In a conversation with THE WEEK, Akkai Padmashali, a prominent activist and community leader, shares her powerful insights on the intersection of gender identity, caste, class, and citizenship, and how these realities deeply influence the mental health of marginalised women in India.
Drawing from her personal experiences as a transgender woman, she sheds light on the silent struggles faced by transgender, sex worker, and other marginalised communities in the country.
The conversation delves into the urgent need for inclusive spaces, systemic change, and community-driven support systems to address the mental health challenges faced by these women.
In this candid Q&A, she reflects on the emotional toll of discrimination, the importance of self-acceptance, and how collective action can lead to a more just, equitable, and supportive environment for all women.
Q: Your life’s journey brings together gender identity, caste, class, and citizenship in very visible ways. From your experience, how do these intersecting realities shape the mental health of women on the margins in India today?
A: The question itself reflects the diversity, plurality, and fraternity that define this country. India is shaped by shared struggles and joys, yet women on the margins continue to be judged because of where they come from—whether by gender identity, caste, class, ethnicity, or language. These layers of discrimination deeply influence mental health and emotional well-being.
Women from marginalised communities—transgender women, sex workers, devdasis, women from sexual minority backgrounds—carry the heaviest burdens. When gender, caste, class, and citizenship intersect, they do not just affect a woman’s social status; they chip away at her dignity and her sense of belonging.
What strengthens our movements is when marginalised women are brought into collective spaces where their voices matter. That is why platforms like the Mpowering Minds Summit 2026 Women's Mental Health are important as they create inclusive spaces for these voices. I thank Mrs Neerja Birla and Mpower for building a forum where women’s mental health—across all identities—gets visibility and respect.
Coming from a sexual minority background myself, I know firsthand what daily mental distress looks like. These are not theoretical issues; these are lived realities. Addressing mental health for marginalised women is not optional—it is urgent. And the only path forward is collective convergence: when all sections of society come together, listen to one another, and work toward a future where every woman can live with dignity.
Mental distress among transgender and marginalized women is often discussed in statistics. From what you have seen on the ground, what are the everyday experiences that quietly—but deeply—affect mental wellbeing
“I am honestly not very concerned about statistics. Numbers are often demanded by conservative donors who want data to justify their funding. Yes, figures have their place, but beyond numbers, there are real social issues that need urgent attention. Statistics alone cannot capture what transgender and marginalised women live through every single day.
We all know we are part of a deeply discriminatory society. And in that context, the question is: how do we address these issues systematically? How do we strengthen the very few safe spaces that exist? Because right now, those spaces are extremely limited, and creating new ones is a huge challenge.
From what I see on the ground, the everyday experiences that affect mental well-being are the constant small humiliations and exclusions—being denied dignity, being stared at, being spoken to harshly, not finding safe housing, being rejected by family, or not feeling welcome in public institutions. These daily experiences build a kind of silent, heavy distress.
Even the numbers that governments or private reports provide do not come close to doing justice to what this community faces. They capture a fraction of the reality. The real work is being done by a handful of organisations and grassroots movements trying to support women at the community level.
For me, the strength lies in the community itself and in the movements we build—not in statistics. It is the lived experiences, the collective struggle, and the everyday resilience of transgender and marginalised women that truly reflect the mental health landscape. Numbers can guide, but they will never tell the full story.
Q: In your decades of community work, what patterns have you observed in how trauma is carried over time—within families, communities, and social systems? What role does silence play in this?
A: In my decades of community work, especially as a transgender woman having experienced backgrounds of begging, sex work, and other marginalised spaces, I have seen how trauma travels across time. It does not stay with one person—it moves through families, communities, and entire social systems.
For many transgender women, the spaces available to us in society feel like they are constantly shrinking. There is very little room to raise our voices. Families, in particular, often struggle with acceptance. There is rejection, reluctance, and a deep discomfort with allowing us to live as we are. Partners, relationships, and every social circle we try to be part of can become spaces where acceptance is missing. And when there is no acceptance, the trauma is carried forward.
This cycle will only change when we create platforms for real conversations—especially one-to-one conversations between people who think deeply about these issues, activists, and those who come from marginalized communities themselves. We need broad, open mindsets to confront the mental and emotional realities that marginalized women face.
And silence is poison. As long as we are not able to speak publicly, our pain remains unresolved. Society silences us in every institution and every system we enter. To break that cycle, we must be loud enough to question those systems—no matter what background we come from. It is only by breaking the silence that we begin to break the trauma.
