At 26, Yagnavalli M. (they/them) has learned to navigate a world that often refuses to listen figuratively and literally. A postgraduate in computer applications who is hard of hearing, Yagnavalli has encountered more than just indifference in healthcare spaces; they have faced outright neglect.
As a person living with disability, they remember the sting of being dismissed by healthcare providers, who brushed aside their concerns during routine vaccinations and medical treatments. Their valid and urgent fears were met with silence.
When they sought medical attention for specific health needs, they were often met with blatant tokenism—their health providers acknowledged their needs in theory. Still, they did not provide the accommodations necessary to translate those into genuine care. Their doctors scribbled prescriptions hastily, did not offer explanations, and never considered alternative approaches that could have made a difference.
The most significant barrier, however, was the absence of deaf-friendly communication.
Doctors handed them illegible handwritten notes without explanation, expecting them to decipher complex medical instructions without support. They were not given written alternatives and offered no patience or effort to bridge the gap.
It made them feel that their ability to understand their health did not matter. Over time, the frustration and exhaustion became overwhelming. Yagnavalli began avoiding certain healthcare facilities altogether—not because they didn't need care, but because they had learned that their needs would always come second in those spaces.
In India, the discourse on disability remains one-dimensional mainly, failing to acknowledge the multiple, intersecting identities that shape the lived experiences of people with disabilities.
Systemic ableism, compounded by factors such as gender, caste, and socioeconomic status, creates deep-rooted barriers to accessibility, education, employment, and healthcare. Despite policy advancements, a lack of implementation, social stigma, and exclusionary frameworks continue to marginalize disabled individuals, particularly those at the intersections of other oppressed identities.
Specific marginalized identities face compounded barriers
Ableism is discrimination or prejudice against individuals with disabilities, rooted in the belief that non-disabled individuals are superior.
Ableism in healthcare often intersects with other forms of marginalization, creating compounded barriers for individuals. For instance, queer and gender-diverse individuals with disabilities face heightened discrimination, as healthcare providers often lack the training to address their unique needs. Healthcare professionals are still struggling to navigate gender-affirming care and queer-affirming practices. When disability is added to the equation, they often view it in isolation rather than adopting an intersectional or holistic approach.
Similarly, the financial cost of healthcare services exacerbates challenges for those from lower socioeconomic backgrounds, making essential treatments unaffordable. Social status and caste play an additional role, with individuals from marginalized communities often encountering prejudice, neglect, or outright denial of care.
Patriarchal norms further sideline disabled women, rendering them invisible in conversations about health and well-being. The lack of sex education compounds these issues as disabled individuals are often excluded from learning about their bodies and rights, leading to misinformation, stigma, and violence.
The healthcare system compounds these challenges instead of mitigating them. There is a pervasive one-size-fits-all approach in healthcare, along with the tendency to equate disability solely with locomotor impairments, overlooking its broader spectrum. This approach disregards the diverse needs of disabled individuals, whether it is accounting for different pain thresholds, communication styles, or the necessity of tailored treatment plans.
Moreover, many disabled individuals lack guardian support to accompany them to healthcare facilities, leaving them to navigate these spaces alone, which can be stressful for them with the system being so unhelpful.
Real-life challenges
For many disabled individuals, these systemic shortcomings translate into deeply personal challenges.
For example, Kiran Nayak, a trans man living with disability, shares his lived experience with the healthcare system, highlighting its compartmentalized approach that often fails to see people beyond rigid categories.
Kiran describes the everyday struggles of navigating public spaces, where even access to clean and hygienic toilets—a fundamental human right—is challenging, particularly in rural areas.
His trans identity further compounds the issue, as wheelchair-accessible public toilets are virtually nonexistent in rural South India. Public spaces like buses and trains also lack essential facilities such as accessible water sources, posing a significant problem for individuals with chronic illnesses who require regular hydration.
