OII Australia has made a third submission to the Senate Inquiry on involuntary and coerced sterilisation and it has now been published by the Senate Standing Committee on Community Affairs.
The reporting date for the inquiry is being pushed into July (update: now September) due to late hearings, and we wished to put additional data to the Inquiry on female genital mutilation, the M.C. case in the US, and also provide material on other investigations into the medical normalisation of intersex people.
Here’s an extract, part of an analysis of the Attorney General’s 24 May report Review of Australia’s Female Genital Mutilation legal framework – Final Report.
Cultural practices and female genital mutilation
Exemptions from protection against female genital mutilation in Australian law do not permit procedures for cultural purposes:
5.1.36 Exception—medical procedures for genuine therapeutic purposes …
(2) The fact that a procedure is performed as, or as part of, a cultural, religious or other social custom is not to be regarded as a genuine therapeutic purpose.
However, the 2006 Consensus Statement on the management of intersex conditions, which is the basis for the 2013 Victorian Health Department decision making framework on the treatment of intersex infants and children explicitly cites cultural, social (“psychosocial”) rationales for surgery:
minimizing family concern and distress
mitigating the risks of stigmatization and gender-identity confusion.
The Victorian Health Department also describes these social risks, in terms that might equally apply to women who have not undergone female genital mutilation in societies where that is the norm, such as marriageability, social and cultural disadvantage and social stigma:
risk of social or cultural disadvantage to the child, for example, reduced opportunities for marriage or intimate relationships, or reduced opportunity for meaningful employment and capacity to earn an income risk of social isolation, restrictions or difficulties, for example, caused by embarrassment or social stigma associated with having genitalia that does not match the gender in which the person lives.
Surgery to change the appearance of the genitals of intersex infants is not medically necessary, it’s considered socially and culturally necessary.
Kuhnle and Krahl (2002) found, in research in Malaysia, that the sex assignment of intersex infants varied not simply based on their diagnosis but also the culture of their parents and the position of women in that culture.
…we would like to analyze briefly the cultural and ethnic differences of the (peoples) living in Malaysia and present some data which in our opinion illustrates the different ways in which intersex patients are accepted.
The ethnic Malay women are Muslims… the independence and the economic power of Malay women can be substantial… The condition of women is quite different in the ethnic Indian and Chinese communities… In neither culture or tradition were women able to inherit or control their own fortune… Among the Indian community girls usually mean a significant financial burden to the family, since depending on the social status of the family a significant dowry is expected, and to marry off several girls can be a financial disaster. In contrast, boys will increase the family’s fortune
The outcome of such cultural norms for intersex infants is thus:
While we were working with different ethnic groups, it was never difficult to convince a Muslim family to assign a severely virilized girl or an undervirilized boy to the female gender. This was not the case for Chinese and Indian families, who on several occasions took off with their ambiguously born child when female sex assignment (or reassignment) was suggested.
Kuhnle and Krahl go on to ask:
Is culture or society imposing a certain gender role, or do individuals shape their own gender roles? The few available case reports, including our own, seem to indicate that intersex individuals find their own gender independent and maybe even undisturbed by external factors
The treatment of intersex infants in Malaysia, and also in Australia, is just as culturally- specific as the cases argued to support female genital mutilation. It is simply the case that it can be difficult to objectively observe our own cultural norms.
We believe that genital surgeries on intersex infants to give them the appearance of a specific sex are just as mutilating as identical surgeries on girls. In our view, the different language used to describe such surgeries reflects a degree of cultural relativism and double standards.
Intersex infants should receive the same protection from mutilation that girls receive. Surgical intervention should conform to the principles established in the Swiss National Advisory Commission on Biomedical Ethics report6, discussed in our first and second submissions.
That is, treatment to modify the appearance of genitals should wait until the patient can personally give fully informed consent.
Full references and more details are available within the submission.
