Monday 15 December 2014

Behind the wall: Being Trans in Bangladesh

"It can be painful to keep significant aspects of the self hidden or to vigilantly separate aspects of the self from each other. Transparency, invisibility, losing ones voice and being stuck behind walls or other barriers are some of the terms used to describe the subjective experience of dissociative detachment." - Bandhu Social Welfare Society

The 'hijra' (transgender) people I have met in Dhaka are some of the warmest, most vibrant, creative and colourful people I have ever met in my life! I have spent most time with 'L' and 'K' who are 'gurus': Having worked their way up through the ranks of the 'hijra' community, they are now responsible for leading and guiding their 'chela's' (followers). 'L' is stunning. She wears a traditional 'sharee', she has a wide, open smile, and she speaks so passionately with expressive gestures about her role as advocate for the 'hijra' community - "because they have no-one else to speak for them" - everyone around us stops to listen. 'K' is no less engaging. I visit her house and sit and talk to her while she carefully applies kohl eye make-up, blusher and lipstick. A small girl, the daughter of her landlord, sits at her feet and gazes at her with admiration. Without warning, 'K' jumps up, switches on the huge stereo that she has in her one room living quarters, and breaks into an expressive dance to a Hindi love song.
   It is hard to imagine that 'L' or 'K' have ever felt invisible or transparent. However, I know, through hearing their stories, that they have travelled a difficult road to get to this point, and many other 'hijra' are still travelling it. Perhaps 'L' and 'K' are so strong now because they have had to constantly challenge societies perceptions and expectations, and break down barriers for themselves and others.

'Hijra's' are assigned male at birth, but express feminine behaviour and characteristics, 'L' and 'K' and the other 'hijra's' I have met identify themselves as 'transgender' or 'third gender', not as 'trans women'. Female to male transgender people are not visible, not heard about and are generally thought not to exist here in Bangladesh, 'L' says "they are lesbians". But with no access to hormone therapies (apart from the oestrogen containing contraceptive pill used by some 'hijra') and no access to safe surgery, it is little wonder that this population remains hidden.

'L' and 'K' describe their lives and the difficulties they have faced as though these difficulties are normal. I suppose in a way they are, for 'hijra's' in Bangladesh. They tell me that no transgender person gets through life here without facing problems. Discrimination and violence starts from their family when they are young - as soon as they start to exhibit behaviour which is not seen as acceptable for their sex. Particularly, all the 'hijra' I have met describe (what could be thought of as 'honour' based) abuse and violence from their fathers and brothers. 'L' says,

"...My elder brother, my father, demand I am going to [be] a boy. Playing football, cricket. Not going to [my] sister or her friends, playing with dolls...Every childs life is similar in Bangladesh. They fight us, they dominate us - 'don't go there, don't do this, don't wear ladies clothes.'"

All the 'hijra's' report that the abuse is mainly from their fathers and brothers,

"...Because they move outside for their job and when they are gossiping with their friends and colleagues they tell them, 'Oh you have a disabled baby in your family, like a trans/ hijra. Oh this is so shameful for you.' Then father comes back to the family and pressures the mum." (L)

"K" described horrific physical abuse from her older brother, who chained her to the bed and beat her telling her she should not "go outside and mix with boys". He beat her so badly she sustained a broken leg. But she says that, even if she had not left the house, it is still bad for the families reputation to have a 'hijra' in the family. She reports that "almost 100%" of 'hijra's' in Bangladesh experience honour-based abuse, and often violence, from their families.

'L' concurs, that all transgender people here in Bangladesh experience problems related to family honour. She is only in touch with her family by telephone. She cannot visit as this will jeopardise her nieces marriage prospects (future husbands families will not allow them to marry into a family where there is a hijra in the family). One of the 'chela' (followers) I spoke to, left home when she knew she was transgender and came straight to Dhaka. She is also only in touch with her family by telephone, they know she is 'hijra' but do not know many other details about her life.