Within healthcare, Kiran has faced severe discrimination from doctors, who question why a disabled person with existing health concerns would even seek hormone replacement therapy (HRT) or gender-affirming treatment—as if they must choose between their disability and their identity.
Beyond this medical gatekeeping, Kiran has endured nurse violence and harassment, where being both trans and disabled makes them particularly vulnerable to mistreatment.
As an activist, Kiran works to drive meaningful change in these spaces. While the road remains difficult, they are beginning to witness small but significant progress—a testament to the impact of advocacy and the fight for intersectional inclusivity.
Similarly, Natasha, a 26-year-old neurodivergent and queer psychologist living with a chronic mental and physical illness, shares their experience of navigating healthcare. This journey has been both mentally exhausting and financially burdensome.
Growing up in a middle-class family, Natasha never faced significant financial barriers to healthcare. She held an optimistic view of the system, believing that all hospitals, big or small, provided a safe space for care. However, during undergraduate studies, while experiencing depressive episodes, Natasha sought help at NIMHANS, attending over 20 sessions alone.
Despite her efforts, the health, which met her concerns with dismissive attitudes, received her complaints as "whining" through perceived gendered expectations as a cis-gendered woman. This experience not only affected her mental health but also made her question her path as a psychology student and future clinician. Now, Natasha is struggling to find neurodivergent-affirming therapists who can support her in navigating daily life. Yet, financial constraints remain a significant barrier, limiting her access to care.
Similarly, as a community health practitioner, Kimberley has witnessed pervasive ableism in healthcare. From peers to professors, there is a disturbing lack of sensitivity and understanding toward disabled individuals.
They had seen an instance where a professor asked a colleague if a disabled patient they were treating had a "normal sibling," when the colleague responded affirmatively, the professor remarked, "Thank goodness, otherwise, it would have been so sad for the family." This comment reflected an ableist mindset, reinforcing the idea that a disabled child is a burden while framing non-disabled siblings as a source of relief for the family.
Slurs and derogatory language are commonplace, and there is little effort to adopt the social model of disability in medical education. Hospital environments are overstimulating, inaccessible, and unaccommodating, particularly for neurodivergent individuals. These systemic failures alienate the people who are meant to be served by the health system.
Policy gaps in addressing disability and intersectionality
India has made strides with laws like the Rights of Persons with Disabilities (RPWD) Act in 2016 and the Mental Healthcare Act in 2017. These policies address the rights of individuals with disabilities and mental illnesses and aim to provide accessible health services. While each act individually offers legal protections for these communities, there is a significant lack of intersectionality in their application, as reflected in Kiran's lived experience as a disabled trans man.
Similarly, reservation policies for SC/ST/OBCs exist separately from disability-based reservations, meaning a disabled person from a marginalized caste must choose between one quota or the other rather than benefiting from an intersectional approach.
The Mental Healthcare Act of 2017 emphasizes autonomy and informed consent, which is crucial for trans individuals seeking gender-affirming care. However, trans persons often face medical gatekeeping, including forced psychiatric evaluations, violating their right to self-identification.
It is also worth noting that while the Mental Healthcare Act ensures access to treatment without discrimination, it does not recognize psychosocial disabilities as valid disabilities under the RPWD Act, creating a legal gap that affects those with severe mental illnesses. The absence of an integrated framework means that while protections exist for each marginalized group separately, the intersection of these identities is not fully recognized or supported, leaving these individuals vulnerable in healthcare settings.
Beyond this, the RPWD Act, while covering many disabilities, excludes conditions like endometriosis and fibromyalgia, which cause chronic pain and significantly impact daily life. Invisible disabilities, including mental health conditions, often go unrecognized, leading to skepticism, inadequate support, and exclusion from disability-specific benefits.
For queer disabled individuals, these challenges are even more pronounced as they navigate intersecting layers of discrimination—ableism, medical gatekeeping, misogyny, and cis-heteronormative biases—that further restrict their autonomy and access to care.
