Intersex human rights
|Human rights and legal issues|
|Medicine and biology|
Intersex infants and children, such as those with ambiguous outer genitalia, may be surgically and/or hormonally altered to fit perceived more socially acceptable sex characteristics. However, this is considered controversial, with no firm evidence of good outcomes. Such treatments may involve sterilization. Adults, including elite female athletes, have also been subjects of such treatment.
Increasingly these issues are recognized as human rights abuses, with statements from UN agencies, the Australian parliament, and ethics institutions. Intersex organizations have also issued joint statements over several years, including as part of an International Intersex Forum.
Implementation of human rights protections in legislation and regulation has been slower. In 2011, Christiane Völling won the first successful case brought against a surgeon for non-consensual surgical intervention. In 2015, the Council of Europe recognized, for the first time, a right for intersex persons to not undergo sex assignment treatment. Also in April 2015, Malta became the first country to outlaw non-consensual medical interventions to modify sex anatomy, including that of intersex people.
- 1 Intersex and human rights
- 2 Protection from non-consensual medical interventions
- 3 Right to life
- 4 Protection from discrimination
- 5 Access to justice and reparations
- 6 Access to information
- 7 Gender identities and recognition
- 8 Human rights investigations and statements
- 8.1 San Francisco Human Rights Investigation, 2005
- 8.2 Yogyakarta Principles, 2006
- 8.3 Report of Swiss National Advisory Council on Biomedical Ethics, 2012
- 8.4 Report of UN Special Rapporteur on Torture, 2013
- 8.5 Resolution by the Council of Europe, 2013
- 8.6 Senate Committee inquiry, Australia, 2013
- 8.7 World Health Organization and UN interagency report, 2014
- 8.8 Council of Europe Issue Paper, 2015
- 8.9 UN Office of the High Commissioner for Human Rights report, 2015
- 8.10 World Health Organization report, "Sexual health, human rights and the law", 2015
- 9 People and organisations
- 10 See also
- 11 Notes
Intersex and human rights
Research indicates a growing consensus that diverse intersex bodies are normal—if relatively rare—forms of human biology, and human rights institutions are placing increasing scrutiny on medical practices and issues of discrimination against intersex people. A 2013 first international pilot study. Human Rights between the Sexes, by Dr. Dan Christian Ghattas, found that intersex people are discriminated against worldwide:
Intersex individuals are considered individuals with a «disorder» in all areas in which Western medicine prevails. They are more or less obviously treated as sick or «abnormal», depending on the respective society.
The Council of Europe highlights several areas of concern:
- unnecessary "normalising" treatment of intersex persons, and unnecessary pathologisation of variations in sex characteristics.
- unnecessary medicalisation is said to also impact a right to life.
- inclusion in equal treatment and hate crime law; facilitating access to justice and reparations.
- access to information, medical records, peer and other counselling and support.
- respecting self-determination in gender recognition, through expeditious access to official documents.
However, the implementation, codification and enforcement of intersex human rights remains slow. These actions take place through legislation, regulation and court cases, detailed below.
Protection from non-consensual medical interventions
Non-consensual medical interventions to modify the sex characteristics of intersex people take place in all countries where the human rights of intersex people have been explored. Such interventions have been criticized by the World Health Organization, other UN bodies such as the Office of the High Commissioner for Human Rights, and an increasing number of regional and national institutions.
Several rights have been stated as affected by involuntary or coerced medical treatment, particularly that on 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.
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 Organization. In April 2015, Malta became the first country to outlaw such interventions. In the same year, the Council of Europe became the first institution to state that intersex people have the right not to undergo sex affirmation interventions.
Constitutional Court of Colombia
Although not many cases of children with intersex conditions are available, a case taken to the Constitutional Court of Colombia led to changes in their treatment. The case significantly reduced the power of doctors and parents to decide surgical procedures on the children's ambiguous genitalia. Due to the decision of the Constitutional Court of Colombia on Case 1 Part 1 (SU-337 of 1999), doctors are obligated to inform parents on all the aspects of the intersex child. Parents can only consent to surgery if they have received accurate information, and cannot give consent after the child reaches the age of five. By then the child will have, supposedly, realized their gender identity. The court case has led to setting legal guidelines for doctors' surgical practice on intersex children.
In April 2015, Malta became the first country to outlaw non-consensual medical interventions in a Gender Identity Gender Expression and Sex Characteristics Act. The Act recognizes a right to bodily integrity and physical autonomy, explicitly prohibiting modifications to children's sex characteristics for social factors:
14. (1) It shall be unlawful for medical practitioners or other professionals to conduct any sex assignment treatment and/or surgical intervention on the sex characteristics of a minor which treatment and/or intervention can be deferred until the person to be treated can provide informed consent: Provided that such sex assignment treatment and/or surgical intervention on the sex characteristics of the minor shall be conducted if the minor gives informed consent through the person exercising parental authority or the tutor of the minor.
(2) In exceptional circumstances treatment may be effected once agreement is reached between the Interdisciplinary Team and the persons exercising parental authority or tutor of the minor who is still unable to provide consent: Provided that medical intervention which is driven by social factors without the consent of the minor, will be in violation of this Act.
In January 2016, the Ministry of Health of Chile ordered the suspension of unnecessary normalization treatments for intersex children, including irreversible surgery, until they reach an age when they can make decisions on their own.