 Abuse continues towards transgender young people throughout school, they are taunted by classmates and teachers usually do not know what to do so throw them out of the classroom. This results in many trans people not completing their education. 'L' and 'K' report many trans young people will discontinue education around age 11 or 12, when they start showing signs they are transgender.

Many trans young people commit suicide due to pressures from family and society. Those who can, escape, and many come to Dhaka where they find more acceptance and ways to make money. They also find a 'new family', within the close-knit transgender community here. The community is like a whole society within itself, with its own language (which is only spoken and understood by South Asian 'hijra'), and strict social codes. One 'guru', for instance, will have usually 10 - 50 'chela's' (followers). The guru provides support, some protection, and guidance in the 'hijra giri' - the traditions of the 'hijra' (songs, dances, how to make money). Most 'hijra' earn money through 'baksheesh' - tips they earn from performing their traditional songs/ dances for the birth of a new baby or for a newly married couple ('badhai'). Each guru has control of a certain area of the city, and they cannot venture into another territory to make money. 'K' admits that some transgender people make money through prostitution, but she is disparaging of this practice, saying that it gives the transgender community a bad reputation.

Despite there being more acceptance in Dhaka than in rural areas, trans people here still experience discrimination from every angle in society, in particular experiencing difficulty obtaining housing and accessing health care. 'L' describes previous experiences going to the doctor who kept asking "Are you a woman? Do you have menstrual period?" 'L' was forced to explain that she is transgender, and the doctor threw her out. 'L' also reported that transgender people particularly experience problems with anal fissures and rectal pain and bleeding and yet these problems are not understood by doctors here, as sexual practices 'against the order of nature' (i.e. anal sex) remains illegal. Despite the law, 'K' reported that some doctors and police men "...want to have sex with hijras because they know they won't get them pregnant. There will be no proof" There is also lack of awareness about transmission of STIs and particularly HIV - it's possible that some men believe that they are less likely to contract HIV through anal sex. In a 2007 study, 1/3 of urban males in Bangladesh did not realise HIV was transmitted through sex, and less than 1/4 thought anal sex was a risk factor for HIV/AIDs (1). Furthermore, the 'hijra' who reports sexual assault or other abuse/ violence is often ridiculed or subjected to further abuse.

Interestingly, 'K' is now accepted by her family, whom she now lives next door to. She reports this is since she had surgery, which has meant she is physically a woman. However, she still prefers to be legally 'third gender' and would not legally change gender to female, even if this was an option. 'L' is also very happy to be legally 'third gender' - she is very proud of the transgender culture and tradition. She is adamant that, although she looks like a woman, she is not a woman (it is a possibility, however, that the social stigma that unmarried women in Bangladesh face might be a factor in this attitude). She is keen to have surgery, but will not have it in Bangladesh as there is nowhere that performs safe surgery. Both 'L' and 'K' talk of many of their friends dying through botched backstreet surgeries performed by men with no medical training. 'K' went to India for her surgery, which cost approximately 2 lakh (just under £2000).

Both 'L' and 'K' have long term male partners ('panthi') (they have been together for 20 years and 17 years respectively). 'L' tells me she and her 'panthi' have had a hindu wedding ceremony. Both 'L' and 'K' receive financial support from their male partner. 'K' reports that both hers and her boyfriends family are aware of the relationship and accept it. The family know that if they did not that 'K' could be forced into prostitution.

I feel that these ideas about family 'honour' and how it can lead to abuse, violence, isolation, suicide and further social exclusion can also be seen in the LGBTQ (lesbian, gay, bisexual, transgender, queer) community in the UK. We know that a disproportionate number of young LGBTQ people are homeless (up to 40% of homeless people in the US are LGBTQ(2)) and LGBTQ people who are "rejected by their families" are possibly up to 8.4 times more likely to attempt suicide (2) (and these are the attempts that have been reported). So how can we apply these ideas about family 'honour' to benefit people here, AND in the UK?

