WUNRN
FIGO - International Federation of
Gynecology & Obstetrics
"Evidence exists, including by
governmental admission and apology, of a long history of forced and otherwise
non-consensual sterilizations of women, including Roma women in
FIGO Executive Board Meeting – June
2011 Page 193
FEMALE CONTRACEPTIVE STERILIZATION
Background
1. Human rights include
the right of individuals to control and decide on matters of their own
sexuality and reproductive health, free from coercion, discrimination and
violence. This includes the right to decide whether and when to have children,
and the means to exercise this right.
2. Surgical
sterilization is a widely used method of contraception. An ethical requirement
is that performance be preceded by the patient‘s informed and freely given
consent, obtained in compliance with the Guidelines Regarding Informed Consent
( 2007) and on Confidentiality (2005). Information for consent includes, for
instance, that sterilization should be considered irreversible, that
alternatives exist such as reversible forms of family planning, that life
circumstances may change, causing a person later to regret consenting to
sterilization, and that procedures have a very low but significant failure
rate.
3. Methods of
sterilization generally include tubal ligation or other methods of tubal
occlusion. Hysterectomy is inappropriate solely for sterilization, because of
disproportionate risks and costs.
4. Once an informed
choice has been freely made, barriers to surgical sterilization should be
minimised. In particular: a) sterilization should be made available to any
person of adult age; b) no minimum or maximum number of children may be used as
a criterion for access; c) a partner‘s consent must not be required, although
patients should be encouraged to include their partners in counseling; d)
physicians whose beliefs oppose participation in sterilization should comply
with the Ethical Guidelines on Conscientious Objection (2005).
5. Evidence exists,
including by governmental admission and apology, of a long history of forced
and otherwise non-consensual sterilizations of women, including Roma women in
6. Medical practitioners
must recognize that, under human rights provisions and their own professional
codes of conduct, it is unethical and in violation of human rights for them to
perform procedures for prevention of future pregnancy on women who have not
freely requested such procedures, or who have not previously given their free
and informed consent. This is so even if such procedures are recommended as
being in the women‘s own health interests.
7. Only women themselves
can give ethically valid consent to their own sterilization. Family members
including husbands, parents, legal guardians, medical practitioners and, for
instance, government or other public officers, cannot consent on any woman‘s or
girl‘s behalf.
8. Women‘s consent to
sterilization should not be made a condition of access to medical care, such as
HIV/ AIDS treatment, natural or cesarean delivery, or abortion, or of any
benefit such as medical insurance, social assistance, employment or release
from an institution. In addition, consent to sterilization should not be
requested when women may be vulnerable, such as when requesting termination of
pregnancy, going into labor or in the aftermath of delivery.
9. Further, it is
unethical for medical practitioners to perform sterilization procedures within
a government program or strategy that does not include voluntary consent to
sterilization.
10. Sterilization for
prevention of future pregnancy cannot be ethically justified on grounds of
medical emergency. Even if a future pregnancy may endanger a woman‘s life or
health, she will not become pregnant immediately, and therefore must be given
the time and support she needs to
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FIGO Executive Board Meeting – June 2011 Page 192
consider her choice. Her
informed decision must be respected, even if it is considered liable to be
harmful to her health.
11. As for all
non-emergency medical procedures, women should be adequately informed of the
risks and benefits of any proposed procedure and of its alternatives. It must
be explained that sterilization must be considered a permanent, irreversible
procedure that prevents future pregnancy, and that non-permanent alternative
treatments exist. It must also be emphasized that sterilization does not provide
protection from sexually transmitted infections. Women must be advised about
and offered follow-up examinations and care after any procedure they accept.
12. All information must
be provided in language, both spoken and written, that the women understand,
and in an accessible format such as sign language, Braille and plain,
non-technical language appropriate to the individual woman‘s needs. The
physician performing sterilization has the responsibility of ensuring that the
patient has been properly counseled regarding the risks and benefits of the
procedure and its alternatives.
13. The U.N. Convention
on the Rights of Persons with Disabilities includes recognition ― that
women and girls with disabilities are often at greater risk … of violence,
injury or abuse, neglect or negligent treatment, maltreatment or exploitation‖.
Accordingly, Article 23(1) imposes the duty ― to eliminate discrimination
against persons with disabilities in all matters relating to marriage, family,
parenthood and relationships, on an equal basis with others, so as to ensure
that:
a)
The right of all persons with disabilities who are of marriageable age to marry
and to found a family … is recognized;
b)
The rights…to decide freely and responsibly on the number and spacing of their
children …are recognized, and the means necessary to enable them to exercise
these rights are provided;
c) Persons with
disabilities, including children, retain their fertility on an equal basis with
others‖.
Recommendations
1. No woman may be sterilized
without her own, previously-given informed consent, with no coercion, pressure
or undue inducement by healthcare providers or institutions.
2. Women considering
sterilization must be given information of their options in the language in
which they communicate and understand, through translation if necessary, in an
accessible format and plain, non-technical language appropriate to the
individual woman‘s needs. Women should also be provided with information on
non-permanent options for contraception. Misconceptions about prevention of
sexually transmitted diseases (STDs) including HIV by sterilization need to be
addressed with appropriate counseling about STDs.
3. Sterilization for
prevention of future pregnancy is not an emergency procedure. It does not
justify departure from the general principles of free and informed consent.
Therefore, the needs of each woman must be accommodated, including being given
the time and support she needs, while not under pressure, in pain, or dependent
on medical care, to consider the explanation she has received of what permanent
sterilization entails and to make her choice known.
4. Consent to
sterilization must not be made a condition of receipt of any other medical
care, such as HIV/AIDS treatment, assistance in natural or cesarean delivery,
medical termination of pregnancy, or of any benefit such as employment, release
from an institution, public or private medical insurance, or social assistance.
5. Forced sterilization
constitutes an act of violence, whether committed by individual practitioners
or under institutional or governmental policies. Healthcare providers have an
ethical response in accordance with the guideline on Violence Against Women
(2007).
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