Right to life
Preimplantation genetic diagnosis (PGD or PIGD) refers to genetic testing of embryos prior to implantation (as a form of embryo profiling), and sometimes even of oocytes prior to fertilization. PGD is considered in a similar fashion to prenatal diagnosis. When used to screen for a specific genetic condition, the method makes it highly likely that the baby will be free of the condition under consideration. PGD thus is an adjunct to assisted reproductive technology, and requires in vitro fertilization (IVF) to obtain oocytes or embryos for evaluation. The technology allows discrimination against those with intersex traits.
Georgiann Davis argues that such discrimination fails to recognize that many people with intersex traits led full and happy lives. Morgan Carpenter highlights the appearance of several intersex variations in a list by the UK Human Fertilisation and Embryology Authority of "serious" "genetic conditions" that may be de-selected, including 5 alpha reductase deficiency and androgen insensitivity syndrome, traits evident in elite women athletes and "the world's first openly intersex mayor". Organisation Intersex International Australia has called for the Australian National Health and Medical Research Council to prohibit such interventions, noting a "close entanglement of intersex status, gender identity and sexual orientation in social understandings of sex and gender norms, and in medical and medical sociology literature".
In 2015, the Council of Europe published an Issue Paper on Human rights and intersex people, remarking:
Intersex people’s right to life can be violated in discriminatory “sex selection” and “preimplantation genetic diagnosis, other forms of testing, and selection for particular characteristics”. Such de-selection or selective abortions are incompatible with ethics and human rights standards due to the discrimination perpetrated against intersex people on the basis of their sex characteristics.
Protection from discrimination
A handful of jurisdictions so far provide explicit protection from discrimination for intersex people. South Africa was the first country to explicitly add intersex to legislation, as part of the attribute of 'sex'. Australia was the first country to add an independent attribute, of 'intersex status'. Malta was the first to adopt a broader framework of 'sex characteristics', through legislation that also ended modifications to the sex characteristics of minors undertaken for social and cultural reasons.
An Australian survey of 272 persons born with atypical sex characteristics, published in 2016, found that 18% of respondents (compared to an Australian average of 2%) failed to complete secondary school, with early school leaving coincident with pubertal medical interventions, bullying and other factors.
A 2015 Australian survey of people born with atypical sex characteristics found high levels of poverty, in addition to very high levels of early school leaving, and higher than average rates of disability. An Employers guide to intersex inclusion published by Pride in Diversity and Organisation Intersex International Australia also discloses cases of discrimination in employment.
Discrimination protection intersects with involuntary and coercive medical treatment. Maltese protections on grounds of sex characteristics provides explicit protection against unnecessary and harmful modifications to the sex characteristics of children.
In May 2016, the United States Department of Health and Human Services issued a statement explaining Section 1557 of the Affordable Care Act stating that the Act prohibits "discrimination on the basis of intersex traits or atypical sex characteristics" in publicly-funded healthcare, as part of a prohibition of discrimination "on the basis of sex".
In 2013, it was disclosed in a medical journal that four unnamed elite female athletes from developing countries were subjected to gonadectomies (sterilization) and partial clitoridectomies (female genital mutilation) after testosterone testing revealed that they had an intersex condition. Testosterone testing was introduced in the wake of the Caster Semenya case, of a South African runner subjected to testing due to her appearance and vigor. There is no evidence that innate hyperandrogenism in elite women athletes confers an advantage in sport. While Australia protects intersex persons from discrimination, the Act contains an exemption in sport.
"Intersex status" became a protected attribute in the federal Sex Discrimination Amendment (Sexual Orientation, Gender Identity and Intersex Status) Act on 1 August 2013, distinguishing intersex status from gender identity, sexual orientation, sex, and disability. It defines intersex as:
intersex status means the status of having physical, hormonal or genetic features that are:
(a) neither wholly female nor wholly male; or (b) a combination of female and male; or (c) neither female nor male.
Since 2015, the Act on Equality between Women and Men includes "gender features of the body" within its definition of gender identity and gender expression, which are the prohibited grounds under the act, meaning that discrimination on these basics is prohibited.
Since 1 September 2015, Discrimination (Jersey) Law 2013 includes intersex status within its definition of sex. Sex is one of the prohibited grounds under the act, meaning that discrimination on this basis is prohibited. The act provides that:
(1) Sex is a protected characteristic.(c) neither male nor female
(2) In relation to the protected characteristic –
(a) a reference to a person who has that characteristic is a reference to a man, a woman or a person who has intersex status;
(b) a reference to persons who share the characteristic is a reference to persons who are of the same sex.
(3) In this paragraph, a person has intersex status if the person has physical, chromosomal, hormonal or genetic features that are –
(a) neither wholly male or female;
(b) a combination of male or female; or— Discrimination (Jersey) Law 2013, Schedule 1, as amended
In April 2015, Malta passed a Gender Identity Gender Expression and Sex Characteristics Act that protects intersex people from discrimination on grounds of "sex characteristics", and also recognizes a right to bodily integrity and physical autonomy.
"sex characteristics" refers to the chromosomal, gonadal and anatomical features of a person, which include primary characteristics such as reproductive organs and genitalia and/or in chromosomal structures and hormones; and secondary characteristics such as muscle mass, hair distribution, breasts and/or structure.
