light on the intensity of the problems faced by them. In situations where the independent variables were nominal in nature, a series of Kurskal Wallis tests were employed to test the association between the independent variables and the dependent variable. Kruskal Wallis test was used as it is more effective compared to the One-Way Analysis of Variance when the data is not normally distributed (Hecke, 2012). Furthermore, Spearman's rank correlation was used when the independent variables were ordinal in nature (Sedgwick, 2014). Ethical considerations The ethical approval for conducting the study was secured from the first author’s institution (Ref No. SJU-SW-01). Furthermore, informed consent was obtained from the respondents. The respondents were assured that no personal data such as names, phone numbers or email addresses, that could be used to identify them, would be collected. Additionally, the authors have adhered to the principles laid down in the Declaration of Helsinki (World Medical Association, 2022) to ensure the ethical nature of the study. Results Quantitative Data In order to gain an insight into the basic characteristics of the respondents, the researchers collected and analyzed data regarding the socio-demographic and economic features of the respondents. The results of this analysis can be seen in Table 1. Some of the interesting findings from this table include the fact that the single largest majority of the respondents (42.5 percent) hail from the scheduled caste community, which is a marginalized section of society that has been discriminated against by mainstream society for centuries (Borooah et al., 2015), leading to significant economic disparities (Madheswaran & Singhari, 2016). In India, the caste system, a system of social stratification, invisibly continues to be a tool for perpetuating discrimination to the point that those who belong to the lower castes or scheduled castes sometimes struggle to access clean drinking water (Dutta et al., 2015). Although a significant number of the total respondents are employed in the private sector, sex work (18.1 percent) and begging (19.1 percent) are the occupations of more than one-third of the total respondents, which is similar to the number reported in another recent study (Manpreet et al., 2021). The level of education of the respondents, as seen in Table 1, is another indication of the disempowerment faced by them. The single largest majority (45.7 percent) of the respondents have dropped out of high school, and the possible reason for this is a combination of poverty and discrimination. Finally, the single largest majority of the respondents live on less than $120 a month, which is a very small income, especially for those living in metropolitan cities such as Bengaluru, the Silicon Valley of India (Bharath et al., 2018), which is known for its comparatively higher cost of living. All these challenges put together reflect a very difficult life indeed. Challenges Faced by Transgendered Women As discussed in one of the previous sections, it has been reported by other studies that the transgender community in India has been traditionally sidelined and discriminated against (Pandya & Redcay, 2021; Ganju & Saggurti, 2017). The researchers wished to further investigate this matter through the present study by examining certain aspects of the lives of transgender women in India, where certain forms of discrimination and victimization have been reported. The results of this inquiry can be observed in Table 2, which provides us with a detailed understanding of some of the most common problems faced by transgender women in India. While the majority of the respondents agree with the statement that they often experience sexual abuse at the hands of people/clients, the single largest majority of the respondents agreed to the fact that they often experience verbal abuse as well as physical abuse, apart from being harassed by law enforcement authorities for practicing sex work/begging, which is one of the major occupations of the transgender community in India. Furthermore, a significant percentage of the total respondents also felt that they were looked down upon by society. These findings are indicative of a deep and systemic problem that involves discrimination against the transgender community in India. In fact, it has been argued that among all the marginalized sections of Indian society, perhaps the transgender community is the one that is most ignored (Kurian & Manoj, 2021). Another