Determinants of inequities in access to healthcare among transgender people in Bangladesh

This study examines the socio-economic, educational, and healthcare challenges faced by transgender individuals who are traditionally known as hijra in Bangladesh. This study employed a cross-sectional survey design conducted between January 1 and February 28, 2024, covering both rural and urban locations. A convenient sampling method was used to recruit transgender individuals due to the limited population size and dispersed community structure. A total of 400 transgender participants were successfully surveyed from the two divisions of Bangladesh. Data were collected using a structured questionnaire by a group of trained interviewers through face-to-face interviews. Data were analyzed using both descriptive and a multinomial logistic regression model to identify factors associated with perceived difficulty in accessing healthcare. Most respondents are young (86% aged 18–30 years), with 57.5% living away from family, highlighting social exclusion. Educational attainment is low, with 37.3% having no formal education, limiting job opportunities and leaving many reliant on donations (38.8%) or unemployed (23%). Healthcare access is hindered by financial barriers, stigmatization (65.1%), and limited provider knowledge, despite widespread access to pharmacies (97.5%). Chronic health issues, including hypertension (21.3%) and skin diseases (12.8%), are prevalent. Multivariable multinomial logistic regression clearly revealed significant disparities at 5% level of significance, with better education and health status reducing the difficulty of accessing healthcare. These findings call for tailored education programs, transgender-specific healthcare training, job creation, public awareness campaigns, and anti-discrimination policies to address systemic barriers and promote equity for transgender individuals in Bangladesh.