Ziya Pavel always wanted to be a mother; Zahad not so much. But the funny thing about love is that it makes you do things that you never imagined you would. And so, Zahad reportedly became the first trans man in India to birth a child.
The journey of Ziya, 21, and Zahad, 23, in embracing their true identities may be similar to many in the transgender community, but as a trans woman and a trans man embarking on a journey of parenthood, it is like no other. Right from their decision to have a baby together a year and a half ago to not revealing the child’s gender soon after its birth on February 8, their story has been unconventional.
Meet cute
The day we meet the couple and the baby is the day for the baby’s routine checkup at the Kozhikode Medical College. The hospital visit was slated for morning but got rescheduled to noon because of the doctor’s unavailability. When we arrive at the couple’s rented place in Kozhikode’s Ummalathoor, we find Ziya, with the baby cradled in her arms, walking down the narrow lane towards the main road. Zahad, still recovering from the C-section, is at home, she says. We decide to accompany Ziya and the little one to the hospital. At the medical college, Ziya navigates her way to the paediatrician’s room with ease. She is a familiar face here, evident from the warm greetings and inquiries she receives from the nurses and staff. Some inquire about Zahad's health and the baby's progress, clearly happy to see the new family thriving. Since the doctor was making his rounds in the maternity ward, Ziya takes the baby there. Post consultation, she makes her way to the milk bank to collect breast milk for the baby, to be fed thrice a day.
Once back home, she feeds the baby with a feeding syringe.
Zahad is friendly but reluctant to talk about the pregnancy. It is only later that he agrees to talk over the phone. The first two weeks post delivery were painful. Even climbing stairs had become an uphill task for him. Ziya put up a cot for him and the baby in the living room. “In the first week after the delivery, I was bedridden,” says Zahad. “I could not even turn to the side. It was very tough to even go to the bathroom back then. But since it is for our child, I forgot about the pain. Each time I look at the baby, I forget every inconvenience.”
Beyond binaries
Inconvenience is not new to Zahad and Ziya. In a world that lives and believes in binaries, they have been living with an inconvenient truth—their identity. Zahad was recorded female at birth but identifies as male, and Ziya was recorded male at birth and identifies as female. “Zahad was born in a Christian family in the coastal belt of Thiruvananthapuram and I was born in an orthodox Muslim family in Kondotty of Malappuram district,” says Ziya. “As a transgender, I have undergone experiences similar to others in my community. I have been through bullying and loneliness, from family and friends. I am the youngest among eight children. My mother died a while ago and my father remarried. I do not have any contact with my father now.”
Ziya is now a dance teacher and performer. The walls of their living room are adorned with portraits of her dance performances. She had a passion for dancing since childhood but never got an opportunity to learn it from a dance teacher. She taught herself the basics of classical dance by watching students at dance classes in school and through videos. “Even as a child, I used to perform in female costumes,” she says. “However, my family did not appreciate it. My family used to question my identity, asking why I couldn't live as either a man or a woman. During my time in plus one (equivalent to class 11), I discovered that there was a transgender community, although my family would often bring it up in a derogatory way, labelling me as someone similar to those in the community. Despite this, I never imagined that I would become a transgender individual, nor did I initially desire to do so. However, due to the constant bullying from my family about my nonconforming identity, I eventually decided to become a woman.”
Ziya’s mother died when she was in plus one and her family stopped sending her to school. “Within a year, I officially came out as a transgender woman and went to a shelter home for transgender individuals in Kozhikode,” she says. Five months later, Ziya left the shelter home to live with her mother in the transgender community—Deepa Rani. “She assured me that she would care for me like a mother,” she says. “She promised to support me in my studies. Despite moving in with my mother, my family tried to take me back twice, with police involvement. Fortunately, as I was already 18, they had no control over my decisions.”
Zahad’s family, meanwhile, was more open towards his decision to go for a transmasculine transition. “When Zahad started going for a job, he underwent breast removal surgery. At that time, he was employed at Techno Park, Thiruvananthapuram,” says Ziya, while adding that a male perception started forming in him from childhood. “If you look at his old photographs, you can see that he always had a masculine demeanour,” she says.