In South Africa, the Judicial Matters Amendment Act, 2005 (Act 22 of 2005) amended the Promotion of Equality and Prevention of Unfair Discrimination Act, 2000 (Act 4 of 2000) to include intersex within its definition of sex. Sex is one of the prohibited grounds under the act, meaning that unfair discrimination on the basis of sex is prohibited. The act provides that:
'intersex' means a congenital sexual differentiation which is atypical, to whatever degree; 'sex' includes intersex;— Act 4 of 2000, section 1, as amended
In May 2016, the United States Department of Health and Human Services issued a statement explaining Section 1557 of the Affordable Care Act stating that the Act prohibits "discrimination on the basis of intersex traits or atypical sex characteristics" in publicly-funded healthcare, as part of a prohibition of discrimination "on the basis of sex".
Access to justice and reparations
Access to reparation appears limited, with a scarcity of legal cases.
Christiane Völling case, Germany
In Germany in 2011, Christiane Völling won what may be the first successful case against her medical treatment. The surgeon was ordered to pay €100,000 in damages after a legal battle that began in 2007, thirty years after the removal of her reproductive organs.
M.C. case, USA
Michaela Raab case, Germany
In 2015, Michaela Raab sued doctors in Nuremberg, Germany who failed to properly advise her. Doctors stated that they "were only acting according to the norms of the time - which sought to protect patients against the psychosocial effects of learning the full truth about their chromosomes." On 17 December 2015, the Nuremberg State Court ruled that the University of Erlangen-Nuremberg Clinic must pay damages and compensation.
Access to information
With the rise of modern medical science in Western societies, many intersex people with ambiguous external genitalia have had their genitalia surgically modified to resemble either female or male genitals. Surgeons pinpointed the birth of intersex babies as a "social emergency". A secrecy-based model was also adopted, in the belief that this was necessary to ensure “normal” physical and psychosocial development. Disclosure also included telling people that they would never meet anyone else with the same condition. Access to medical records has also historically been challenging. Yet the ability to provide free, informed consent depends on the availability of information.
Some intersex organizations claim that secrecy-based models have been perpetuated by a shift in clinical language to Disorders of sex development. Morgan Carpenter of Organisation Intersex International Australia quotes the work of Miranda Fricker on "hermeneutical injustice" where, despite new legal protections from discrimination on grounds of intersex status, "someone with lived experience is unable to even make sense of their own social experiences" due to the deployment of clinical language and "no words to name the experience".
Gender identities and recognition
Depending on the jurisdiction, access to a birth certificate may be an issue, including a birth certificate with a sex marker. Access to a birth certificate with a correct sex marker may be an issue for people who do not identify with their sex assigned at birth, including non-binary gender options.
Like all individuals, some intersex individuals may be raised as a certain sex (male or female) but then identify with another later in life, while most do not. Like non-intersex people, some intersex individuals may not identify themselves as either exclusively female or exclusively male. Research has shown gender identities of intersex individuals to be independent of sexual orientation, though some intersex conditions[example needed] also affect an individual's sexual orientation.
Distinctions between sex and gender are lost in many official or legal documents, and also online. In 2014, Facebook introduced dozens of options for users to specify their gender, including the option of "intersex'.
The passports and identification documents of Australia and some other nationalities have adopted "X" as a valid third category besides "M" (male) and "F" (female), at least since 2003. In 2013, Germany became the first European nation to allow babies with characteristics of both sexes to be registered as indeterminate gender on birth certificates, amidst opposition and skepticism from intersex organisations who point out that the law appears to mandate exclusion from male or female categories.
The third International Intersex Forum called for infants and children to be assigned male or female, on the understanding that later identification may differ:
- 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. (Third International Intersex Forum)
The Council of Europe acknowledged this approach, and concerns about recognition of third and blank classifications in a 2015 Issue Paper, stating that these may lead to "forced outings" and "lead to an increase in pressure on parents of intersex children to decide in favour of one sex." The Issue Paper argues that "further reflection on non-binary legal identification is necessary":
Mauro Cabral, Global Action for Trans Equality (GATE) Co-Director, indicated that any recognition outside the “F”/”M” dichotomy needs to be adequately planned and executed with a human rights point of view, noting that: “People tend to identify a third sex with freedom from the gender binary, but that is not necessarily the case. If only trans and/or intersex people can access that third category, or if they are compulsively assigned a third sex, then the gender binary gets stronger, not weaker”
Australian federal guidelines enable intersex (and other) people to identify gender as male, female or X on all federal documents, including passports. Documentary evidence must be witnessed by a doctor or psychologist, but medical intervention is not required. Alex MacFarlane received the first Australian passport with an 'X' sex descriptor, reported in January 2003.
Birth certificates are a State and Territory issue in Australia. Organisation Intersex International Australia asserts that identification changes are managed as an administrative correction, and that this process has enabled some adults to obtain birth certificates with an indeterminate or unspecified sex.
Alex MacFarlane is believed to be the first person in Australia to obtain a birth certificate recording sex as indeterminate. The West Australian reported in January 2003 that the Department of Foreign Affairs and Trade "had decided to accommodate people whose birth certificates recorded their sex as indeterminate ... Alex is also believed to be the first Australian issued with a birth certificate acknowledging a gender other than male or female". Councillor Tony Briffa JP, of the City of Hobsons Bay, Victoria, previously acknowledged as the world's first openly intersex mayor, states on Tony's website that "my birth certificate is silent as to my sex".
