Does sterilisation without valid consent happen in the 21st Century?
ESC Congress Library. Rowlands S. 05/10/18; 208230; ESC58
Prof. Dr. Sam Rowlands
Prof. Dr. Sam Rowlands
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Background: Non-consensual sterilisation was permitted by law in certain countries in the first half of the 20th century, mostly as part of wider eugenics campaigns. Since 1945, non-consensual sterilisation has been used as part of population control, for people with intellectual disability and in other marginalised groups. However, in the 21st century it might be expected that the practice would have stopped. Objective: To determine whether sterilisation without valid consent has been happening since the turn of the century and, if so, where. Method: Literature review. Interventions included were surgical procedures that took place between 2000 and 2016 for the purposes of fertility regulation and those in which loss of fertility is a secondary outcome of other types of procedure. Results: Throughout the literature, a gender bias is apparent, with women being sterilised far more than men. It is likely that non-consensual sterilisation is under-reported. The following categories of people were found recently being targeted for sterilisation. Involuntary limitation of family size. This was taking place in India, China (one-child policy until 2015; two-child policy from 2016) and Uzbekistan (two-child policy). Indigenous and ethnic minority women. Abuses have taken place against Romani women in three central European countries and against Aboriginal women in one Canadian province. Women living with HIV. Reports were found from 27 countries of sterilisation of such women under duress, coercion, compulsion, intimidation and undue influence. Disabled people. People with intellectual disability in some countries are being sterilised without court approval. Those of short stature are segregated and sterilised under the repressive regime in North Korea. Transgender and intersex people. There is widespread practice of gonadectomy without conserving gametes in transgender people undergoing transition. The practice of early gender assignment and radical surgery as an infant is still done in many countries, despite this not being recommended nowadays. Conclusions: Despite laws permitting non-consensual sterilisation having been repealed, policies changed and human rights treaties developed, abuses in relation to sterilisation continue in many countries around the world. The United Nations and the World Health Organization have jointly issued recommendations on how non-consensual sterilisation can be eliminated. Legal, regulatory, policy and medical practice measures need to be continued and strengthened.
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