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What Is Happening?

Although many of us do not realise it, binary classification of sex and gender are everywhere in our society and can inform the way we understand and organise the world around us. There is perhaps no more encompassing classification than that of 'male' and 'female', the splitting of humans into two categories. This binary code is entrenched in society, informing the categories in identification documents and exposing those who do not fit neatly into either category to human rights abuses and violations. Intersex people are especially vulnerable here.

The stereotyping of gender as one or the other and the medically established 'norms' of male and female bodies have previously allowed for routine medical and surgical interventions on Intersex people, even when these interventions are purely aesthetic or cosmetic rather than medically necessary, or are conducted without the consultation or informed consent of the patient or their guardians. What this often does is cause "permanent infertility, pain, incontinence, loss of sexual sensation, and lifelong mental suffering, including depression." Secrecy and shame surrounding Intersex bodies have allowed this to continue for decades, whilst the human rights issues at stake have remained primarily unaddressed. Even today, society remains largely oblivious to the reality of Intersex people. 

Several rights have been stated as affected by involuntary or coerced medical treatment, particularly pertaining to minors:

  • the right to life.
  • the right to privacy, including a right to personal autonomy or self-determination regarding medical treatment.
  • prohibitions against torture and other cruel, inhuman and degrading treatment.
  • a right to physical integrity and/or bodily autonomy.
  • additionally, the best interests of the child may not be served by surgeries aimed at familial and social integration.

Intersex individuals must be protected from prejudice and discrimination, and must be able to choose what is done to their bodies (excluding the instances where medical health risks are directly involved). Discriminatory attitudes can never justify human rights violations, including forced treatment and violations of the right to physical integrity. Given their irreversible nature and impact on physical integrity and autonomy, such medically unnecessary, unsolicited surgery or treatment should be prohibited. Intersex children and their families should receive adequate counselling and support, including from peers.

People with intersex conditions often suffer discrimination and abuse if it becomes known that they are intersex, or if they are perceived not to conform to gender norms. Governments have a duty to combat harmful stereotypes and discrimination, rather than reinforcing them. Anti-discrimination laws do not typically ban discrimination against intersex people, which leaves them vulnerable to discriminatory practices in accessing health services, education, public services, employment and sports. Some intersex people face barriers and discrimination when seeking to amend sex markers on birth certificates and official documents.

The human rights abuses against Intersex people are beginning to change due to the work of Intersex groups and Intersex activists and educators. Positive steps such as the United Nations interagency statement on sterilisation that refers to breaches of bodily integrity of Intersex people is a milestone in combining the approaches of human rights, and medical ethics and practice. Bodies such as the UN, civil society organisations, and governments have called on states, societies, and medical bodies alike to end medically unnecessary "normalising" treatment of Intersex persons when it is enforced or administered without the free and fully informed consent of the person concerned. In addition, these bodies are working to provide more in the way of protection against discrimination of Intersex people, adequate recognition of Intersex people, improving access to justice, and educating the public about Intersex. 

These issues have been addressed by a rapidly increasing number of international institutions including, in 2015, the Council of Europe, the United Nations Office of the United Nations High Commissioner for Human Rights and the World Health Organisation, as well as numerous Intersex civil society organisations. These have brought together intersex activists and organisations from around the world, resulting in joint statements about human rights and bodily autonomy. 

What Is To Be Done?

Recommendations:

From the International Intersex Form (2013):

(The International Intersex Forum 2013, brought together 34 activists representing 30 intersex organisations from all continents)