Germany is the first European country to allow "indeterminate" sex as an option. A report by the German Ethics Council stated that the law was passed because, "Many people who were subjected to a 'normalizing' operation in their childhood have later felt it to have been a mutilation and would never have agreed to it as adults."  Deutsche Welle reported that an "indeterminate" 'option' was made available for the birth certificates of intersex infants with ambiguous genitalia on 1 November 2013. The move is controversial with many intersex advocates in Germany and elsewhere suggesting that it might encourage surgical interventions. The Council of Europe Issue Paper on intersex restates these concerns:
Human rights practitioners fear that the lack of freedom of choice regarding the entry in the gender marker field may now lead to an increase in stigmatisation and to “forced outings” of those children whose sex remains undetermined. This has raised the concern that the law may also lead to an increase in pressure on parents of intersex children to decide in favour of one sex.
In 2014, a Kenyan court ordered the Kenyan government to issue a birth certificate to a five-year-old child born with ambiguous genitalia. In Kenya a birth certificate is necessary for attending school, getting a national identity document, and voting.
The term "other" may be used in citizenship and other documents to classify intersex and third gender persons in Nepal.
Birth certificates are available at birth showing "indeterminate" sex if it is not possible to assign a sex. The New Zealand Department of Internal Affairs states, "A person's sex can be recorded as indeterminate at the time of birth if it cannot be ascertained that the person is either male or female, and there are a number of people so recorded." Nevertheless, material presented by the Australasian Paediatric Endocrine Group to the Australian Senate in 2013 showed New Zealand to be a regional outlier in cases of Congenital adrenal hyperplasia, with genital surgical interventions favoured on infant girls aged less than 6 months.
Human rights investigations and statements
San Francisco Human Rights Investigation, 2005
The 2005 Human Rights Investigation into the Medical "Normalization" of Intersex People, by the Human Rights Commission of the City and County of San Francisco is thought "likely to be the first human rights report into the treatment of intersex people, certainly in the English language." The report found that:
- Infant genital surgeries and sex hormone treatments that are not performed for the treatment of physical illness, such as improving urinary tract or metabolic functioning, and have not been shown to alleviate pain or illness (hereafter referred to as "normalizing" interventions) are unnecessary and are not medical or social emergencies.
- "Normalizing" interventions done without the patient's informed consent are inherent human rights abuses.
- "Normalizing" interventions deprive intersex people of the opportunity to express their own identity and to experience their own intact physiology.
- It is unethical to disregard a child's intrinsic human rights to privacy, dignity, autonomy, and physical integrity by altering genitals through irreversible surgeries for purely psychosocial and aesthetic rationales. It is wrong to deprive a person of the right to determine their sexual experience and identity. ...
- It is ethically wrong to treat people differently or unfairly because they are perceived by others to be "monsters" or "oddities."— Human Rights Commission of the City and County of San Francisco
Yogyakarta Principles, 2006
The 2006 Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity is a set of principles relating to sexual orientation and gender identity, intended to apply international human rights law standards to address the abuse of the human rights of lesbian, gay, bisexual and transgender (LGBT) people. It briefly mentions intersex, influenced by the Declaration of Montreal which first demanded prohibition of unnecessary post-birth surgery to reinforce gender assignment until a child is old enough to understand and give informed consent. The Yogyakarta Principles detail this in the context of existing UN declarations and conventions under Principle 18, which called on states to:
B. Take all necessary legislative, administrative and other measures to ensure that no child's body is irreversibly altered by medical procedures in an attempt to impose a gender identity without the full, free and informed consent of the child in accordance with the age and maturity of the child and guided by the principle that in all actions concerning children, the best interests of the child shall be a primary consideration;
C. Establish child protection mechanisms whereby no child is at risk of, or subjected to, medical abuse;— The Yogyakarta Principles
Report of Swiss National Advisory Council on Biomedical Ethics, 2012
In late 2012, the Swiss National Advisory Commission on Biomedical Ethics reported on intersex. The Commission report makes a strong case against medical intervention for "psychosocial" reasons:
Especially delicate are those cases where a psychosocial indication is used to justify the medical urgency of surgical sex assignment in children who lack capacity. Here, there is a particularly great risk of insufficient respect being accorded to the child's (future) self-determination and its physical integrity...
Decisions on sex assignment interventions are to be guided by the questions of what genitalia a child actually requires at a given age (apart from a functional urinary system) and how these interventions will affect the physical and mental health of the child and the future adult. Treatment needs to be carefully justified, especially since – in functional, aesthetic and psychological respects – surgically altered genitalia ... are not comparable to natural male or female genitalia. Decisions are to be guided, above all, by the child's welfare...The harmful consequences may include, for example, loss of fertility and sexual sensitivity, chronic pain, or pain associated with dilation (bougienage) of a surgically created vagina, with traumatizing effects for the child. If such interventions are performed solely with a view to integration of the child into its family and social environment, then they run counter to the child's welfare. In addition, there is no guarantee that the intended purpose (integration) will be achieved.— Swiss National Advisory Commission on Biomedical Ethics
The report is notable for making a clear apology for damage done to intersex people in the past, and up until the present. It recommends deferring all "non-trivial" surgeries which have "irreversible consequences". The report also recommended criminal sanction for non-medically necessary genital surgeries.