inference that can be made from the results in Table 2 is that on the one hand, the transgender community in India faces various forms of violence, discrimination, and exclusion at the hands of the public, and on the other side, they are prone to being harassed by law enforcement authorities since sex work, a major occupation of the members of the transgender community, is not entirely legal in the country (Panchanadeswaran, 2017). Presence of Meaning As mentioned previously, the meaning in life questionnaire has two dimensionsthe presence of meaning and the search for meaning (Steger et al., 2006). The first dimension, that is, the presence of meaning, examines cognitive appraisals of how meaningful the respondents find their lives to be (Bailey & Phillips, 2016). Since one of the major objectives of the present study is to examine the independent factors associated with the meaning in life among the respondents, the researchers carried out a series of Spearman’s rank correlation tests to identify those significant factors that are correlated with the sub-scalepresence of meaning. Spearman’s rank correlation was chosen as the data were not found to be normally distributed, and it is believed that Spearman’s rank correlation is more powerful when the data is not normally distributed (Zar, 2014). The members of the transgender community in India and to pass laws that can help protect them from various forms of violence and empower them economically so that they can live a life filled with dignity and meaning, which must be ensured and protected, not just by the state, but also by the citizens of the country. 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John Wiley & Sons, Ltd. https://doi.org/10.1002/9781118445112.stat05964 Variables N % x  (min) (max) Location of the Respondents Bengaluru Other cities in India 68 59 53.5 46.5 Caste Scheduled Caste Scheduled Tribe Other Backward Castes General Category 54 08 26 39 42.5 6.3 20.5 30.7 Type of Family Living Alone/Nuclear Family Living with the Community 39 88 30.7 69.3 Age Group (in years) 18-30 31 and above 48 79 37.8 62.2 36.23 (19) (79) Level of Education Dropped out before high school High school Undergraduate Masters 58 39 24 06 45.7 30.7 18.9 4.7 Occupation Sex work Begging Government sector Private sector Unemployed/Not working 23 25 02 66 11 18.1 19.7 1.5 52 8.7 Number of days working in a month 0-10 days 11-20 days 21 days or above 49 40 38 38.6 31.5 29.9 15.33 (0) (30) Monthly income ( Rs. converted to $) Below Rs. 10,000 (below $120) Rs.10,000 to 20,000 ($120-$240) Rs. 20,001 and above (above $240) 81 34 12 63.8 26.8 9.4 $135 ($0) ($722) Table 1Socio-demographic and economic features of the respondents. Variables N (127) % I am looked down upon by everyone in society. Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree 01 14 47 44 21 0.8 11 37 34.6 16.6 I am often chased or harassed by law enforcement authorities for practicing sex work/begging Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree 2 7 42 60 16 1.6 5.5 33.1 47.2 12.6 I often experience verbal abuse at the hands of people/clients Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree 1 9 40 62 15 0.8 7.1 31.5 48.8 11.8 I often experience physical abuse at the hands of people/clients Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree 1 10 42 63 11 0.8 7.9 33.1 49.6 8.6 I often experience sexual abuse at the hands of people/clients Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree 2 10 37 67 11 1.6 7.9 29.1 52.7 8.7 Table 2Challenges faced by transgendered women ** Significant at 0.05 level. * Significant at 0.10 level Table 3Spearman’s Rank Correlation between presence of meaning and select independent variables 1 Days working in a month Monthly Income Optimistic about future Love taking care of children Love reading books Presence of Meaning Days working in a month 1 0.538 Sig. 0.000 -0.097 Sig. 0.280 -0.093 Sig. 0.299 -0.083 Sig. 0.354 -0.152* Sig. 0.089 Monthly Income 0.538*** Sig. 0.000 1 -0.25 Sig. 0.782 -0.49 Sig. 0.586 0.018 Sig. 0.838 -0.164* Sig. 0.066 Optimistic about future -0.97 Sig. 0.280 -0.025 Sig. 782 1 0.106 Sig. 0.234 0.166 Sig. 0.062 0.228* Sig 0.10 Enjoy taking care of children -0.93 Sig. 0.299 -0.049 Sig. 0.566 0.106 Sig. 0.234 1 0.279 Sig. 0.001 0.177** Sig. 0.047 Love reading books -0.083 Sig. 0.354 0.018 Sig 0.988 0.166 Sig. 0.062 0.279 Sig. 0.001 1 0.152* Sig. 0.088 Presence of Meaning 0.152 Sig 0.089 -0.164 Sig. 0.066 0.228 Sig. 0.10 0.177 Sig. 0.47 0.152 Sig. 0.088 1