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.