Report of UN Special Rapporteur on Torture, 2013
On 1 February 2013, Juan E. Méndez, the UN Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, issued a statement condemning non-consensual surgical intervention on intersex people. His report states:
76. … There is an abundance of accounts and testimonies of persons being denied medical treatment, subjected to verbal abuse and public humiliation, psychiatric evaluation, a variety of forced procedures such as sterilization, State-sponsored forcible … hormone therapy and genital-normalizing surgeries under the guise of so called "reparative therapies". These procedures are rarely medically necessary, can cause scarring, loss of sexual sensation, pain, incontinence and lifelong depression and have also been criticized as being unscientific, potentially harmful and contributing to stigma (A/HRC/14/20, para. 23).
77. Children who are born with atypical sex characteristics are often subject to irreversible sex assignment, involuntary sterilization, involuntary genital normalizing surgery, performed without their informed consent, or that of their parents, "in an attempt to fix their sex", leaving them with permanent, irreversible infertility and causing severe mental suffering…79. The mandate has noted that "members of sexual minorities are disproportionately subjected to torture and other forms of ill-treatment because they fail to conform to socially constructed gender expectations.— UN Special Rapporteur on Torture
Resolution by the Council of Europe, 2013
undertake further research to increase knowledge about the specific situation of intersex people, ensure that no-one is subjected to unnecessary medical or surgical treatment that is cosmetic rather than vital for health during infancy or childhood, guarantee bodily integrity, autonomy and self-determination to persons concerned, and provide families with intersex children with adequate counselling and support— Resolution 1952/2013, Council of Europe
Senate Committee inquiry, Australia, 2013
In October 2013, the Australian Senate published a report entitled Involuntary or coerced sterilisation of intersex people in Australia. The Senate found that "normalising" surgeries are taking place in Australia, often on infants and young children, with preconceptions that it described as "disturbing": "Normalising appearance goes hand in hand with the stigmatisation of difference".
They commented: "...normalisation surgery is more than physical reconstruction. The surgery is intended to deconstruct an intersex physiology and, in turn, construct an identity that conforms with stereotypical male and female gender categories" and: "Enormous effort has gone into assigning and 'normalising' sex: none has gone into asking whether this is necessary or beneficial. Given the extremely complex and risky medical treatments that are sometimes involved, this appears extremely unfortunate."
The report makes 15 recommendations, including ending cosmetic genital surgeries on infants and children and providing for legal oversight of individual cases.
Organisation Intersex International Australia welcomed the report, saying that,
At a first view, many of the headline conclusions and recommendations are positive – accepting our recommendations on minimising genital surgery, concern over the lack of adequate data, insufficient psychosocial support, and concern that decision making on cancer risk is insufficiently disentangled from wider concerns about a person's intersex status itself; we also broadly welcome the recommendations relating to the prenatal use of Dexamethasone ... The distinction between therapeutic and non-therapeutic treatment has failed many intersex people in Australia. We welcome the recommendation for the proper oversight of individual cases.— Organisation Intersex International Australia
World Health Organization and UN interagency report, 2014
In May 2014, the World Health Organization issued a joint statement on Eliminating forced, coercive and otherwise involuntary sterilization, An interagency statement with the OHCHR, UN Women, UNAIDS, UNDP, UNFPA and UNICEF. The report references the involuntary surgical "sex-normalising or other procedures" on "intersex persons". It questions the medical necessity of such treatments, patients' ability to consent, and a weak evidence base. The report recommends a range of guiding principles for medical treatment, including ensuring patient autonomy in decision-making, ensuring non-discrimination, accountability and access to remedies.
Council of Europe Issue Paper, 2015
In a wide-ranging first detailed analysis on intersex health and human rights issues by an international institution, the Council of Europe published an Issue Paper entitled Human rights and intersex people in May 2015. The document highlighted an historic lack of attention to intersex human rights, stating that current social and biomedical understandings of sex and gender make intersex people "especially vulnerable" to human rights breaches. The report cited previous reports from San Franscisco, the Swiss National Advisory Commission on Biomedical Ethics and the Australian Senate. The Commissioner for Human Rights made eight recommendations. For this first time, these recognized a right to not undergo sex assignment treatment.
UN Office of the High Commissioner for Human Rights report, 2015
In 2015, the UN Office of the High Commissioner for Human Rights (OHCHR) described human rights violations against intersex people:
53. Many intersex children, born with atypical sex characteristics, are subjected to medically unnecessary surgery and treatment in an attempt to force their physical appearance to align with binary sex stereotypes. Such procedures are typically irreversible and can cause severe, long-term physical and psychological suffering.
The OHCHR acknowledged Australia and Malta as "the first countries to expressly prohibit discrimination against intersex persons," and Malta as "the first State to prohibit sex-assignment surgery or treatment on intersex minors without their informed consent." It called on UN member states to protect intersex persons from discrimination, and address violence by:
- "Banning “conversion” therapy, involuntary treatment, forced sterilization and forced genital and anal examinations;"
- "Prohibiting medically unnecessary procedures on intersex children"
World Health Organization report, "Sexual health, human rights and the law", 2015
In June 2015, the World Health Organization published a major report on sexual and reproductive rights and the law. Section 3.4.9, on intersex people, identifies discrimination and stigma within health systems (citations omitted):
Intersex people may face discrimination and stigma in the health system, in many cases being subjected to lack of quality of care, institutional violence and forced interventions throughout their lifetime.
A major concern for intersex people is that so-called sex normalizing procedures are often undertaken during their infancy and childhood, to alter their bodies, particularly the sexual organs, to make them conform to gendered physical norms, including through repeated surgeries, hormonal interventions and other measures. As a result, such children may be subjected to medically unnecessary, often irreversible, interventions that may have lifelong consequences for their physical and mental health, including irreversible termination of all or some of their reproductive and sexual capacity.
