In Pakistan, they are also called Khawaja Sira, the equivalent of transgender in the Urdu language. Hijras are officially recognized as a third gender in the Indian subcontinent and are considered neither fully male nor female. A series of court rulings have legally recognized a third gender since 2009, but implementation has been problematic. Socially, transgender individuals continue to be treated as inferior beings who have no right to privacy, personal dignity, or even safety. Transgender dancers at weddings are not only a cheaper alternative, but also spare hosts the censure they would expect from community elders if they invited same-sex women. For the dancers, it's a way to avoid having to beg or enter sex work. Across the world, transgender people face high levels of stigma and discrimination when accessing health services. Discrimination against transgender people increases when health services are overburdened. Many transgender individuals in Pakistan cannot afford private health care and face severe discrimination in public hospitals, which prevents them from accessing health care. In 2021, Pakistan opened its first government school for transgender students in the central city of Multan. The school, established by the Ministry of Education of Punjab Province, where Multan is located, opened its doors on the first day of school and enrolled 18 students.