Q: India has seen some positive shifts in conversations around gender identity and mental health. From your perspective, what changes feel meaningful on the ground, and where do gaps still remain for transgender and marginalized women?
A: There has certainly been a shift in India’s conversations around gender identity and mental health, but it is not yet a major transformation. Many feminist and women’s rights spaces have created important platforms—but for a transgender person, it can still be difficult to feel fully comfortable or heard within systems shaped by long-standing social norms. These norms often make it hard for trans and marginalised women to speak openly or claim space.
Yes, discussions around gender and health are increasing, and mental health is finally being recognised as part of the fundamental right to health. But when it comes to marginalised minorities—such as Jogappa, Malardi, Shive Shakthi, Jogti, Malhari, Bandhi Sadla, and Khoyur communities—the gaps remain significant. These are groups that may be culturally or traditionally recognised in some ways, yet socially excluded. Their right to health, as human beings with the same needs and aspirations as anyone else, is still not fully respected.
For many transgender people, the journey includes breast implants, sex-reassignment surgeries, hormone therapy, and other procedures simply to be accepted in society. These experiences deeply affect mental health. Yet, India still does not have strong, comprehensive systems to support their physical or emotional well-being throughout these transitions.
What is needed now is the strengthening of systems, so that transgender and marginalised women can access friendly, non-discriminatory health care environments. Mobilising community members so they feel safe using these services is equally important. This requires substantial investment. The government and the organisations working in this space need dedicated funding streams specifically for the health and wellbeing of these communities.
In our organisation, Vandade, we work through a human-rights lens. For us, the right to health is central. We focus on ensuring that marginalised communities can access services without discrimination. Only when systems are strengthened and resources committed will real, meaningful change be felt on the ground.
Q: Could you share examples of how collective support, cultural practices, or peer networks have helped women rebuild dignity and mental strength outside formal clinical spaces?
A: The process of healing is a very big challenge—especially for women on the margins—because it cannot happen without safe spaces. Many women do not have access to formal mental-health services, so the role of the community becomes essential. Informal gatherings, small collectives, and community groups often become the first places where women feel seen and supported.
When women come together in these informal spaces, they find room to talk about things that are otherwise silenced—beliefs, faith, sexuality, their own bodies, and the experiences that shape their daily lives. These conversations help rebuild dignity. But the truth is that peer networks are still very limited, and building them for marginalized communities remains difficult.
Outside clinical spaces, access to healing is rare because there is already a shortage of trained experts and very little infrastructure. That is why the most immediate and effective intervention is peer support: creating safe drop-in spaces, strengthening community-led groups, and building environments where women can share without fear or judgment.
These community spaces help women gain confidence, recognise their own strength, and slowly rebuild their mental resilience. Healing does not start without building self-confidence first and leveraging accessible spaces and connections. And when women support one another, that collective energy becomes a powerful source of recovery and dignity.
Q: Access to mental health care remains uneven across regions and populations. What kinds of care models or innovations do you believe could make mental health support more reachable for women living outside urban or privileged spaces?
A: I absolutely believe it is possible to make mental health care more accessible—but today, everything is still heavily centralised. In many states, the capital or major cities such as Bengaluru become the dominant hubs.
Opportunities, services, and mental-health resources cluster in these urban spaces, making them far more reachable for privileged communities.
But when you look at rural regions—talukas, gram panchayats, and hill panchayats—these areas are almost completely unreached. The question of how we reach these women is one of the biggest challenges we face, and it’s something donors, policymakers, and community movements need to understand deeply.
Many organisations are willing to work at the grassroots, but the realities are complex. Think of a farmer woman, a Dalit woman doing daily-wage labour, or a person living with a disability in a remote area. There are simply no safe spaces for them to access mental-health support. On top of this, the level of domestic violence in many rural and marginalised communities is unimaginable, and existing law-enforcement structures often lack the familiarity or capacity to respond in a sensitive, supportive way. This makes mental-health access even more difficult.
One strong solution is to bring mental-health services directly into villages and talukas rather than expecting women to travel long distances. Community-based care models could be transformative—mobile counselling units, trained rural mental-health workers, peer-support groups, and partnerships with local panchayats. These decentralised models would offer dignity, safety, and culturally rooted support, far beyond what urban-centred systems can provide.