It was when Ziya was living with Deepa Rani that she grew closer to Zahad, thanks to social media. “Initially, we planned to keep our relationship a secret till we got jobs and were ready to settle down,” says Ziya. “Unfortunately, my mummy caught us, and it caused issues. When the matter became problematic, Zahad suggested that we live together, and Ashitha, his community mother, agreed to let us stay with her for a while.”
Thus, the duo started living together. And that is when they decided to have a child. “I had always dreamed of having a baby, as I have great fondness for children,” says Ziya. “It was primarily my interest, and Zahad had never considered getting pregnant before. When I shared my desire to have a baby, Zahad was hesitant at first owing to concerns about societal perceptions. I, too, had apprehensions. However, after seeking advice from medical professionals who provided assurance as well as receiving support from one of my sisters, we began to feel more confident about having a baby.”
Zahad had started taking testosterone therapy as part of his transition process in 2020 after coming to Kozhikode. “This was after I had done breast removal surgery,” he says. “I had already taken eight to nine doses. I stopped taking the hormones after taking advice from the doctors. They advised that our wish to have a baby would be successful only if we stop taking hormones.” Like Zahad, Ziya also had been undergoing hormone therapy. When they decided to have a child, she, too, halted the hormone therapy.
The couple had considered the possibility of a trans woman pregnancy instead of a trans man pregnancy. But the complexity and very low chance of success deterred them. “An adoption is an unviable option for transgender couples in India,” says Ziya. “We also explored alternatives such as surrogacy, but since Zahad had not yet undergone uterine removal surgery, we decided to delay it until the birth of a child. The doctors advised us to have a thorough discussion before making this decision, which we did. We made our choice and took every scenario into account.”
Activist Abhina Aher, a trans woman herself, says that those who criticise the choice made by Ziya and Zahad do not understand that sexuality and gender are different concepts. “Procreation is an individual’s right, irrespective of whether that person is a man, woman or transgender,” she says.
Pregnant pause
Multiple studies have shown that many transgender and gender-diverse individuals desire genetically related children. They regret missed opportunities for fertility preservation, and are willing to delay or interrupt hormone therapy to preserve fertility and/or conceive. Air Commodore (Dr) Sanjay Sharma (retd), CEO and managing director of the Association for Transgender Health in India, says that contemporary Indian societies need to normalise trans man pregnancies just as in many countries. But when compared with cis-gender women (women who identify with the gender they were assigned at birth), it is a more weighted decision that trans men have to make regarding pregnancy, considering the complexities it involves. “For cis-women, bodies and their perception would match. Trans men would have a uterus and ovaries, but their perception may not match that,” says Sharma. “So, there comes the first sort of gender incongruence.” He explains how most people decide about parenthood in their second to third decade of life, but gender perception starts very early in life, at two or three years of age. “And, you are trying to push a narrative that is not being believed by others,” he says. “By the time you feel empowered enough to start expressing this, your priority may not be parenting; it is of acceptance. And herein comes the biggest hurdle to becoming a parent. Acceptance in your peer group means you want interventions that will help you pass among the peer group. So, if I am a transmasculine person, I would be looking for masculinisation, and I would be asking for interventions that will cause masculinisation. But these interventions may interfere, not may, they do interfere with a person’s ability to conceive.”
Sharma adds that the hormone treatments that are done as part of transitioning are teratogenic, meaning they can cause damage to the growing foetus. “So, if a transgender person approaches a doctor for hormone therapy, then the doctor needs to discuss with him/her the effect the hormones can have on fertility,” he says. “But a lot of people come for hormone therapy in their late teens, and the perception at that time would be just to start interventions. The demand for pregnancy comes later when you have a partner.”
Those who start their transition in adolescence are often treated with gonadotropin-releasing hormone agonists (GnRHas)—substances that keep the testicles and ovaries from making sex hormones by blocking other hormones that are needed to make them. GnRHas may be used for pubertal and menstrual suppression until a transgender individual is ready for a masculinising treatment. Studies show that GnRHas has an impact on the maturation of gametes (reproductive cells), but they do not cause permanent damage to the functions of gonads (testes or ovaries). So, if GnRHas are discontinued, oocyte maturation is likely to resume. There are also studies talking about the effect of testosterone therapy on reproductive function in trans men. Researchers have observed that normal ovarian function with oocyte maturation resumed after testosterone interruption in transgender men who have achieved natural conception. However, the scientific world is yet to come up with a major study evaluating the effect of long-term hormone therapy on fertility. Also, the optimal time for both the discontinuation of testosterone prior to pregnancy and its resumption after pregnancy is still unknown.