The report stated that intersex persons are entitled "to access health services on the same basis as others, free from coercion, discrimination and violence", with the ability offer free and informed consent. The report also called for the education and training of medical and psychological professionals on "physical, biological and sexual diversity and integrity".
People and organisations
- United Nations; Office of the High Commissioner for Human Rights (2015). Free & Equal Campaign Fact Sheet: Intersex (PDF).
- Submission 88 to the Australian Senate inquiry on the involuntary or coerced sterilisation of people with disabilities in Australia, Australasian Paediatric Endocrine Group (APEG), 27 June 2013
- Rebecca Jordan-Young, Peter Sonksen, Katrina Karkazis (2014). "Sex, health, and athletes". BMJ. 2014 (348): g2926. PMID 24776640. doi:10.1136/bmj.g2926.
- Macur, Juliet (6 October 2014). "Fighting for the Body She Was Born With". The New York Times. Retrieved 9 February 2015.
- Report of the UN Special Rapporteur on Torture, Office of the UN High Commissioner for Human Rights, February 2013.
- Eliminating forced, coercive and otherwise involuntary sterilization, An interagency statement, World Health Organization, May 2014.
- Involuntary or coerced sterilisation of intersex people in Australia, Australian Senate Community Affairs Committee, October 2013.
- Swiss National Advisory Commission on Biomedical Ethics NEK-CNE (November 2012). On the management of differences of sex development. Ethical issues relating to "intersexuality".Opinion No. 20/2012 (PDF). 2012. Berne.
- "German Gender-Assignment Case Has Intersexuals Hopeful". DW.COM. Deutsche Welle. 12 December 2007. Retrieved 2015-12-21.
- Council of Europe; Commissioner for Human Rights (April 2015), Human rights and intersex people, Issue Paper
- Reuters (1 April 2015). "Surgery and Sterilization Scrapped in Malta's Benchmark LGBTI Law". The New York Times.
- Star Observer (2 April 2015). "Malta passes law outlawing forced surgical intervention on intersex minors". Star Observer.
- Zderic, Stephen (2002). Pediatric gender assignment : a critical reappraisal ; [proceedings from a conference ... in Dallas in the spring of 1999 which was entitled "pediatric gender assignment - a critical reappraisal"]. New York, NY [u.a.]: Kluwer Acad. / Plenum Publ. ISBN 0306467593.
- Human Rights Between the Sexes, Dan Christian Ghattas and Heinrich Böll Foundation, September 2013.
- A preliminary study on the life situations of inter* individuals, OII Europe, 4 November 2013.
- United Nations; Committee on the Rights of Persons with Diabilities (April 17, 2015). Concluding observations on the initial report of Germany (advance unedited version). Geneva: United Nations.
- Cabral, Mauro (April 8, 2015). "Making depathologization a matter of law. A comment from GATE on the Maltese Act on Gender Identity, Gender Expression and Sex Characteristics". Global Action for Trans Equality. Retrieved 2015-07-03.
- Curtis, Skyler (2010–2011). "Reproductive Organs and Differences of Sex Development: The Constitutional Issues Created by the Surgical Treatment of Intersex Children". McGeorge Law Review. 42: 863. Retrieved 15 November 2012.
- "Corte Constitucional de Colombia: Sentencia T-1025/02". Retrieved 2 December 2012.
- Malta (April 2015), Gender Identity, Gender Expression and Sex Characteristics Act: Final version
- OII Europe (April 1, 2015). "OII-Europe applauds Malta's Gender Identity, Gender Expression and Sex Characteristics Act. This is a landmark case for intersex rights within European law reform". Retrieved 2015-07-03.
- Carpenter, Morgan (April 2, 2015). "We celebrate Maltese protections for intersex people". Organisation Intersex International Australia. Retrieved 2015-07-03.
- Davis, Georgiann (October 2013). "The Social Costs of Preempting Intersex Traits". The American Journal of Bioethics. 13 (10): 51–53. ISSN 1526-5161. PMID 24024811. doi:10.1080/15265161.2013.828119. Retrieved 2014-10-21.
- Carpenter, Morgan (July 18, 2014). "Morgan Carpenter at LGBTI Human Rights in the Commonwealth conference". Glasgow.
- Carpenter, Morgan; Organisation Intersex International Australia (April 30, 2014). Submission on the Review of Part B of the Ethical Guidelines for the Use of Assisted Reproductive Technology in Clinical Practice and Research, 2007 (Report). Sydney: Organisation Intersex International Australia.
- Judicial Matters Amendment Act, No. 22 of 2005, Republic of South Africa, Vol. 487, Cape Town, 11 January 2006.
- Sex Discrimination Amendment (Sexual Orientation, Gender Identity and Intersex Status) Act 2013, No. 98, 2013, ComLaw, C2013A00098, 2013.
- Jones, Tiffany (March 11, 2016). "The needs of students with intersex variations". Sex Education: 1–17. ISSN 1468-1811. doi:10.1080/14681811.2016.1149808. Retrieved 2016-05-28.
- Jones, Tiffany; Hart, Bonnie; Carpenter, Morgan; Ansara, Gavi; Leonard, William; Lucke, Jayne (February 2016). Intersex: Stories and Statistics from Australia. Cambridge, UK: Open Book Publishers. ISBN 978-1-78374-208-0. Retrieved 2016-02-02.
