Third submission to Senate Inquiry on involuntary sterilisation

OII Australia has made a third submission to the Senate Inquiry on involuntary and coerced sterilisation and it has now been published by the Senate Standing Committee on Community Affairs.

The reporting date for the inquiry is being pushed into July (update: now September) due to late hearings, and we wished to put additional data to the Inquiry on female genital mutilation, the M.C. case in the US, and also provide material on other investigations into the medical normalisation of intersex people.

Here’s an extract, part of an analysis of the Attorney General’s 24 May report Review of Australia’s Female Genital Mutilation legal framework – Final Report.

Cultural practices and female genital mutilation

Exemptions from protection against female genital mutilation in Australian law do not permit procedures for cultural purposes:

5.1.36 Exception—medical procedures for genuine therapeutic purposes …
(2) The fact that a procedure is performed as, or as part of, a cultural, religious or other social custom is not to be regarded as a genuine therapeutic purpose.

However, the 2006 Consensus Statement on the management of intersex conditions, which is the basis for the 2013 Victorian Health Department decision making framework on the treatment of intersex infants and children explicitly cites cultural, social (“psychosocial”) rationales for surgery:

minimizing family concern and distress
mitigating the risks of stigmatization and gender-identity confusion.

The Victorian Health Department also describes these social risks, in terms that might equally apply to women who have not undergone female genital mutilation in societies where that is the norm, such as marriageability, social and cultural disadvantage and social stigma:

  • risk of social or cultural disadvantage to the child, for example, reduced opportunities for marriage or intimate relationships, or reduced opportunity for meaningful employment and capacity to earn an income
  • risk of social isolation, restrictions or difficulties, for example, caused by embarrassment or social stigma associated with having genitalia that does not match the gender in which the person lives.
  • Surgery to change the appearance of the genitals of intersex infants is not medically necessary, it’s considered socially and culturally necessary.

    Kuhnle and Krahl (2002) found, in research in Malaysia, that the sex assignment of intersex infants varied not simply based on their diagnosis but also the culture of their parents and the position of women in that culture.

    …we would like to analyze briefly the cultural and ethnic differences of the (peoples) living in Malaysia and present some data which in our opinion illustrates the different ways in which intersex patients are accepted.

    The ethnic Malay women are Muslims… the independence and the economic power of Malay women can be substantial… The condition of women is quite different in the ethnic Indian and Chinese communities… In neither culture or tradition were women able to inherit or control their own fortune… Among the Indian community girls usually mean a significant financial burden to the family, since depending on the social status of the family a significant dowry is expected, and to marry off several girls can be a financial disaster. In contrast, boys will increase the family’s fortune

    The outcome of such cultural norms for intersex infants is thus:

    While we were working with different ethnic groups, it was never difficult to convince a Muslim family to assign a severely virilized girl or an undervirilized boy to the female gender. This was not the case for Chinese and Indian families, who on several occasions took off with their ambiguously born child when female sex assignment (or reassignment) was suggested.

    Kuhnle and Krahl go on to ask:

    Is culture or society imposing a certain gender role, or do individuals shape their own gender roles? The few available case reports, including our own, seem to indicate that intersex individuals find their own gender independent and maybe even undisturbed by external factors

    The treatment of intersex infants in Malaysia, and also in Australia, is just as culturally- specific as the cases argued to support female genital mutilation. It is simply the case that it can be difficult to objectively observe our own cultural norms.

    We believe that genital surgeries on intersex infants to give them the appearance of a specific sex are just as mutilating as identical surgeries on girls. In our view, the different language used to describe such surgeries reflects a degree of cultural relativism and double standards.

    Intersex infants should receive the same protection from mutilation that girls receive. Surgical intervention should conform to the principles established in the Swiss National Advisory Commission on Biomedical Ethics report6, discussed in our first and second submissions.

    That is, treatment to modify the appearance of genitals should wait until the patient can personally give fully informed consent.

    Full references and more details are available within the submission.

    San Franscisco report

    On 3 June we took the opportunity to table a 2005 Human Rights Investigation into the Medical “Normalization: of Intersex People, by the Human Rights Commission of the City and County of San Francisco. This is likely to be the first human rights report into the treatment of intersex people, certainly in the English language

    Download the Inquiry reports on involuntary or coerced sterilisation

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