Zahad and Ziya underwent numerous tests before conception to ensure safe and healthy childbirth. “Sperm analysis was done [in my case],” says Ziya. “We did not have all of Zahad's medical records following his breast removal surgery, so he underwent a comprehensive physical examination to determine the extent of procedures performed on his body. This involved multiple tests.”
The couple did not publicise the details of the pregnancy until the third trimester. Zahad used to work in a supermarket in Kozhikode. He stopped going for that job. During the early stages of pregnancy, Zahad experienced frequent vomiting and required intravenous therapy. He was hospitalised for a couple of days. The Kozhikode Medical College helped the couple deal with psychological and physiological stress. “Mentally, there was a risk of issues arising, since the patient was a man and suddenly he became pregnant. There are psychological changes coming over. So, he was given psychiatric consultation and mental health support,” says Dr Jyoti Ramesh Chandran, professor and head of the Institute of Maternal and Child Health at Kozhikode Medical College. “For consultation, we used to see him at a separate place. He used to come in his normal attire [which is masculine], and did not require to stand in a normal queue, because other women may not like a man standing in the queue.”
As the pregnancy progressed, it became tough to walk or travel for Zahad. “I faced a major weight loss,” he says. “Currently, I am 57kg, but my weight had gone down to 40kg during pregnancy. Also, I became frail, so when I was six months pregnant, I was shifted to my home in Thiruvananthapuram. I was under my [biological] mother’s care for the next couple of months.” Ziya had dance classes at Pathanamthitta then. She kept travelling back and forth to visit her partner.
The couple returned to Kozhikode and the delivery was planned for March 4 at Kozhikode Medical College. However, in the first week of February, Zahad’s sugar level shot up—a dangerous condition for the child in the womb. “So, we conducted the delivery earlier than we planned,” says Chandran. “After [the C-section], another issue arose. Though the patient had removed the breasts, a part of the chest in the axilla (underarm) started swelling as it started producing milk. We gave medication to suppress it.”
Chandran adds that though Zahad has a manly demeanour, he also has motherly instincts. “It was there in his eyes…the way he was caring for the baby,” she says.
Ziya and Zahad also reject a father-mother binary division while taking care of the child. “Right now, I am playing the roles of both a father and a mother, because I have to take care of both,” says Ziya. “I have to manage the financial issues. But a strong motherly feeling developed in me even before the delivery of the child. Though Zahad was carrying our child in the womb, I had a special feeling…. For instance, when we felt the baby kick or move in the womb… I do not how to express that feeling in words. It is something to be experienced.” She says that parenting cannot be divided into separate columns of a father and mother. “It is the situations that define our role at a particular time,” says Ziya. “It is our child, and we want to give the best to her. It is not the title of father or mother that matters. Our only concern is to love our child as much as we can.”
Whether it is in the case of a cis-gender or transgender person, pregnancy and post-pregnancy phases are challenging, not just at the physical level but also emotional and psychological levels. Dr Jithin Joseph, clinical research fellow and senior resident at Kasturba Medical College, Manipal, says that in the case of transgenders, the challenges are more because of the hostile way society and even the health care system treat them. “Our society thinks that only a [cis-gender] woman can give birth,” says Joseph, who is a comprehensive sexuality educator and a gender and sexuality researcher, and a member of the World Professional Association of Transgender Health. “There is huge discrimination against transgenders; a transgender man may get ridiculed for getting pregnant. Even our health care system may not provide inclusive care to them.”
During pregnancy, a person—whether cis-gender or transgender—will undergo hormonal changes. So, there is a risk of developing postpartum depression or postpartum psychosis. In the case of trans men pregnancy, there is an added challenge. “In a planned trans man pregnancy, they would require to stop testosterone four to six months before conceiving,” says Joseph. “In those with gender incongruence, there is a risk—stopping hormone treatment may worsen their incongruence along with the pregnancy. There is a heightened risk of developing mental health issues. However, instead of blaming them, our focus should be to create a more supportive and inclusive environment.”