 (Bandhu works across Bangladesh in 21 districts, acting as an umbrella organisation for smaller groups, often run and co-ordinated by community leaders chosen and developed from within the sexual minority communities.

Studying at Bandhu leadership training.

(1) S. Charnley (2007) Speaking up: Muslim views on HIV and AIDs. Asian Muslim Action Network: Bangkok, Thailand.

(2) Johnson R (2014) Gay, Lesbian, Bisexual, Transgender and Questioning Youth Suicide Statistics. [Online] [Accessed 15/12/14]

Friday 12 December 2014

Bangladesh so far....

I'm here! And have been for a week already! Time flies by in this beehive of a city. When I arrived I have to say I was quite daunted: hundreds, or even thousands of faces peered through the fences at the airport. The trip to the hotel was helter-skelter through the streets packed with rickshaws, cars, cows, wheelbarrows and people weaving in and out of the traffic. We passed the 'Future Park' full of rickety looking fairground rides, people sorting foul-smelling rubbish, a pile of huge pieces of bamboo - probably for use as scaffolding, as well as vegetable and flower markets scattered through the shouting streets. One thing that strikes you is that there are just so many people - the 11th largest 'mega-city' in the world, with approximately 12 million inhabitants and the highest population growth in the world. Only 10% of houses are concrete, and at least 1/3 of residents are living in poverty (1).  However, everyone is doing something - mending clothes on a singer sewing machine in the street, carrying a basket full of live chickens or geese, riding an elephant through the streets, selling snacks or chai or betel leaf.
   So far I have worked with BRAC and spoken to participants in their microfinance programme (where BRAC lends typically up to 50,000 taka to women to start small businesses), Community Empowerment Programme (generally raising awareness of issues such as domestic abuse and early marriage), Health (observing community health worker giving advice and visiting households) and Human Rights and Legal Aid (HRLA) Programme - providing free advice and legal aid to those in need (approximately 80% of their cases involve domestic violence).
    I have also visited Bandhu Social Welfare Organisation, who work to promote the rights of gay and transgender people across the country, as well as acting as an umbrella organisation for a number of support groups and health clinics. They successfully lobbied the government in order to obtain 'third gender' status for the transgender population in November 2013, and in November 2014 they organised the very first Transgender Pride in Dhaka! I spent the afternoon with 'L' who identifies as 'hijra' (meaning transgender or 'third gender'). 'Hijra' is a term used in Bangladesh and some other parts of South Asia. The term describes those who are (usually) assigned male at birth but adopt feminine gender roles. The 'hijra' I have met so far describe their gender identity as 'transgender' or 'third gender'. Many 'hijra' have breast implants and/or surgery to remove their male genitalia. Some take the oral contraceptive pill in place of prescribed hormone medication (unavailable in Bangladesh) in order to enhance feminine characteristics. In Bangladesh, trans men or female to male (FTM) transsexuals are not visible or heard about (perhaps due to the lack of available hormones and safe gender reassignment surgery).
  'L' is a talented dancer, community leader and advocate for the rights of transgender people in Bangladesh. She took me to the Bandhu resource centre where I met transgender representatives and community leaders from all over Bangladesh, including the remote Chittagong (hill tracts) region where there remain indigenous tribes. The transgender community leaders had come to Dhaka for training in finance and leadership in order to better run their respective groups.
  In terms of my objectives for this project, to learn about the cultural beliefs and practices in South Asian communities which may contribute to domestic abuse, I have learnt a lot so far, and feel enlightened by what I have learned. I started with the aim of better understanding the notion of family 'honour' and how it might contribute to violence within the family. Many people have had difficulty expressing exactly what family 'honour' means (whether I am just not asking in the right way, I am not sure!) In terms of family values, the general consensus is that family bonding is so tight, that families just want the best for their children and this is what informs some of the (maybe misguided) decisions that might be made. This includes the family choosing the best husband (in the girls 'best interest') and marrying girls to husbands from overseas so that they might have a better life. There is, however, increasing acceptance that women want to choose their own husband and I have witnessed community mobilisation against early marriage. Furthermore (somewhat a surprise to me), rather than being ashamed and dismissive of a woman who has experienced domestic abuse, according to a lawyer working with BRAC HRLA programme, the family and community are generally supportive of the woman.
  A families lack of tolerance and support for their child if they are showing signs of gender non-conformity or homosexuality, could also be to do with 'best interests' - not just for the child who is showing these signs, but also for the other family members. The family feels they must try to prevent their child being gay or transgender, as society will not accept it and their life will be very difficult. Of course, in Bangladesh, homosexual relationships remain illegal, and transgender people (despite their legal 'third gender' status) still experience multiple problems with earning money, being denied housing or health care and often experience discrimination and abuse. Furthermore other family members will be affected by a family members sexuality or gender identity by default: 'L' informed me that she is only in touch with her family by telephone because the families of her nieces future husbands will not allow them to marry into their family if it is known that there is a 'hijra' in the family. 'L' reported that all transgender people in Bangladesh experience problems with their family.
  So in conclusion, so far I have heard that domestic abuse in Bangladesh is not necessarily about family 'honour', it is about a lack of women's empowerment. It is about fear. It is about ignorance. But things are definitely changing for the better here! In terms of how this knowledge can be applied in London, I have some ideas but it will take a bit more thought!