  • To put an end to mutilating and ‘normalising’ practices such as genital surgeries, psychological and other medical treatments through legislative and other means. Intersex people must be empowered to make their own decisions affecting own bodily integrity, physical autonomy and self-determination.
  • To put an end to preimplantation genetic diagnosis, pre-natal screening and treatment, and selective abortion of intersex foetuses.
  • To put an end to infanticide and killings of intersex people.
  • To put an end to non-consensual sterilisation of intersex people.
  • To depathologise variations in sex characteristics in medical guidelines, protocols and classifications, such as the World Health Organization’s International Classification of Diseases.
  • To register intersex children as females or males, with the awareness that, like all people, they may grow up to identify with a different sex or gender.
  • To ensure that sex or gender classifications are amendable through a simple administrative procedure at the request of the individuals concerned. All adults and capable minors should be able to choose between female (F), male (M), non-binary or multiple options. In the future, as with race or religion, sex or gender should not be a category on birth certificates or identification documents for anybody.
  • To raise awareness around intersex issues and the rights of intersex people in society at large.
  • To create and facilitate supportive, safe and celebratory environments for intersex people, their families and surroundings.
  • To ensure that intersex people have the right to full information and access to their own medical records and history.
  • To ensure that all professionals and healthcare providers that have a specific role to play in intersex people’s wellbeing are adequately trained to provide quality services.
  • To provide adequate acknowledgement of the suffering and injustice caused to intersex people in the past, and provide adequate redress, reparation, access to justice and the right to truth.
  • To build intersex anti-discrimination legislation in addition to other grounds, and to ensure protection against intersectional discrimination.
  • To ensure the provision of all human rights and citizenship rights to intersex people, including the right to marry and form a family.
  • To ensure that intersex people are able to participate in competitive sport, at all levels, in accordance with their legal sex. Intersex athletes who have been humiliated or stripped of their titles should receive reparation and reinstatement.
  • Recognition that medicalization and stigmatisation of intersex people result in significant trauma and mental health concerns.
  • In view of ensuring the bodily integrity and well-being of intersex people, autonomous non-pathologising psycho-social and peer support be available to intersex people throughout their life (as self-required), as well as to parents and/or care providers.

» Prohibit medically unnecessary surgery and procedures on the sex characteristics of intersex children, protect their physical integrity and respect their autonomy.

 » Ensure that intersex people and their families receive adequate counselling and support, including from peers.

» Prohibit discrimination on the basis of intersex traits, characteristics or status, including in education, health care, employment, sports and access to public services, and address such discrimination through relevant anti-discrimination initiatives.

» Ensure that human rights violations against intersex people are investigated and alleged perpetrators prosecuted, and that victims of such violations have access to effective remedy, including redress and compensation.

» National human rights bodies should research and monitor the human rights situation of intersex people.

» Enact laws to provide for facilitated procedures to amend sex markers on the birth certificates and official documents of intersex people.

» Provide health care personnel with training on the health needs and human rights of intersex people and the appropriate advice and care to give to parents and intersex children, being respectful of the intersex person's autonomy, physical integrity and sex characteristics.

» Ensure that members of the judiciary, immigration officers, law enforcement, healthcare, education and other officials and personnel are trained to respect and provide equal treatment to intersex persons.

» Ensure that intersex people and organisations are consulted and participate in the development of research, legislation and policies that impact on their rights.

The Media

» Include the voices of intersex people and groups in newspaper, TV and radio coverage.

» Give an objective and balanced picture of intersex people and their human rights concerns.

» Do not make assumptions about the sexual orientation or gender identity of intersex people.

» You, your friends and other individuals can make a difference too: » Speak out when you see any form of discrimination or violence against intersex people. » Remember that intersex people may have any sexual orientation and gender identity.

 

 

 

From the UN Free & Equal Fact Sheet:

 

 

 

 

From The European Commission For Human Rights (2015)

1. Member states should end medically unnecessary “normalising” treatment of intersex persons, including irreversible genital surgery and sterilisation, when it is enforced or administered without the free and fully informed consent of the person concerned. Sex assignment treatment should be available to intersex individuals at an age when they can express their free and fully informed consent. Intersex persons’ right not to undergo sex assignment treatment must be respected.

2. Intersex persons and their families should be offered interdisciplinary counselling and support, including peer support. Intersex persons’ access to medical records should be ensured.

3. National and international medical classifications which pathologise variations in sex characteristics should be reviewed with a view to eliminating obstacles to the effective enjoyment, by intersex persons, of human rights, including the right to the highest attainable standard of health.

4. Member states should facilitate the recognition of intersex individuals before the law through the expeditious provision of birth certificates, civil registration documents, identity papers, passports and other official personal documentation while respecting intersex persons’ right to self-determination. Flexible procedures should be observed in assigning and reassigning sex/gender in official documents while also providing for the possibility of not choosing a specified male or female gender marker. Member states should consider the proportionality of requiring gender markers in official documents.