San Franscisco report
On 3 June we took the opportunity to table a 2005 Human Rights Investigation into the Medical “Normalization: of Intersex People, by the Human Rights Commission of the City and County of San Francisco. This is likely to be the first human rights report into the treatment of intersex people, certainly in the English language
Download the Inquiry reports on involuntary or coerced sterilisation
- Our initial thoughts on the Senate report, “Involuntary or coerced sterilisation of intersex people in Australia”, 25 October 2013
- Intersex report: Download report on the involuntary or coerced sterilisation of intersex people, 25 October 2013
- People with disabilities report: Download report on the involuntary or coerced sterilisation of people with disabilities, 17 July 2013
- German proposals for a “third gender” on birth certificates miss the mark
- Clinicians acknowledge lack of justification for surgeries on intersex infants in Australia a compilation of quotes from submissions by the Australasian Paediatric Endocrine Group and the Royal Children’s Hospital, 15 July 2013
- Update on Senate Inquiry on involuntary and coerced sterilisation 13 July 2013, including data on Female Genital Mutilation
OII Australia submissions
- About our fifth, concluding, submission to the Inquiry
- Our fifth submission, dated 29 August 2013 (PDF) a concluding submission, taking into account recent developments
- About our fourth submission a response to the submission by the Australasian Paediatric Endocrine Group, and new data from the Council of Europe
- Fourth submission, dated 30 June 2013 (PDF)
- About our third submission focusing on the rationales for involuntary surgery on intersex infants, and comparisons with Female Genital Mutilation; also presenting information on the M.C. legal case in the US and the 2005 City of San Francisco human rights investigation
- Third submission, dated 3 June 2013 (PDF)
- On our second submission which focused on a case detailed by the Chief Justice of the Family Court, but also the new Victorian Health Department report, and the Senate’s report on the Human Rights and Anti-Discrimination Bill
- Second submission, dated 8 March 2013 (PDF)
- About our first submission
- First OII Australia submission, dated 15 February 2013 (PDF)
AISSGA and National LGBTI Health Alliance submissions
- AISSGA submission, dated 12 March 2013 (PDF)
- Third National LGBTI Health Alliance submission, dated 9 July 2013 (PDF)
- Second National LGBTI Health Alliance submission, dated 15 April 2013 (PDF)
- First National LGBTI Health Alliance submission, dated 12 March 2013 (PDF)
- Australasian Paediatric Endocrine Group (APEG), dated 27 June 2013 (PDF)
- Royal Children’s Hospital (RCH), dated 10 July 2013 (PDF)
- Office of the Public Advocate, Victoria, dated 13 September 2013 (PDF)
- Ms Diana Bryant AO, Chief Justice of the Family Court of Australia, first submission dated 22 February 2013 (PDF)
- Ms Diana Bryant AO, Chief Justice of the Family Court of Australia, second submission dated 2 September 2013 (PDF)
Documents tabled by OII Australia
- Swiss National Advisory Commission on Biomedical Ethics, ‘On the management of differences of sex development’ (PDF)
- Anne Tamar-Mattis (Advocates for Informed Choice), ‘Report to the Inter-American Commission on Human Rights: Medical Treatment of People with Intersex Conditions as a Human Rights Violation’ (PDF)
- Victoria, Department of Health, ‘Decision-making principles for the care of infants, children and adolescents with intersex conditions’ (PDF)
- OII Australia, ‘Response to Victorian Health Department framework document’ (PDF)
- National LGBTI Health Alliance policy statement on the Victorian Department of Health approach to intersex young people (PDF)
- City and County of San Francisco, Report of a 2005 Human Rights Investigation into the medical “normalization” of intersex people (PDF)
- All submissions to the Senate Inquiry on involuntary sterilisation
- Terms of reference for the Senate Inquiry
- Transcript of the public oral hearing on intersex issues on 28 March 2013 (HTML and PDF) witnesses represented OII Australia, AISSGA and the National LGBTI Health Alliance
- Article on the public hearing of the Senate Inquiry on involuntary sterilisation
- Opening statement at the Senate hearing on involuntary or coerced sterilisation, 29 March 2013
- Press coverage of the intersex aspects of the Senate Inquiry, by The Age newspaper, 20 June 2013
- The OII Australia submission was written by our secretary, Morgan Carpenter.