The picture is of Minara, who married at age 13, and now attends BRAC Community Empowerment Programme group - to learn about issues such as health, education, child-care and domestic abuse.

1) The World Bank Group (2013) Urban Growth: A Challenge and an Opportunity. [Online] [Accessed 12/12/14]

Thursday 20 November 2014

"Shanti's" story

"Shanti"'s * attendance to A&E was one of the moments I realised I needed to learn more about the cultural and social factors which add to the complexity of domestic violence, and eventually resulted in this WCMT travel fellowship.
(* ALL names and details have been changed to protect confidentiality)

“Shanti" attended the A&E department with police late one night. I was nurse in charge of majors, and as the police entered I felt a pang of frustration. The department was hectic as usual, phones ringing, the bustle of doctors and nurses and the stress of patients crackling in the air. The arrival of police officers is never associated with anything good. I didn't even notice Shanti at first, the police officers were tall and imposing and I deferred to them, wondering why they had come to the department. As they started to tell her story in controlled voices, I noticed her. One of the police officers held her gently but firmly by the elbow. Birdlike, her eyes flitted around the department, seemingly debating fight or flight. She was shrouded in a faded sari, the hood of which cast lunar shadows on her face. She did not make eye contact with the police or the nurses.

The police told me Shanti had been effectively kept prisoner since being brought from Bangladesh following her marriage four years previously. She had been taken out of school at age 16 even though she had wanted to continue her education, she was married in Bangladesh and brought over to the UK to live with her UK born Bangladeshi husband (her second cousin) at age 18. Now age 22, she had not seen her family for four years. She had no family or friends in London. Her husband had been violent and abusive from early on in their marriage. He didn't like her to leave the house, he treated her as if she was only useful for housework and cooking and often forced her into sex against her will. Having finished school at a young age, she spoke little English and her situation was becoming increasingly desperate. She had suffered two miscarriages previously due to physical violence from her husband whilst pregnant, and she believed she was pregnant again, yet she had no idea of the gestation as had received no ante-natal care. Shanti was terrified that harm would come to her baby and had managed to make a phone call to her uncle in Bangladesh who had alerted the police. Shanti had been brought from the house and her husband had been taken into police custody.

The story shocked me. How could a woman be living in such terror just a couple of miles from our hospital for four years?

But then I started to think... what if Shanti had attended our department during the previous four years? With an injury, or with a miscarriage. Would she have been questioned about domestic violence?