Furthermore, the World Health Organization's (WHO) definition of health is "a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity to lead a socially and economically productive life." This definition—emphasizing economic productivity and social well-being—often excludes disabled individuals.
This narrow perspective is rooted in capitalist ideals, equating health with one's ability to contribute economically. Disability, seen through this lens, is framed as a deficit rather than a natural aspect of human diversity.
Proposed solutions
To address these issues, systemic reform is essential.
First, conducting disability orientation workshops for healthcare professionals can foster a deeper understanding of the social model of disability. Medical institutions must hire diverse groups, including disabled individuals, not as a token effort but as a genuine step toward inclusivity. Supporting queer and marginalized individuals in establishing healthcare practices and normalizing their visibility can also challenge entrenched biases.
Reforming medical education is another crucial step. Medical education must shift to incorporate the social model of disability, which recognizes that disability is not just an individual impairment but a result of societal barriers, attitudes, and lack of accommodations. By focusing on the social aspects of disability, medical training can move beyond viewing disabled individuals as "patients to be fixed" and instead promote a more inclusive and holistic understanding of health and well-being.
This shift would help dismantle entrenched ableism, encouraging healthcare professionals to view disability not as a burden to healthcare, society, or families but as part of human diversity that requires thoughtful and empathetic care. Through this lens, medical professionals can advocate for accessible infrastructure, policies, and attitudes that empower disabled individuals to lead fulfilling lives within their communities.
Textbooks must adopt inclusive language and perspectives and cover topics like gender, disability, and intersectionality. Training programs should emphasize universal design, pain management, and patient-centered care.
The Supreme Court of India recently overturned the discriminatory requirement that medical students must have both hands intact, a rule that had unjustly prevented individuals with upper limb disabilities from pursuing an MBBS degree. This decision came after a student, Anmol, challenged the regulation when he was denied admission despite meeting all academic criteria.
The court emphasized that such exclusionary policies reinforce ableism in medical education and we must replace them with a more inclusive approach. This ruling is a crucial step toward ensuring that disability is not a barrier to entering the healthcare profession, and we must make more such policies to ensure that there is no ableism in medicine.
We must implement 'Universal Design' to ensure accessibility, from ramps and elevators to non-slippery floors, clean and functional toilets with grab rails, and braille signage to make healthcare facilities genuinely inclusive. Hospitals should also address ableism in their physical spaces by providing adjustable examination tables for wheelchair users, hearing aid-compatible equipment, and quiet rooms for patients with sensory processing issues.
Beyond infrastructure, healthcare professionals must be trained in disability awareness to combat attitudinal ableism, ensuring that all patients are treated with respect and dignity, free from derogatory language or assumptions about their capabilities. Solutions include implementing accessible communication methods, like offering written instructions, sign language interpreters, or visual aids for patients with hearing or speech impairments, and fostering a culture of inclusion that sees disability as part of human diversity rather than a burden.
Research into pain management techniques tailored to the needs of disabled patients is equally important. Beyond physical changes, awareness campaigns can empower disabled individuals to understand and assert their rights in healthcare settings.
Community-based rehabilitation (CBR) models offer valuable insights. These approaches actively involve society in the treatment and rehabilitation of disabled individuals, fostering a sense of inclusion and support. For instance, organizations in India like the Spastics Society of Karnataka have successfully integrated disabled individuals into community activities while providing tailored healthcare and rehabilitation services.
Toward inclusive healthcare
Healthcare should be a boon, not a burden, for disabled individuals. It must accommodate their needs rather than forcing them to adapt to a system not designed with them in mind. Disability is a natural part of life; our healthcare systems must reflect this understanding.
Through systemic reforms, intersectional approaches, and community involvement, we can create a healthcare model that values equity, inclusivity, and dignity. Only by addressing these structural and attitudinal barriers can we hope to bridge the divide between disability and health, ensuring a future where everyone has access to the care they deserve.
Edited by Christianez Ratna Kiruba
Image by Gayatri