Joseph says that the first step towards that would be discussing the various reproductive options for the transgender couple. “In many countries, transgender pregnancy is a normal affair, and there is more awareness and support to preserve ovum or sperm before starting hormone therapy or undergoing surgery,” he says. Joseph also advises transgenders not to have accidental pregnancies while on hormone therapy to avoid any congenital disorder in their babies. The psychiatrist also notes the need for trans men to have a close followup with their gynaecologist, endocrinologist and mental health professionals to monitor for any issue in the post-delivery period.
“If a trans man wants to feed the baby, we may have to withhold testosterone therapy for a while, like probably two to six months to one year,” says Joseph. “But if that person has severe dysphoria, we may not be able to withhold the hormone treatment. In such cases, we may have to find alternative feeding options for the baby. But the inability to feed the baby may affect them emotionally. At the same time, if testosterone therapy is not restarted, it may add to the incongruence, which in turn could worsen their mental health. So, a post-delivery followup, tailored for each individual, should be made available by our health care systems to support transgenders.”
Ziya says that the medical college is providing good care and support to Zahad, the baby and her. “Also, we are grateful that we get enough breast milk from the hospital,” she says. “In fact, many well-wishers of ours donated breast milk at the bank at the medical college so that we could get adequate quantity for our child.”
Chandran says that Zahad will undergo an examination after six weeks to check whether everything is fine. “Within three months, he will be able to start hormone [treatment] again,” she says. “We advised him not to do removal of uterus and ovaries now, as he is just 23. Because ovaries protect him from so many problems like atherosclerosis, heart diseases and osteoporosis. We told him that he can decide on it later. He can do it when he is around 40.”
Baby and a better world
The world came to know about Ziya and Zahad’s story when their pregnancy photo shoot went viral on social media. “The photo shoot was not intended for publicity, but rather to commemorate every aspect of childbirth,” says Ziya. “I meticulously documented everything, and even created a cast of Zahad’s belly. I planned to share everything with my child, to show her where she came from. The photos were meant for our personal album, but we were so impressed by their beauty that we decided to share them on our social media handles.”
The photos were uploaded on January 31. A week later, the baby was born. The baby’s name—Zabiya—and her sex were revealed exactly a month after her birth (March 8). But the discussions that the pictures ignited continue. There were many to appreciate and bless them. Equally, there were many to criticise the couple and their choice. There was also a section raising bizarre concerns about the child’s future.
Ziya is well aware of the negativity that a section of society holds. “Our main concern is to protect our child from any negative experiences and ensure her safety,” she says. “Our goal is to raise a compassionate and humane individual, without imposing any gender expectations on the baby. If someday she wants to undergo a gender transition, we will support her completely. Although we acknowledge that society may not always be accepting, we believe in empowering our child to be resilient and strong. A lot of people have commented about the future of the child. If society ensures a safe environment, that question does not need to arise. Just let us live peacefully.”
Aher notes that many are concerned about how the child will relate to her parents. “Who will the child call mother? Who will the child call father? All these are very stupid perspectives,” she says. “They should be least bothered about it because motherhood and fatherhood are not associated with your sexual organs, or your sexuality, or your gender expression. It is a feeling.”
Aher adds that the story of Ziya and Zahad started a dialogue within India’s transgender community, too. “Here when we are talking about transgender identity, we are still following the binary rules,” she says. “Like a trans woman has to dress up like this. A trans man has to dress up like that. A trans man should not be doing this… trans men should be drinking. So, all these gender stereotypical rules are being applied to the trans community, too.”
Shaman Gupta, who is the co-chair of Transgender Welfare Equity and Empowerment Trust and identifies as a trans man, says that it “opened the mind” of many within the community, and “broke the internal stigma” related to trans men pregnancy. “Many have realised that if this person is doing it [pregnancy] so confidently, then they can also embrace it,” he says. The story of Zahad and Ziya, adds Gupta, would inspire more transgender couples to think about having babies.