Beyond Binary Health: Addressing Menstrual, Reproductive, and Menopause Inequities Among South Asia’s Hijra Communities

Hijra communities in South Asia have long held spiritual and cultural significance, yet colonial legacies and ongoing structural inequities have relegated them to the margins of health policy and research. Despite legal recognition as a third gender in several countries, reproductive and ageing health needs—including menstrual health, fertility, and menopause care—remain largely invisible. This highlights the historical, ethical, legal, and cultural dimensions of Hijra exclusion from health systems, with particular focus on menopause and reproductive inequities. Addressing these gaps is critical to expanding reproductive and ageing health beyond binary frameworks and advancing health equity for all gender-diverse populations.