When faith hurts, when faith heals: Spiritual exclusion as a determinant of transgender health in Pakistan

Background Religion takes a major role in determining moral belonging, social identity, and emotional life in Pakistan. Although increased focus on transgender health inequalities has been placed on these issues, appropriately the issue of how religious inclusion and exclusion can influence the wellbeing of transgender persons has received inadequate attention, especially in Global South settings where religious systems form the basis of daily social activities.Methods This qualitative study involved an Interpretative Phenomenological Analysis IPA)-informed design to discuss how transgender people in Pakistan are experiencing and making meaning of spiritual inclusion and rejection. Transgender Muslims, Christians, and Hindus that reportedly had been involved in faith and religious institutions were interviewed in-depth using semi-structured interviews. The analysis of interviews was anticipated to give insights into the lived experience, meaning-making, and emotional interpretation instead of the causal health outcomes.Results Spiritual exclusion was defined by the participants as a health-relevant social process on which moral legitimacy, emotional strain, and belonging were explained. Three themes were identified as related and they were faith as fragmented belonging, sacred spaces as socially dangerous places, and religious reform as resilience. Being put out of the mosques, churches, temples, and rituals was felt as socially and ethically immediate, influencing the vigilance, withdrawal, and emotional and psychological discomposure. Instead of giving up faith, participants reported limited adjustments like private worship and trans-affirming religious space to maintain spiritual continuity in conditions of exclusion.Conclusion The results emphasize spirituality as a cultural inherent area where transgender people in religious communities derive meaning to wellbeing, distress, and endurance. This paper with its focus on lived experience in a Global South situation adds to the literature on transgender health by showing how religious inclusion and exclusion can be a health-making experience without positing causal influences and intervention outcomes.