- Carpenter, Morgan; Hough, Dawn (2014). Employers' Guide to Intersex Inclusion. Sydney, Australia: Pride in Diversity and Organisation Intersex International Australia. ISBN 978-0-646-92905-7.
- interACT. "Federal Government Bans Discrimination Against Intersex People in Health Care". interactadvocates. Retrieved 2016-05-27.
- Fénichel, Patrick; Paris, Françoise; Philibert, Pascal; Hiéronimus, Sylvie; Gaspari, Laura; Kurzenne, Jean-Yves; Chevallier, Patrick; Bermon, Stéphane; Chevalier, Nicolas; Sultan, Charles (June 2013). "Molecular Diagnosis of 5α-Reductase Deficiency in 4 Elite Young Female Athletes Through Hormonal Screening for Hyperandrogenism". The Journal of Clinical Endocrinology & Metabolism. 98 (6): –1055–E1059. ISSN 0021-972X. doi:10.1210/jc.2012-3893. Retrieved 2016-05-28.
- Jordan-Young, R. M.; Sonksen, P. H.; Karkazis, K. (April 2014). "Sex, health, and athletes". BMJ. 348 (apr28 9): –2926–g2926. ISSN 1756-1833. doi:10.1136/bmj.g2926. Retrieved 2016-05-21.
- "Semenya told to take gender test". BBC Sport. 19 August 2009. Retrieved 19 August 2009.
- "A Lab is Set to Test the Gender of Some Female Athletes.". New York Times. 30 July 2008.
- Bermon, Stéphane; Garnier, Pierre Yves; Lindén Hirschberg, Angelica; Robinson, Neil; Giraud, Sylvain; Nicoli, Raul; Baume, Norbert; Saugy, Martial; Fénichel, Patrick; Bruce, Stephen J.; Henry, Hugues; Dollé, Gabriel; Ritzen, Martin (August 2014). "Serum Androgen Levels in Elite Female Athletes". The Journal of Clinical Endocrinology & Metabolism: –2014–1391. ISSN 0021-972X. doi:10.1210/jc.2014-1391. Retrieved 2016-05-28.
- Branch, John (27 July 2016). "Dutee Chand, Female Sprinter With High Testosterone Level, Wins Right to Compete". The New York Times. Retrieved 22 May 2016.
- On the historic passing of the Sex Discrimination Amendment (Sexual Orientation, Gender Identity and Intersex Status) Act 2013, Organisation Intersex International Australia, 25 June 2013.
- "Australian Parliament, Explanatory Memorandum to the Sex Discrimination Amendment (Sexual Orientation, Gender Identity and Intersex Status) Bill 2013". Retrieved 6 October 2014.
- We welcome the Senate Inquiry report on the Exposure Draft of the Human Rights and Anti-Discrimination Bill 2012, Organisation Intersex International Australia, 21 February 2013.
- (Finnish) Laki naisten ja miesten välisestä tasa-arvosta annetun lain muuttamisesta
- Standing up for the human rights of intersex people – how can you help?
- (Greek) NOMOΣ ΥΠ’ ΑΡΙΘ. 3456 Σύμφωνο συμβίωσης, άσκηση δικαιωμάτων, ποινικές και άλλες διατάξεις.
- (Greek) Πρώτη φορά, ίσοι απέναντι στον νόμο
- DISCRIMINATION (SEX AND RELATED CHARACTERISTICS) (JERSEY) REGULATIONS 2015
- Transgender Europe (April 1, 2015). Malta Adopts Ground-breaking Trans and Intersex Law – TGEU Press Release.
- Promotion of Equality and Prevention of Unfair Discrimination Act No. 4 of 2000, as amended.
- Office for Civil Rights (OCR) (2016). "Section 1557 of the Patient Protection and Affordable Care Act" (Text). HHS.gov. Retrieved 2016-05-27.
- Zwischengeschlecht (August 12, 2009). "Christiane Völling: Hermaphrodite wins damage claim over removal of reproductive organs". Retrieved 2015-07-20.
- The Local (February 27, 2015). "Intersex person sues clinic for unnecessary op". Retrieved 2015-12-21.
- DW Staff (August 2010). "Christiane Völling". German Ethics Council. Retrieved 2015-12-21.
- Southern Poverty Law Centre (May 14, 2013). "Groundbreaking SLPC Lawsuit Accuses South Carolina Doctors and Hospitals of Unnecessary Surgery on Infant". Retrieved 2015-07-20.
- Reis, Elizabeth (May 17, 2013). "Do No Harm: Intersex Surgeries and the Limits of Certainty". Nursing Clio. Retrieved 2015-07-20.
- Dreger, Alice (May 16, 2013). "When to Do Surgery on a Child With 'Both' Genitalia". The Atlantic. Retrieved 2015-07-20.
- Zwischengeschlecht (December 17, 2015). "Nuremberg Hermaphrodite Lawsuit: Michaela "Micha" Raab Wins Damages and Compensation for Intersex Genital Mutilations!". Retrieved 2015-12-21.
- Coran, Arnold G.; Polley, Theodore Z. (July 1991). "Surgical management of ambiguous genitalia in the infant and child". Journal of Pediatric Surgery. 26 (7): 812–820. PMID 1895191. doi:10.1016/0022-3468(91)90146-K.
