The World Health Organization, together with OHCHR, UN Women, UNAIDS, UNDP, UNFPA and UNICEF, have issued an interagency statement on Eliminating forced, coercive and otherwise involuntary sterilization. The statement covers intersex people, trans people, women, women with HIV, indigenous and ethnic minority women, and people with disabilities.
This is an important development, that recognises the lack of information given to parents and individuals, and (in many cases) a weak evidence basis. OII Australia warmly welcomes this important statement.
Intersex persons may be involuntarily subjected to so-called sex-normalizing or other procedures as infants or during childhood, which, in some cases, may result in the termination of all or some of their reproductive capacity. Children who are born with atypical sex characteristics are often subjected to cosmetic and other non-medically indicated surgeries performed on their reproductive organs, without their informed consent or that of their parents, and without taking into consideration the views of the children involved (64; 147, para 57; 148; 149). As a result, such children are being subjected to irreversible interventions that have lifelong consequence for their physical and mental health (64; 150, para 20; 151).
Medical procedures that might result in sterility may sometimes be justified because of benefits to health, including the reduction of cancer risk (152). Such treatments may be recommended for transgender or intersex persons; however, they may be proposed on the basis of weak evidence, without discussing alternative solutions that would retain the ability to procreate (151, 153–157). Parents often consent to surgery on behalf of their intersex children, including in circumstances where full information is lacking (151, 158, 159).
We warmly welcome the statement on full, free and informed consent:
It has been recommended by human rights bodies, professional organizations and ethical bodies that full, free and informed consent should be ensured in connection with medical and surgical treatments for intersex persons (64, 150) and, if possible, irreversible invasive medical interventions should be postponed until a child is sufficiently mature to make an informed decision, so that they can participate in decision-making and give full, free and informed onsent (15, 149). It has also been recommended that health-care professionals should be educated and trained about bodily diversity as well as sexual and related biological and physical diversity, and that professionals should properly inform patients and their parents of the consequences of surgical and other medical interventions (149; 150, para 20; 160–162).
The statement recommends a series of guiding principles for the provision of sterilization services, including:
- autonomy in decision-making.
- provision of information and support.
- access to medical records.
- ensuring non-discrimination.
- accountability, participation and access to remedies.
For intersex children and parents of intersex children, the report recommends psychosocial counselling, peer support, and self-help groups, as well as counselling for survivors of coercive sterilisation. The report also recommends the recognition of past and present practices of coercive sterilisation.