The hijra are neither a new phenomenon nor a Western import. Anthropological and historical scholarship, including the classic ethnographic work of Serena Nanda on the hijras of India, has documented for decades a community whose members are typically assigned male at birth but who live outside the male-female binary, often within structured guru-chela (teacher-disciple) households, performing ritual roles at weddings and births. Historical analyses of classical Indian medicine, such as the work of Sweet and Zwilling, trace taxonomies of gender and sexual variance back many centuries, demonstrating that third-gender categories existed in South Asian thought long before modern sexology or contemporary gender politics. What is new is the state’s attempt to translate this culturally embedded identity into the bureaucratic language of law, epidemiology, and public health—and it is precisely at this translation step, Hossain argues, that trouble begins.

Bangladesh took a pioneering step in 2013, when the Ministry of Social Welfare issued a gazette notification recognizing the hijra population as “Hijra Lingo,” a distinct sex/gender category. On paper, this granted formal recognition to a community that had long faced severe discrimination and social exclusion—exclusion documented in reviews published in journals such as Heliyon, which catalogued barriers to employment, housing, education, and healthcare. But the Bangladeshi recognition came with a definitional ambiguity that has haunted policy ever since. The gazette did not clearly specify whether hijra status was reserved for individuals born with specific anatomical characteristics, or whether it encompassed the broader community of masculine-to-feminine gender-diverse people, including those who might in Western frameworks be described as transgender women. In practice, Hossain notes, some hijra identified through medical screening were required to undergo physical examinations—a process widely criticized as degrading and scientifically incoherent, since it imposed a biological essentialism on what is fundamentally a social and cultural identity.

The consequences of this ambiguity are not merely symbolic. Health surveillance systems in Bangladesh have struggled to categorize the population consistently. Data from the Integrated Biological and Behavioural Surveillance (IBBS) 2020 survey, analyzed in a recent study in Discover Public Health, reveal geographic and age-related patterns in HIV-related indicators among “transgender women or Hijra” populations—a composite label that itself illustrates the category confusion. The Ministry of Health and Family Welfare issued guidelines in 2023 on standard operating procedures for sexual and reproductive health services for the “third gender population,” yet the operational definitions underlying such documents continue to waver between cultural, anatomical, and identity-based criteria. When a health worker cannot determine which category a client belongs to, or when program eligibility criteria exclude people who identify as hijra but do not fit an official anatomical definition, the result is gaps in HIV prevention, hormone-related care, and mental health services.

Pakistan pursued a different legislative route. The Transgender Persons (Protection of Rights) Act of 2018 was among the most progressive laws of its kind in the Muslim world, allowing individuals to self-identify as male, female, khwaja sira, or a combination, and to have that identity reflected on national identity cards. Crucially, the Act was grounded in self-perceived gender identity rather than anatomical verification, aligning Pakistani law more closely with international human rights frameworks. For a time, it was hailed as a model for the region.

Yet the Pakistani experience demonstrates that even self-identification laws are vulnerable to definitional backlash. In 2023, the Federal Shariat Court struck down key provisions of the Act, ruling that certain aspects were “against Islam,” a decision reported widely in Pakistani media and one that plunged the community into renewed legal uncertainty. The court’s objections centered in part on the conflation of intersex individuals—whose status in Islamic jurisprudence has long been acknowledged through the category of khuntha—with transgender women who are not intersex. Critics of the Act argued that it had blurred this line, extending protections designed for a biologically distinct group to a broader gender-diverse population, thereby provoking religious and political opposition that ultimately endangered the entire legal framework. The episode illustrates, Hossain contends, that how a law defines its protected category is not a drafting technicality but the very terrain on which legal battles are fought.

The comparison between the two countries yields what Hossain describes as a paradox of recognition, echoing the analysis of anthropologist Adnan Hossain, who wrote in Culture, Health & Sexuality about how Bangladesh’s recognition of hijra simultaneously elevated the category in official discourse while creating new hierarchies and exclusions within the community itself. Those who fit stereotypical expectations of what a hijra “looks like” gained access to recognition and its modest benefits, while others—particularly those who identify as transgender women without any claim to hijra cultural identity—found themselves in a definitional no-man’s-land, eligible for neither the protections attached to the hijra category nor any other formal recognition.

The stakes extend into education and public discourse. In 2024, Bangladesh witnessed a public controversy over a Class VII textbook chapter titled “Sharifa’s Story,” which depicted the life of a hijra individual. Media outlets reported escalating objections from conservative quarters, and the government ultimately removed the chapter. Hossain points to this episode as evidence that even carefully framed, culturally grounded narratives about the hijra community can become flashpoints when the broader public lacks a scientifically and historically accurate understanding of who hijra are and how their identity differs from, and overlaps with, contemporary transgender identities.

Against this backdrop, Hossain’s letter makes a case that will resonate far beyond South Asia: terminology in science and policy must be both culturally grounded and analytically precise. He draws on commentary in the Archives of Sexual Behavior by Paul Vasey, who examined questions of objectivity and inter-subjectivity in the study of male femininity across cultures, to argue that researchers must resist the urge to flatten culturally specific identities into universal Western categories such as “transgender women.” At the same time, he cautions against the opposite error—romanticizing cultural categories to the point of freezing them in essentialist definitions that exclude community members and invite judicial attack. The scientific literature on gender diversity, Hossain suggests, needs what might be called a bilingual approach: fluency in the local historical and cultural meanings of terms like hijra and khwaja sira, combined with rigorous attention to how those terms map onto health-relevant variables such as HIV risk, hormone use, surgical history, and access to care.

The practical implications are concrete. Survey instruments, national censuses, and HIV surveillance systems should record identity terms as respondents themselves use them, rather than forcing choices between imported or imposed categories. Legal drafters, he argues, should separate protections for intersex individuals—whose needs involve medical and bodily integrity concerns—from protections based on gender identity and expression, so that a single contested definition cannot be used to topple the entire edifice of rights. Public health programs should define eligibility by vulnerability and need rather than by anatomical screening. And educators and communicators should present the hijra community in its full historical depth, which makes both erasure and caricature harder to sustain.

What emerges from this comparative analysis is a lesson with global reach. Around the world, from South Asia to Africa to parts of Latin America, states are grappling with how to recognize, count, protect, and serve gender-diverse populations. The Bangladeshi and Pakistani experiences show that recognition without definitional clarity can produce exclusion, surveillance, and legal fragility, while recognition built on self-identification can still collapse if it fails to anticipate and address the specific religious, cultural, and anatomical fault lines in a given society. Terminology, in other words, is not the decoration on top of policy—it is the load-bearing structure. Getting it wrong does not merely confuse datasets; it determines who is seen, who is served, and who is left behind.