The Tokyo High Court on Nov. 28 ruled the lack of marriage rights for same-sex couples in Japan is constitutional.

The Associated Press notes Judge Ayumi Higashi upheld the legal definition of a family in Japan as a man and a woman and their children. The court also dismissed the eight plaintiffs’ demand for 1 million yen ($6,406.85) in damages.

Hiromi Hatogai, one of the plaintiffs, told reporters after the court ruled that she is “so disappointed.”

“Rather than sorrow, I’m outraged and appalled by the decision,” said Hatogai, according to the AP. “Were the judges listening to us?”

Japan remains the only G7 country without legal recognition of same-sex couples, even though several courts in recent years have ruled in favor of it.

The Sapporo District Court in 2021 ruled the denial of marriage benefits to same-sex couples violates the constitution’s equality clause. The Nagoya District Court in 2023 issued a similar ruling. The Fukuoka District Court in a separate decision said Japan’s current legal framework is unconstitutional. The Tokyo High Court in 2024 came to the same conclusion.

The Washington Blade last month noted Prime Minister Sanae Takaichi, who is Japan’s first female head of government, opposes marriage equality and has reiterated the constitution’s assertion the family is an institution based around “the equal rights of husband and wife.”

The transgender community has been part of India’s social fabric for centuries, but decades of policy neglect pushed many into poverty and inadequate health care. 

The Supreme Court formally recognized trans people as a third gender in 2014, yet state-level services developed slowly. Telangana opened India’s first dedicated trans clinic, the Mitr Clinic, in 2021 with support from the U.S. Agency for International Development and Johns Hopkins University. Jharkhand State has now ordered all government hospitals and medical colleges to establish dedicated outpatient units for transgender patients.

People for Change, an LGBTQ organization, spent the past year mapping gaps in trans health care across Jharkhand. Its surveys of 100 trans residents in five districts found limited access to gender-affirming care, hormone therapy, dermatology, and mental-health services. The group followed this survey with a May 2025 consultation in Jamshedpur, an industrial town in Jharkhand, that brought together clinicians and community leaders to outline a feasible outpatient model. 

Those findings were presented to Health Minister Irfan Ansari in June, backed by input from allied organizations and more than 50 trans leaders. The process helped inform the state’s decision to introduce dedicated trans outpatient departments in all government hospitals and medical colleges.

People for Change, which played a central role in shaping the policy, noted that government hospitals in Jharkhand still face infrastructure and resource gaps. Even so, the group said the order reflects a clear policy commitment to creating dedicated trans health services.

If Jharkhand’s trans outpatient departments system functions as planned, it could become a regional model for states with comparable gaps in public health access. 

Government data from the 2011 Census — the latest official count to identify an “other” gender category — lists 13,463 trans residents in Jharkhand, alongside sizable populations in neighboring states: 40,827 in Bihar, 30,349 in West Bengal, 22,364 in Odisha, 18,489 in Chhattisgarh, and 137,465 in Uttar Pradesh. Though likely underreported, these figures underscore the scale of need across eastern and central India.

“The decision to start dedicated transgender OPDs (outpatient departments) is not just an administrative step — it is a statement of inclusion, a recognition that the transgender community deserves discrimination-free, dignified, and responsive healthcare. When the government takes such a deliberate step, it sets a tone for systemic change,” said Souvik Saha, founder of People for Change. “It creates an official entry point for transgender healthcare.”

“For the first time, transgender persons will have a recognized and respectful space within the public health system,” added Saha. “That itself is a major shift. It signals to doctors, nurses, and administrators that transgender health is a priority. This leads to sensitization, accountability, and the gradual improvement of attitudes within hospitals.”

Saha told the Washington Blade the policy is likely to trigger broader improvements, noting that once a service is formally notified, budget allocations, training, infrastructure, and staffing typically follow. He said the move could strengthen the system gradually, “step by step.”

“We are realistic: we know improvements won’t happen overnight. But we are also optimistic because the state has already shown genuine leadership and empathy by issuing this order,” said Saha. “And since Jharkhand is celebrating its 25th year of formation, this decision reflects the state’s intention to move towards greater equality and social justice.” 

“For the transgender community, this is not just a service — it is dignity. It is visibility. It is inclusion,” he added. “And with the government, civil society, and community working together, we believe this will lead to meaningful and lasting change in the years ahead.”

Saha told the Blade that the dedicated transgender outpatient will operate within existing government medical colleges and hospitals in Jharkhand and will be staffed by current medical and paramedical teams, with no separate funding required at this stage. He said the policy does not call for separate wards or beds, but for clearly designated outpatient spaces for trans patients. The service, he added, will be run by existing staff who will receive training and orientation as needed.

