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.

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.

"I tell you what, the voluntary sterilization line is forming to the right. You go first." The cost of undergoing a voluntary sterilization procedure is prohibitive. If the government were offering the procedure for free, I would jump at the chance.

"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." It does prevent you from transmitting the virus to any offspring. That's the entire point. If someone wants to have unprotected sex with you despite knowing that you have AIDS and they might become infected, that's their prerogative. But why would anyone force the disease, or even the possibility of contracting the disease, on a child who did not and cannot offer informed consent? Most of the commenters on this article are continually babbling about informed consent. What about the informed consent of the child who might grow up with AIDS?

"Every Citizen has the right to refuse any medical procedure against his/her will." This argument only makes sense if the medical procedure in question will ONLY affect the person undergoing the it and no one else. Is this the case with reproduction? If you have children, who is affected by your decision? Only you? No. Numerous other people are affected by your choice. The people most drastically affected by your decision to reproduce are your children, because they would not exist without you. Did they give informed consent to being created? No. Eventually your children will probably go on to affect society at large by the choices that they make. Did the rest of society give informed consent to be affected by your children's choices? No. If the choices you make can affect other people, then restrictions are placed on those choices as a result. You can refuse any medical procedure you want, as long as it affects only you. As soon as there is the possibility that you might affect someone else with your decision, you no longer have the freedom to do whatever you want.

If I have AIDS and I want to give you a transfusion of my blood against your will, of course you would agree that this should not be allowed. You would not wish to accept even the possibility of contracting AIDS without giving consent, and rightly so. So why should the offspring of an AIDS positive woman have to accept the possibility of contracting the disease without consent? What kind of monster would force the chance of getting AIDS on someone without giving that person a choice in the matter? That is exactly what happens every time a woman with AIDS gets pregnant. There is a 25% chance that a woman with untreated HIV can pass the disease to her children through pregnancy, vaginal birth, and breastfeeding. Even with treatment, there is no guarantee that the child will not contract the disease. Would you drink the breast milk of a woman with AIDS and take that chance? I doubt it. Would you force your children to drink it? I doubt it.

It is perfectly legal in the United States for a woman with AIDS to let it go untreated. Fine. That decision affects only her. (Although let us hope she is telling her sexual partners, if any, about her condition, and using protection.) But it is also perfectly legal in the United States for a woman with untreated AIDS to get pregnant, give birth to a child, and breastfeed that child thereafter. And that is where the argument of personal freedom, bodily autonomy, and the right to refuse medical procedures falters and fails. As soon as there is a possibility of anyone else being harmed by your decision, you lose those freedoms. A woman with AIDS should not be legally allowed to breastfeed her baby; to do so harms the non-consenting child by exposing it to a terrible disease. Likewise, a woman with AIDS should not be allowed to refuse treatment for her disease while pregnant. And with this same reasoning in place, a woman with AIDS should not be legally allowed to reproduce. I repeat, to do so harms the non-consenting child by exposing it to a terrible disease.

Anyone who brings up informed consent as the reason why people like AIDS-positive women should not be forcibly sterilized, and should be able to choose whether or not they reproduce, is ignoring the complete lack of informed consent on the part of the possibly-infected child born to such a woman.

I challenge anyone to refute the following: Whenever people's actions and/or decisions could possibly cause others physical harm, they do not, nor should they, have absolute freedom to do whatever they want.

One can hope that in such a case, AIDS-positive will make the right choice, the safe choice, and not reproduce, but unfortunately that is not a guarantee. If they do not make the right decision on their own, then they should be legally forced to do so, for the purpose of preventing physical harm to their future non-consenting children.

Has anyone heard of instances where a woman is sterilized during a routine procedure, in the United States?

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