Against Her Will: Putting an End to Forced Sterilization

As a task force meets this week in North Carolina to discuss historic cases of forced sterilization, we continue to hear from women throughout the world who have been sterilized without their consent. This is clearly an ongoing problem for vulnerable women—especially poor women, racial and ethnic minorities, women living with HIV, and women with disabilities. All too often, medical workers and government officials take it upon themselves to deem these women “unworthy of reproduction.”

That is why the members of the International Federation of Gynecology and Obstetrics (FIGO) met last week to take a critical step to end this human rights abuse. The federation released strong new guidelines on “Female Contraceptive Sterilization,” recognizing the long history of forced and coerced sterilization of marginalized women and providing detailed recommendations for when and how consent to sterilization can be obtained.  The updated guidelines specify:

  • Only women themselves can give ethically valid consent to their own sterilization.  Family members, including husbands and parents, legal guardians, medical practitioners, and public officials cannot consent on their behalf.
  • Sterilization should not be performed within a government program or strategy that does not include voluntary consent.
  • Health care providers should not initiate judicial proceedings for sterilization of their patients or serve as witnesses in such proceedings.
  • Sterilization to prevent future pregnancy is never an emergency procedure and does not justify departure from general principles of free and informed consent.
  • Consent to sterilization should not be made a condition of access to medical care, such as HIV/AIDS treatment, delivery of a baby, or termination of pregnancy, as well as any other benefit, such as medical insurance, social assistance, employment, or release from an institution.
  • Consent to sterilization should not be requested when women are vulnerable, such as when requesting termination of pregnancy, going into labor, or in the aftermath of delivery.
  • Women considering sterilization must be informed that it is a permanent procedure, which does not protect against sexually transmitted diseases, and provided information on non-permanent options for contraception. Information should be provided in language women understand, through translation if necessary, in plain, non-technical terms, and in an accessible format, including sign language or Braille.

The guidelines further recognize the importance of protecting women’s access to sterilization while ensuring consent.  Forced sterilization is an “act of violence,” necessitating an ethical response by health care providers.  However, voluntary sterilization is an important reproductive option for women, and once an informed choice has been made, barriers to sterilization should be minimized.

During the past year and a half, advocates working to stop forced and coerced sterilization in different parts of the world and among different populations have come together to share information and strategies and collaborate on advocacy as part of the Campaign to Stop Torture in Health Care. Along with the Center for Reproductive Rights, we have established a Working Group to Stop Forced/Coerced Sterilization, and engagement with FIGO has been one of our strategies.  The new FIGO guidelines bring us one step closer in this struggle.  However, they are just a start.  It is now up to Ministries of Health and national policymaking bodies, medical institutions, and health care providers to incorporate them into practice.

We hope we will soon see a world where health care protects the health and human rights of all, and no woman is sterilized against her will.

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This is 180 degrees the wrong approach. Sterilization should be expanded and include males as well as females. Chronic diseases such as AIDS/HIV, serious negative genetic mutations and low IQ should all be considered valid reasons for sterilization. Times have changed, realities of overpopulation, and dwindling natural resouces require evolution of ethical thinking. The greater good of society and the earth as a whole often must outweigh our personal desires. Those with serious negative health problems, genetic mutations or intellectual deficits should not be allowed to reproduce. Sterilization can be done humanely and can leave sexual function largely intact, they just will not have defective offspring. It is nice to be nice to everyone and let everyone do what they want. That doesn't make it the right thing to do for mankind in the longrun. I am not advocating sterilization for specicific racial or ethnic groups, nor for people with divergnent ideas, beliefs or values. But those who will pass serious health or mental deficits on to their children should not reproduce.

Where should the line be drawn of what is considered "serious", and who will make the policy decisions? If there is a genetic predisposition to smoking or drinking, what of that? In your world Stephen Hawking would not have been born. We all have genetic predispositions for various illnesses and conditions. Thin teeth. Heart disease. Obesity. What is YOUR genetic predisposition? What human imperfections run in YOUR family? I tell you what, the voluntary sterilization line is forming to the right. You go first.

Thinking like this is the reason the American revolutionaries thoughtfully included the Second Amendment in the Bill of Rights to the United States Constitution. If elitist murder advocates get in to power, self-defense is all that is left. Steve has good historical precedent in Adolf Hitler and the Nazi Party. What a lunatic.

I am commenting here as someone who has personally worked with Romani women who were sterilized against their will in the former Czechoslovakia and present-day Czech Republic. It is a violation of human rights to perform a sterilization without the person concerned having fully understood that choosing this form of contraception ends his or her reproductive capacity forever. The history of this practice has revealed far too many cases in which patients - not only women, but mostly women, and almost always women from marginalized communities - have either been coerced, misinformed or misled about these procedures, or have been sterilized during the course of other ob/gyn procedures without any consultation whatsoever.

The commentator who says HIV/AIDS should be grounds for sterilization obviously does not understand how HIV/AIDS works. Sterilization will not prevent transmission of the HIV virus. He is also evidently ignorant of the fact that the arguments he is presenting in favor of "expanding sterilization" here are not examples of "evolved thinking", but are themselves more than 100 years old. Such flawed hereditarian reasoning as a rationale for preventing people from reproducing in the name of public health was debunked at least 80 years ago. Those of us working on this issue are attempting to prevent its revival.

I recommend those interested in these issues read the following books:

Eugenic Nation, by Alexandra Minna Stern;
Fatal Misconception, by Matthew Connelly;
Medical Apartheid, by Harriet A. Washington;
The Mismeasure of Man, by Stephen Jay Gould; Three Generations No Imbeciles, by Paul A. Lombard

Erm, Steve. When you're posting comments that Adolf Hitler would whole-heartedly agree with, you have to worry, surely. Though I see you are good enough not to consider sterilization for specific ethnic or racial groups. Glad to see you're drawing the line somewhere.

Thanks for sharing the guidelines, Lydia! This is very helpful.

An important story. The woman leader who raised these issues with US gov't. health services in the 1970's, and proposed gov't. sterilization regulations later passed , was the late Helen Rodriguez-Trias, MD. Dr. Rodriguez-Trias,a pediatrician, feminist, and former President of the American Public Health Assn., began this work during research on Latina immigrant women, African-American and Native American women sterilized by the US gov't.,often without their consent,sometimes without their knowledge, as an extension of earlier US eugenic practices. These new FIGO guidelines are almost identical to those proposed by Dr. Rodriguez-Trias.[Source:National Women's Health Network, US Congressional Record.]

I agree wholeheartedly with these new guidelines and they must be enforced and implemented fully. Here is my experience working with Quechua-speaking women in the Peruvian Andes during Fujimori.

http://www.bc.edu/content/dam/files/schools/law/lawreviews/journals/bctw...

The scariest problem with advocacy to combat (en)forced sterilization is the backlash against sterilization as a method of family planning. It is the free and informed consent that we are advocating for, not an end to sterilization, so long as it is practiced ethically, safely, and taking a rights-based approach.

Every Citizen has the right to refuse any medical procedure against his/her will. and this is something that will spark debates.

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