As health professionals in the emergency department we have a unique opportunity, in that we see people who might otherwise not have access to any other health services. People like Shanti, where abuse is happening 'behind the walls', and yet, whom occasionally have need of emergency medical care.

Working with a colleague, we carried out an audit to assess staff knowledge and resources for domestic violence. We found that language and cultural barriers were a main hindrance in assessment for domestic abuse. Nurses felt they did not always have time to use interpreters, and professional interpreters were not always available. Two nurses felt concerned about being culturally insensitive, in particular, if asking the husband or family to wait outside the cubicle. The majority of nurses wanted specific training on domestic abuse, which focused on how to detect it in the emergency department. None of the nurses highlighted pregnancy as a risk factor for domestic abuse. On further discussion, there was confusion among many of the nurses about 'honour' based violence and forced marriage.

This is consistent with the research and policy in this area. It suggests that people experiencing abuse will frequently attend health services and yet health care professionals often fail to ask about, or recognize domestic abuse (1). Domestic Violence London (1) cites a 1997 study in which only 6% of women attending A&E were questioned about violence, and yet approx 35% had experienced violence. When abuse is disclosed the patient may not be supported adequately (2). Furthermore, and even more worrying, are the suggestions that domestic abuse, “honour” based violence and forced marriage may be overlooked because health professionals do not wish to seem 'culturally insensitive' or they don't want to highlight their lack of understanding of certain religious or cultural practices (3). 

It was clear to me that something needed to be done to improve services in our department for victims of domestic abuse, and that health professionals require specific training on domestic abuse and how to identify it (in the emergency department), and that this training should include how to deal with the issues of “honour” based violence and forced marriage.

Since "Shanti's" attendance, we have made many changes to improve care for victims of domestic violence in our department, including the appointment of an independent domestic violence advisor who follows up referrals and carries out training in the Emergency Department. There is a much clearer referral pathway and we have increased the resources available e.g. leaflets, posters and lip balms with helpline number. However, there is a suggestion that the incidence of "honour"-based violence is increasing (4). Yet, although the need for specialist services for BME women is increasing, many are being closed down due to lack of funding (4). A 'Women's Aid' report (5) suggests that 47% of these services have had their funding cut. Some women are being advised to sleep in A&E departments or even night buses due to lack of space in refuges (6). 

As well as lobbying to ensure that provision of specialist services and refuges is preserved (you can start by signing 'womens aid' petition here:, I feel it is necessary for those of us who work with people who may have experienced violence, to find innovative and creative ways to ensure that these patients continue to receive advice, support and a high standard of quality of care.

I found that I wanted to know more about the issues of 'honour'-based violence and forced marriage and hear from survivors themselves why these abuses occur and how we can prevent them. I want to be able to train staff in emergency departments London-wide to understand and recognize this type of abuse, and better support those who report it.  

  1. NHS (2014) Domestic Violence London: A resource for health professionals. NHS Barking and Dagenham. [Online] [Accessed 19/11/14] 
  2. HM Gov (2009) Domestic violence, forced marriage and “honour” based violence. The Stationary Office. Crown Copyright.[Online] [Accessed 19/11/14]
  3. Kazimirski A, Keogh P, Kumari V, Smith R, Gowland S, Purdon S, Khanum N (2009) Forced marriage: Prevalence and service response. National centre for social research.
  4. Williams (2011) 'Honour' crimes against women in UK rising rapidly, figures show. The Guardian. Saturday 3rd December 2011. [Online] [Accessed 19/11/14]
  5. Taylor K (2013) A growing crisis of unmet need: what the figures alone don't show you. Women's Aid: Bristol. [Online] [Accessed 20/11/14]
  6. Fawcett (2014) The triple jeopardy: the impact of service cuts on women. [Online] [Accessed 20/11/14] 

Monday 3 November 2014

Bangladesh Itinerary

I finally feel like I am fairly organised for the first stage of my WCMT fellowship in Bangladesh. I am so privileged to have the opportunity to undertake this study, thanks to the Winston Churchill Memorial Trust. 