“At this moment, the specific operational details are still being discussed with the government of Jharkhand. However, what is clear is: the OPD will function as a dedicated space within the hospital, not limited to a specific day,” said Saha. “Transgender individuals will have access to focused, discrimination-free services through this dedicated space. The clinic will run through existing hospital systems, with linkages to psychiatry, dermatology, endocrinology, and other departments when required.”

“This structure allows the government to start services immediately without needing new construction, new staff positions, or separate budget lines,” he added. “It is a practical and efficient first step, making the service accessible while keeping the doors open for: future budget allocations, specialized staffing, expansions into gender-affirming services, and strengthened infrastructure. The government’s intent is very clear: to ensure dignified, equitable, and discrimination-free healthcare for the transgender community. This order is a strong beginning, and operational details will continue to evolve through collaborative discussions between the government, hospitals, and People for Change.”

Saha acknowledged that taboos, misinformation, and stereotypes about the trans community persist in Jharkhand and in many other states. However, Saha said there are encouraging models at which to look. 

He pointed to Kerala and Chhattisgarh, which have introduced sensitization programs and begun integrating trans-inclusive practices into their public health systems. These examples, he noted, show that when health departments invest in training and awareness, attitudes shift and services become more respectful and accessible.

“In Jharkhand, People for Change has proposed a similar approach. We have formally recommended to the government that civil surgeons, chief medical officer, doctors, nurses, and other hospital staff be trained on gender sensitization and transgender health challenges. This includes understanding gender identity, psychological needs, respectful communication, medical protocols, and ways to ensure discrimination-free services,” said Saha. “The encouraging part is that these proposals are already being discussed in detail with the government of Jharkhand. The government has shown strong intent through the issuance of the transgender OPD order, and training health professionals is naturally the next crucial step.”

Saha noted that it remains unclear whether trans people will be recruited into government health roles, saying it is too early to make any definitive statement. He explained that recruitment requires separate processes, policies, and approvals, and the current order does not address new staffing or the creation of government positions.

A recent performance audit by the Comptroller and Auditor General of India, the constitutional authority responsible for auditing government spending and administration, outlined severe human-resource and medicine shortages across Jharkhand’s public health system. 

Tabled in the state assembly in February, the report found that about 61 percent of sanctioned posts for medical officers and specialists were vacant, along with more than half of all staff-nurse positions and roughly four-fifths of paramedic posts. The audit also documented acute shortages of essential drugs in the hospitals it reviewed, with stock gaps ranging from 65 to 95 percent during the 2020-2022 period. The findings highlight the systemic constraints that the new trans outpatients will have to navigate.

Saha acknowledged that drug shortages remain a serious issue in government hospitals and said the concern is valid. Even so, he added that he is approaching the new outpatient policy with hope and confidence.

“The government of Jharkhand has made a historic and intentional decision by opening dedicated transgender OPDs,” said Saha. “When a government takes such a strong step of recognition and inclusion, it also shows the readiness to understand the specific health challenges and medication needs of the transgender community.” 

“As more transgender persons start coming to the OPDs and their health requirements become clearer through proper documentation and reporting, we are confident that the state will make every effort to ensure that essential medicines are available for them,” he added.

Saha said People for Change is also seeking support outside the public system. The organization has begun briefing civic service groups — including Lions Club, Rotary Club and Inner Wheel, international volunteer organizations that run local welfare and health projects — on the outpatient order and the community’s needs. According to Saha, several of these groups have indicated they may help trans patients with medicines and other essentials when prescribed by a doctor.

“So the effort is two-fold: the government is creating an inclusive health system and will be informed of the community’s specific medicinal needs through the OPDs. People for Change and partners are strengthening the safety net to ensure that transgender persons are never left unsupported,” said Saha. “We truly believe that this collaborative approach will ensure that transgender individuals receive the medication and care they deserve — with dignity, consistency, and compassion.”

“Every hospital may take a slightly different amount of time depending on internal readiness, but overall: The foundational work is already underway, Hospitals have started preparing their designated OPD spaces, And coordination is happening at the level of civil surgeons, medical superintendents, and hospital management teams,” he added.

Sanae Takaichi last month became Japan’s first female prime minister after she secured the Liberal Democratic Party’s leadership and both chambers of the Diet confirmed her.

She now leads a minority government after forming a coalition with the right-leaning Japan Innovation Party, following Komeito’s decision to end its 26-year partnership with the LDP. Her rise marks a historic break in Japanese politics, but the question remains whether she will advance the rights of Japan’s LGBTQ community?

Despite the milestone her election represents, Takaichi’s record on gender issues offers little indication of progressive change. 

