Suspended Selves: Necropolitics and the Denial of Gender-Affirming Care in India

Abstract (English)

This paper studies the necropolitical structures that govern transgender lives in India, with a particular focus on the inaccessibility of gender-affirming surgeries. Despite the landmark NALSA (2014) judgment and subsequent recognition of transgender identities, access to medical transition remains severely limited due to economic precarity, medical gatekeeping, and structural indifference. In contrast to Global west contexts such as the United States and parts of Europe—where gender-affirming healthcare, though imperfect, is increasingly integrated into public and private health systems—trans individuals in India often find themselves suspended in a state of limbo. Here, transition becomes not a right, but a privilege contingent upon caste, class, and region.

Engaging with Achille Mbembe’s framework of necropolitics and theories of queer vitalism, this research foregrounds how the Indian state’s passive denial of transition-related care enacts a form of slow death, effectively controlling who is allowed to fully inhabit life. The paper adopts a mixed-methods qualitative approach, incorporating semi-structured interviews with transgender individuals from urban and semi-urban regions of India. These narratives explore real life experiences around body dysphoria, aspirations for surgery, economic and bureaucratic barriers, and alternative forms of healing and embodiment. In addition, comparative analysis is used to juxtapose the Indian context with global standards of trans healthcare access.

The structure of the paper is organized into key sections: a theoretical framework grounding the study in necropolitics and queer theory; a comparative overview of trans healthcare in the west; a critical analysis of India’s current legal and medical infrastructures; presentation of fieldwork and interview data; and a discussion on trans resistance and queer futurism. Ultimately, this paper repositions the transgender body in India as a contested site—caught between structural abandonment and radical life-making—and argues for an urgent reimagining of healthcare, not as a token of inclusion, but as a terrain of political struggle and bodily sovereignty.