I hope the project continues to shed light on the issues of gender and domestic abuse, and that the messages will resonate in the UK and in India and Bangladesh. It is daunting (particularly with such an emotive subject), but I am confident I can learn something new and inspire change. Each individual thread seems insignificant, but once they are woven together the resulting tapestry will tell a story...

The itinerary is as follows:

Arrive 3rd December

4th December Visit 'HEED' (Health Education and Economic Development) Centre. Lesson to brush up on my Bengali, and visit to the 'Centre for the rehabilitation of destitute women'

5th/6th Weekend

7th- 9th BRAC exposure programme. 2 days visiting rural programmes, 1 day urban programmes.

Visiting BRAC programmes including: Microfinance, Health Nutrition and Population Programme (HNPP), Human Rights and Legal Aid Services (HRLS), Gender Justice and Diversity (GJ&D)), Migration Programme, Community Empowerment Programme (CEP) and BRAC Education Programme (BEP). Quite a lot for 2 days! 

10th - 14th Working at Acid Survivors Foundation 20 bed hospital for victims of acid violence in Mirpur. Interviewing staff and speaking with survivors.

15th - 18th Working with 'Bandhu social welfare' organisation which will link me with their community organisations (Shustah Jiban and Badhan Hijra Shangah) supporting 'Hijra' (transgender) community in Dhaka.

19th Return home. 

Friday 24 October 2014

Behind the Wall: Gender & domestic abuse - WCMT fellowship India & Bangladesh

As some of you may know I have been awarded a 2014 Winston Churchill Memorial Trust travel fellowship, to travel to India and Bangladesh and research the issues surrounding domestic abuse and gender issues in these two diverse countries. It is known that, to some extent, issues such as honour-based abuse and acid violence occur within families and communities here in the UK. Certainly, within our society, there currently seems to be a backlash against strong females, and online abuse and misogyny seem to be becoming ever more prevalent. Furthermore, according to Office of National Statistics figures, recorded rape in the UK has risen by 29% in 2014 from last year (BBC 2014). There have also been suggestions that honour based violence is on the increase (Guardian 2011). 

In terms of abuse within South Asian communities, I first considered these issues when I cared for a woman in A&E who had been brought to London as a victim of forced marriage. It made me realise how many women attend A&E with their family or their partner, and how easily their abuse might go unseen. Whether because of language barriers, not wishing to seem culturally insensitive, lack of time, or not wishing to 'open a can of worms', we as health professionals might not always question the story given for a persons injury or presentation, or pick up on the subtle signs of abuse

I felt I needed to get to the bottom of this problem, and with funding from the Winston Churchill Memorial Trust, I have been given the incredible opportunity to travel to Bangladesh and India to face up to  these issues first hand. Through visiting various organisations and meeting survivors of abuse, as well as experts in the field, I hope to gain a diverse perspective of the multi-faceted problem of domestic abuse: I want to find out about 'honour' and how it may contribute to abuse within families (and whether this can also be applied to people outside of a South Asian background). I will delve in to the question of gender, asking what it means to be a man or a woman in today's society. How much does violence stem from stepping outside of one's perceived 'gender role'? I want to ask why violence occurs and why figures are on the increase in the UK. Is it, as some experts argue, because more victims are coming forward, or are there other reasons?  

At the moment, I only have questions, but hopefully soon I will have some answers! Please keep following my blog and I appreciate any comments.

Twitter @freethechangeUK

BBC (2014) Rapes increase by 29% as overall crime falls in England and Wales. [Online] [Accessed 23rd October 2014] 

Guardian (2011) 'Honour' crimes against women in UK rising rapidly, figures show. [Online] [Accessed 23rd October 2014] 

(Picture taken in Manila, Philippines 2011).