5. National equal treatment and hate crime legislation should be reviewed to ensure that it protects intersex people. Sex characteristics should be included as a specific ground in equal treatment and hate crime legislation or, at least, the ground of sex/gender should be authoritatively interpreted to include sex characteristics as prohibited grounds of discrimination.

6. National human rights structures such as ombudspersons, equality bodies, human rights commissions and children’s ombudspersons should be active in their outreach towards intersex people, including children. They should be clearly mandated to work on issues related to intersex people and to provide victim-support services to them. There is a need to facilitate intersex persons’ access to justice. 

7. Member states should carry out research into the situation and human rights protection needs of intersex people in different settings. There is an urgent need to improve public awareness and professional training about the problems encountered by intersex persons. Intersex people and organisations representing them should be enabled to participate actively in research concerning them and in the development of measures improving their enjoyment of human rights.

8. The human rights violations intersex people have suffered in the past should be investigated, publicly acknowledged and remedied. Ethical and professional standards, legal safeguards and judicial control should be reinforced to ensure future human rights compliance.

 

From the UN Office of the High Commissioner for Human Rights - Twelve UN agencies issue unprecedented joint statement on rights of lesbian, gay, bisexual, transgender & intersex people

Failure to uphold the human rights of LGBTI people and protect them against abuses such as violence and discriminatory laws and practices, constitute serious violations of international human rights law and have a far-reaching impact on society – contributing to increased vulnerability to ill health including HIV infection, social and economic exclusion, putting strain on families and communities, and impacting negatively on economic growth, decent work and progress towards achievement of the future Sustainable Development Goals. States bear the primary duty under international law to protect everyone from discrimination and violence. These violations therefore require an urgent response by governments, parliaments, judiciaries and national human rights institutions. Community, religious and political leaders, workers’ organizations, the private sector, health providers, civil society organizations and the media also have important roles to play. Human rights are universal – cultural, religious and moral practices and beliefs and social attitudes cannot be invoked to justify human rights violations against any group, including LGBTI persons.

Demands

·      To put an end to mutilating and ‘normalising’ practices such as genital surgeries, psychological and other medical treatments through legislative and other means. Intersex people must be empowered to make their own decisions affecting own bodily integrity, physical autonomy and self-determination.

·      To put an end to pre-implantation genetic diagnosis, pre-natal screening and treatment, and selective abortion of intersex foetuses.

·      To put an end to infanticide and killings of intersex people.

·      To put an end to non-consensual sterilisation of intersex people.

·      To depathologise variations in sex characteristics in medical guidelines, protocols and classifications, such as the World Health Organization’s International Classification of Diseases.

·      To register intersex children as females or males, with the awareness that, like all people, they may grow up to identify with a different sex or gender.

·      To ensure that sex or gender classifications are amendable through a simple administrative procedure at the request of the individuals concerned. All adults and capable minors should be able to choose between female (F), male (M), non-binary or multiple options. In the future, as with race or religion, sex or gender should not be a category on birth certificates or identification documents for anybody.

·      To raise awareness around intersex issues and the rights of intersex people in society at large.

·      To create and facilitate supportive, safe and positive environments for intersex people, their families and surroundings.

·      To ensure that intersex people have the right to full information and access to their own medical records and history before medical intervention.

·      To ensure that Intersex people are provided with lifelong free prescription medication regardless of prior medical treatment or intervention.

·      To ensure that all professionals and healthcare providers that have a specific role to play in intersex people’s wellbeing are specifically trained to provide quality services.

·      To provide sufficient acknowledgement of the suffering and injustice caused to intersex people in the past, and provide sufficient redress, reparation, access to justice and the right to truth.

·      To build intersex anti-discrimination legislation in addition to other grounds, and to ensure protection against intersectional discrimination.

·      To ensure the provision of all human rights, legal and citizenship rights to intersex people, including the right to marry and form a family.

·      To ensure that intersex people are able to participate in competitive sport, at all levels, in accordance with their legal sex. Intersex athletes who have been humiliated or stripped of their titles should receive reparation and reinstatement.

·      Recognition that medicalization and stigmatisation of intersex people result in significant trauma and mental health concerns.

·      In view of ensuring the bodily integrity and well-being of intersex people, as prescribed by the GMC, autonomous non-pathologising psycho-social and peer support be available to intersex people throughout their life (as self-required), as well as to parents and/or care providers.

Taken from Third International Intersex Forum Public Statement