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The Australian Medical Association (AMA) recently passed a transformative motion titled ‘Recognition of Intersex Variations and Deferral of Non-Urgent Medical Interventions.’ This landmark decision recognises intersex variations—differences in chromosomal, gonadal, hormonal, or anatomical sex characteristics that challenge binary male-female norms—as natural aspects of human diversity, not disorders to be corrected. By rejecting the pathologization of intersex bodies, which has historically fuelled stigma and justified non-consensual surgeries and hormonal treatments on infants and children, the motion champions bodily autonomy. It advocates deferring all non-urgent medical interventions until individuals can provide informed consent, ensuring their right to self-determination. This progressive stance sets a global benchmark for ethical medical practice and human rights, offering a model for countries like India, where intersex healthcare and rights lag, despite legal advancements.
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Intersex variations
Intersex variations, also known as Differences of Sex Development (DSD), encompass a range of congenital conditions affecting sex characteristics. These may include chromosomal variations (e.g., XXY in Klinefelter’s syndrome or XO in Turner’s syndrome), gonadal differences (e.g., ovo-testicular conditions where both ovarian and testicular tissue are present), hormonal imbalances (e.g., Congenital Adrenal Hyperplasia affecting cortisol and sex hormone production), or anatomical differences (e.g., ambiguous genitalia or internal reproductive structures that do not align with typical male or female patterns). Estimates suggest 1 in 2,000 to 1 in 4,500 births involve intersex traits, though broader definitions, including subtler variations, may apply to 1.7% of the population. These conditions are often identified at birth or puberty but may remain undetected without genetic or hormonal testing. Historically, medical interventions aimed to “normalise” intersex bodies to fit binary norms, often causing irreversible harm, such as infertility, loss of sexual function, or psychological trauma. The AMA’s motion emphasises that most intersex variations pose no immediate health risks, advocating for a shift from surgical correction to informed, patient-centred care.
Situation in India
In India, the struggle for intersex rights highlights a gap between policy and medical practice. In 2019, the Madras High Court issued a groundbreaking judgment in Arun Kumar vs. Inspector General of Registration, directing the Tamil Nadu government to ban sex-selective surgeries on intersex infants except in life-threatening cases. The court emphasised informed consent and drew from cultural narratives to affirm diverse sex characteristics, inspiring similar rulings in Kerala and Delhi High Courts on intersex rights, including marriage recognition and intersectional protections. In response, the Tamil Nadu issued a government order in August 2019 prohibiting non-essential medical interventions on intersex infants. However, implementation has been abysmal. Reports reveal ongoing violations, from 2020 to 2024, with over 500 intersex infants subjected to surgeries in Tamil Nadu alone, despite the ban.
A critical issue exacerbating this problem is the absence of scientific medical standards to identify intersex infants and children at birth, leading to misdiagnoses or premature interventions driven by societal pressure to conform to binary norms. Such systemic failures reflect outdated medical practices that continue to “normalise” intersex bodies without consent, violating ethical standards and human rights.
Moreover, the heteronormative binary lens prevalent in Indian society extends beyond heterosexual communities into Sexual Orientation, Gender Identity, Gender Expression, and Sex Characteristics (SOGIESC) communities, creating internal divisions that undermine collective advocacy. Within the Indian transgender community, particularly among some transwomen, homophobia and a heteronormative concept of gender identity and expression often exclude those who do not conform to their rigid definitions of femininity or masculinity. This exclusion marginalises diverse queer identities—such as non-binary, genderqueer, or other gender-nonconforming individuals—within the broader SOGIESC spectrum, reinforcing a hierarchy that prioritizes transwomen who align with heteronormative ideals. Similarly, transphobia is prevalent among some predominantly heteronormative gay men and a few lesbians, who may reject or stigmatiae transgender and intersex individuals, viewing them as outside the binary norms they themselves uphold. These internal prejudices—homophobia within transgender communities and transphobia within gay and lesbian circles—fragment the SOGIESC movement, diluting its ability to address systemic issues like legal recognition, healthcare access, and social inclusion for all.
Tokensim, bureaucratic inertia
The Tamil Nadu government’s issuance of intersex ID cards, intended to affirm identity, remains largely symbolic without inclusion in the national census. Without census recognition, intersex individuals—potentially millions in India—remain statistically invisible, hindering targeted policies and resource allocation. This tokenism underscores the marginalisation of intersex people, often described as a “minority among minorities.” Compounding this issue is the unregulated transgender ‘hijra jamath’ system, which operates outside formal legal frameworks and often coerces gender-nonconforming children into begging and prostitution. This exploitative system highlights the urgent need for regulation to protect vulnerable individuals and ensure their rights to education, healthcare, and dignity. The pending Supreme Court case, Gopi Shankar M vs. Union of India, further highlights these issues. In April 2024, the then-Chief Justice issued notices to eight Union Ministries, demanding responses on including intersex persons in the census, amending the Registration of Births and Deaths Act, 1969, and distinguishing sex from gender identity to avoid conflation. As of 2025, the case remains unresolved, reflecting bureaucratic inertia.
Tamil Nadu’s 2025 State Transgender and Intersex Policy addresses education, employment, and healthcare, marking a step toward improved health outcomes. However, without census inclusion, amendments to the 1969 Act, regulation of the hijra jamath system, and efforts to address internal community prejudices, such policies risk being superficial. Kenya offers a contrasting example, having amended laws since 2025 to include intersex as part of the sex category, enabling accurate data collection and rights protection.
The path forward
India’s intersex and SOGIESC communities require a scientific, health-focused, and rights-based approach over mere gestures. The Indian Council of Medical Research (ICMR) and Indian Medical Association (IMA) must prioritise research on intersex variations, including genetic, hormonal, and anatomical markers, to develop standardised protocols to identify intersex traits at birth and to guide ethical, non-invasive care. Training healthcare providers to recognise and respect intersex variations without defaulting to surgical intervention is critical. Equally important is fostering unity within SOGIESC communities by addressing homophobia and transphobia that reinforce heteronormative biases, ensuring inclusive advocacy that embraces diverse queer identities.
Before the next census and potential delimitation, the government of India and Tamil Nadu must align with the AMA’s motion, which echoes the Madras High Court’s ethos of deferring interventions and ending pathologization. Only through census inclusion, legal amendments, ending exploitative practices, robust enforcement of laws, evidence-based medical guidelines, and internal community solidarity can India affirm the health, dignity, and autonomy of intersex and gender-nonconforming persons, moving beyond symbolic measures to meaningful, science-driven change.
(Gopi Shankar Madurai is India’s first openly Intersex Statutory Authority, appointed by the government of India in the Ministry of Social Justice and Empowerment in 2020. br.gopishankar@gmail.com )
Published – August 16, 2025 04:34 pm IST
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