Another important strategy is to bifurcate our approach by recognising the different needs of urban, rural, remote, and backward regions. Each context requires its own design—one model cannot fit all.
If we look beyond urban boundaries and invest seriously in rural mental-health infrastructure, we can create a support system that genuinely reaches women who have been invisible for far too long.
Q: Many women on the margins spend a lifetime explaining or defending their existence. What emotional toll does this take, and what coping strategies have you seen women develop to protect their mental health?
A: This is absolutely true. Many women on the margins spend their entire lives justifying who they are, and this takes a tremendous emotional toll. We live in a system shaped by deep patriarchy—where power, dominance, and hierarchy still affect every aspect of a woman’s life. Women are expected to carry so much: responsibility for themselves, dependence on partners, expectations from family, pressures from extended relatives, neighbours, communities, and then the demands of the workplace. Everything somehow falls on women, and this constant weight creates exhaustion, self-doubt, and emotional strain.
When it comes to coping strategies, there is also an inequality. Some coping tools—like access to information, safe spaces, counselling, or mental-health resources—are more available to women who are literate or who have access to supportive networks. Marginalised women often do not have these same opportunities, which widens the gap further.
So the real question is: how do we bridge this gap? Until we address the class barriers and the discrimination that shape access to support, it is very difficult for all women to protect their mental health equally.
What I have seen is that confidence-building becomes the first and most essential step. Supporting a woman to believe in her own worth, helping her recognise her rights, creating safe spaces where she is heard, and ensuring equal opportunities—these are the foundations that allow them to develop coping strategies. When a woman gains confidence, she begins to protect herself emotionally. She starts to navigate the world with a stronger sense of self.
Ultimately, the emotional toll is heavy—but when we build systems that give all women access, dignity, and equal opportunity, we also build the conditions for collective healing and resilience.
Q: If institutions—governments, health care systems, or civil society—were truly listening, what are the most important steps they could take today to better support the mental well-being of transgender and marginalised women?
A: The members who shape our institutions—across government, healthcare, and civil society—often have access to strong resources and well-established systems. Yet, from the perspective of marginalised communities, it can feel as though these systems are not always designed with their realities or well-being at the center.
That gap reinforces the sense of being unseen. Today, too many medical and legal professionals still operate from a place of bias and self-interest. When a sex-worker, a transgender woman, or any marginalised woman who has been abused or harassed by the very system approaches a hospital or a police station for help, she is met with judgement. Instead of being seen as a victim, she is blamed. Instead of addressing the violence caused by the perpetrator, the questioning is directed at her—with insensitivity, ignorance, and a complete lack of professionalism.
What we urgently need is for the health department to strengthen systems, enforce clear legal guidelines, and ensure that discrimination has no place in medical or mental-health support. Training, accountability, and survivor-centered protocols must become the norm, not the exception.
Civil society also has a critical responsibility. NGOs, advocacy groups, and policy think-tanks must work from within systems to push for gender-responsive budgeting, inclusive policymaking, and the integration of the lived experiences of working-class and vulnerable communities. Right now, these narratives are often ignored in planning, budgeting, and policy formulation.
So the most important step is collective action: institutions must be accountable, and civil society must amplify the voices of those most affected. Only when we work together—sensitising systems, reforming structures, and centering real experiences—can we build a world where the mental wellbeing of transgender and marginalised women is truly supported.
Q: As a journey speaker at this Summit, speaking to millions of women in India and across the world who may see themselves in your story—what message of hope, strength, or direction would you like to leave them with?
A: All of us have stories — and sharing them isn’t always easy. But without sharing our stories, society will never change. Real change begins with self-acceptance and the courage to be who we are. Whether we live with a disability, whether we are Black, Dalit, Muslim, upper-caste, sex workers or the children of sex workers, Devdasis and their children, or children from any minority community — whoever we are, we must first accept ourselves with dignity.
When we learn to stand in our truth, we build the confidence to live fully and fearlessly. And when we give that same dignity to others, we create the foundation of a just and non-discriminatory world.
From there, we can come together — people with similar values, similar dreams, organisations with shared commitments, and donors who believe in equity. Because no one is superior, we are all equal.
So I invite everyone listening: do not judge. Do not discriminate. Support gender identity, support sexual diversity, and support every person’s right to live with dignity. That is how we move forward. That is what comes next.