She has long emphasized “equality of opportunity” over structural reforms and has opposed measures that include allowing married couples to use separate surnames, a policy many women say would ease workplace discrimination. During her leadership bid Takaichi pledged to elevate women’s representation in government to Nordic levels, yet she appointed only two women to her 19-member Cabinet. Takaichi has also resisted efforts to modernize the Imperial Household Law to permit female succession, reinforcing her reputation as a conservative on women’s rights.

Takaichi’s stance on LGBTQ rights has been similarly cautious. 

In a 2023 Diet budget committee session, she said there should be “no prejudice against sexual orientation or gender identity,” yet described extending marriage rights to same-sex couples as an “extremely difficult issue.” 

Her earlier record is consistent.

In 2021, she opposed an LGBTQ-inclusive anti-discrimination bill that members of her own party, arguing its wording was too vague. 

Even after becoming LDP leader in October 2025, she reiterated her opposition to marriage equality and emphasized traditional family values. Takaichi highlighted that Article 24 defines marriage as being based on “the mutual consent of both sexes” and frames the institution around “the equal rights of husband and wife,” language she argues leaves no constitutional room for extending marriage rights to same-sex couples.

While her rhetoric avoids overt hostility, her record suggests limited appetite for the structural reforms sought by Japan’s LGBTQ community.

A series of landmark court rulings has built escalating pressure for national reform. 

On March 17, 2021, the Sapporo District Court ruled that denying same-sex couples the legal benefits of marriage violated the constitution’s equality clause. In May 2023, the Nagoya District Court similarly declared the ban unconstitutional, with a subsequent decision from the Fukuoka District Court reaffirming Japan’s current legal framework clashes with constitutional equality principles. 

The momentum peaked on Oct. 30, 2024, when the Tokyo High Court found the marriage ban incompatible with guarantees of equality and individual dignity. 

Japan remains the only G7 country without legal recognition of same-sex couples.

Akira Nishiyama, a spokesperson for the Japan Alliance for LGBT Legislation, noted to the Washington Blade that in leadership surveys the group conducted within the LDP in 2021 and again in 2025, Takaichi offered only a cautious position on reforming Japan’s legal gender recognition law. When asked whether she supported easing the requirements under the Act on Special Cases in Handling Gender Status for Persons with Gender Identity Disorder, she responded that “multifaceted and careful discussion is necessary,” avoiding any commitment to substantive change.

Nishiyama added the legal landscape has already shifted. 

In October 2023, the Supreme Court ruled that the law’s sterilization requirement for legal gender recognition is unconstitutional, and several family courts have since struck down the appearance requirement on similar grounds. She urged the Takaichi administration to act quickly by amending the statute to remove these provisions, along with other elements long criticized as human rights violations.

“[Prime Minister] Takaichi has stated that ‘careful discussion is necessary’ regarding amendments to ‘Act on Special Cases in Handling Gender Status for Persons with Gender Identity Disorder’ and the enactment of anti-discrimination laws based on Sexual Orientation and Gender Identity (SOGI),” noted Nishiyama. “However, as indicated in Candidate (at that time) Takaichi’s responses to our survey, if she considers issues related to SOGI to be human rights issues, then she has to work hard to advance legal frameworks to address these issues.” 

“For example, regarding the government’s announcement that they will consider whether same-sex couples could be included or not in the 130 laws concerning common-law marriages couples, [Prime Minister] Takaichi responded to our survey that ‘the government should continue to advance its consideration,’” she added. “As per this response, the Takaichi Cabinet should continue deliberating on this matter and ensure that same-sex couples are included in each relevant law.”

Takeharu Kato, an advocate for marriage equality who spoke to the Blade in a personal capacity, urged observers not to view Takaichi’s appointment solely through a negative lens. 

He acknowledged she holds deeply conservative views within the LDP and has openly opposed marriage equality, but noted several aspects of her background could leave room for movement. 

“She is Japan’s first female prime minister in history. Furthermore, she does not come from a political family background but rather from an ordinary household,” said Kato. “She also has an unusual career path, having graduated from a local university and worked as a television news anchor before entering politics.” 

“Additionally, while her husband is a member of the Diet, he became partially paralyzed due to a cerebral infarction, and she has been caring for him,” he further noted. “She possesses several minority attributes like these, and depending on our future efforts, there is a possibility she could change her stance on same-sex marriage. It could also be said that, as a woman navigating the conservative Liberal Democratic Party, she has deliberately emphasized conservative attitudes to appeal to her base of right-wing supporters.” 

Kato stressed that “having reached the pinnacle as prime minister, it cannot be said she (Takaichi) has no potential to change.”

“We need not alter the strategy we have pursued thus far,” Kato told the Blade. “However, we believe some fine-tuning is necessary, such as refining our messaging to resonate with those holding more conservative values.”