- Holmes, Morgan. "Is Growing up in Silence Better Than Growing up Different?". Intersex Society of North America.
- Intersex Society of North America. "What's wrong with the way intersex has traditionally been treated?".
- World Health Organization (2015). Sexual health, human rights and the law. Geneva: World Health Organization. ISBN 9789241564984.
- Carpenter, Morgan (February 3, 2015). Intersex and ageing. Organisation Intersex International Australia.
- "Kenya takes step toward recognizing intersex people in landmark ruling". Reuters.
- Hida Viloria, The Advocate, "Op-ed: Germany’s Third-Gender Law Fails on Equality"
- Money, John; Ehrhardt, Anke A. (1972). Man & Woman Boy & Girl. Differentiation and dimorphism of gender identity from conception to maturity. USA: The Johns Hopkins University Press. ISBN 0-8018-1405-7.
- Domurat Dreger, Alice (2001). Hermaphrodites and the Medical Invention of Sex. USA: Harvard University Press. ISBN 0-674-00189-3.
- Furtado P. S.; et al. (2012). "Gender dysphoria associated with disorders of sex development". Nat. Rev. Urol. 9: 620–627. doi:10.1038/nrurol.2012.182.
- Marañón, Gregorio (1929). Los estados intersexuales en la especie humana. Madrid: Morata.
- "Sexual identity and sexual orientation". Retrieved 6 October 2014.
- "Australian Government Guidelines on the Recognition of Sex and Gender, 30 May 2013". Retrieved 6 October 2014.
- Here's a list of 58 gender options for Facebook users ABC, February 2014.
- ""Ingrid Holme, "Hearing People's Own Stories", in Science as Culture, Volume 17, Issue 3, 2008"". Retrieved 6 October 2014.
- "New Zealand Passports - Information about Changing Sex / Gender Identity". Retrieved 6 October 2014.
- Third sex option on birth certificates, Deutsche Welle, 1 November 2013.
- Third Gender: A Step Toward Ending Intersex Discrimination, Der Spiegel, 22 August 2013.
- "Intersex: Third Gender in Germany" (Spiegel, Huff Post, Guardian, ...): Silly Season Fantasies vs. Reality of Genital Mutilations, Zwischengeschlecht, 1 November 2013
- Sham package for Intersex: Leaving sex entry open is not an option, OII Europe, 15 February 2013
- ‘X’ gender: Germans no longer have to classify their kids as male or female, RT, 3 November 2013.
- "X marks the spot for intersex Alex", The West Australian, 11 January 2003, via bodieslikeours.org.
- "Neither man nor woman", Sydney Morning Herald. 27 June 2010
- "On intersex birth registrations | OII Australia - Intersex Australia", OII Australia. 13 November 2009
- "Intersex Mayor Elected in Australia", Advocate.com, December 9, 2011
- "Tony Briffa Of Australia's City Of Hobsons Bay Becomes World's First Intersex Mayor", HuffingtonPost.com, December 10, 2011
- "About Tony ... | cr Tony Briffa", Briffa.org, 2012
- "OII VP Tony Briffa to wed partner in NZ ceremony - Gay News Network", Gay News Network, 27 September 2013
- "Deutsche Welle, "Third sex option on birth certificates", 1 November 2013". DW.DE. Retrieved 6 October 2014.
- "OII Australia, "German proposals for a "third gender" on birth certificates miss the mark", 20 August 2013". OII Australia - Intersex Australia. Retrieved 6 October 2014.
- Department of Internal Affairs, "General information regarding Declarations of Family Court as to sex to be shown on birth certificates"
- "Open birth sex assignments do not reduce surgical interventions". Organisation Intersex International Australia. 4 November 2013. Retrieved 2014-12-31.
- "Jaimie Veale - Academia.edu, "The prevalence of transsexualism among New Zealand passport holders, passports with an X sex descriptor are now available in New Zealand", 2008". Retrieved 6 October 2014.
- Third submission to Senate Inquiry on involuntary sterilisation, Organisation Intersex International Australia, 6 June 2013.
- Human Rights Investigation into the Medical "Normalization" of Intersex People, Human Rights Commission of the City and County of San Francisco, 2005, via Senate of Australia
- Concluding submission to the Senate Inquiry on involuntary or coerced sterilisation, Organisation Intersex International Australia, 12 September 2013.
- Center for Human Rights & Humanitarian Law; Washington College of Law; American University (2014). ￼Torture in Healthcare Settings: Reflections on the Special Rapporteur on Torture's 2013 Thematic Report. Washington, DC: Center for Human Rights & Humanitarian Law.
- Resolution 1952/2013, Provision version, Children’s right to physical integrity, Council of Europe, 1 October 2013
- Statement on the Senate report Involuntary or coerced sterilisation of intersex people in Australia , Organisation Intersex International Australia, 29 October 2013.
- It's time to defend intersex rights, Morgan Carpenter at Australian Broadcasting Corporation, 15 November 2013.
- Australian Parliament committee releases intersex rights report, Gay Star News, 28 October 2013.
- Intersex advocates address findings of Senate Committee into involuntary sterilisation, Gay News Network, 28 October 2013.
- WHO/UN interagency statement on involuntary or coerced sterilisation, Organisation Intersex International Australia, 30 May 2014.
- United Nations High Commissioner for Human Rights (May 4, 2015), Discrimination and violence against individuals based on their sexual orientation and gender identity