Compulsory sterilization
Compulsory sterilization, also known as forced or coerced sterilization, refers to any government-mandated program to involuntarily sterilize a specific group of people. Sterilization removes a person's capacity to reproduce, and is usually done by surgical or chemical means.
Purported justifications for compulsory sterilization have included population control, eugenics, limiting the spread of HIV, and ethnic genocide.
Forced sterilization can also occur as a form of racial discrimination. While not always mandated by law, there are cases where forced sterilization has occurred in practice. This distinction highlights the difference between official policies and actual implementation, where coerced sterilization take place even without explicit legal authorization.
Several countries implemented sterilization programs in the early 20th century. Although such programs have been made illegal in much of the world, instances of forced or coerced sterilizations still persist.
Affected populations
Governmental family-planning programs emerged in the late 1800s, and have continued to progress through the 21st century. During this time, as feminists began advocating for reproductive choice, eugenicists and hygienists were advocating for low-income and disabled peoples to be sterilized or have their fertility tightly regulated, in order to "clean" or "perfect" nations. The second half of the 20th century saw national governments' uptake of neo-Malthusian ideology that directly linked population growth to increased poverty, which, during the embrace of capitalism, meant that countries were unable to economically develop due to this poverty.Much of these governmental population control programs were focused on using sterilization as the main avenue to reduce high birth rates, even though public acknowledgement that sterilization made an impact on the population levels of the developing world is still widely lacking. Early population programs of the 20th century were marked as part of the eugenics movement, with Nazi Germany's programs providing the most well-known examples of sterilization of disabled people. In the 1970s, population control programs focused on the "third world" to help curtail over population of poverty areas that were beginning to "develop".
As of 2013, 24 countries in Europe required sterilization for legal gender recognition and 16 countries did not provide for any possibility to change legal gender at all, which meant that transgender people could have challenges applying for jobs, opening bank accounts, boarding planes, or may not be able to do these things at all. Disabled women in Europe are also common targets of forced sterilization. "'So many times, you hear it’s in the best interest of the woman,' said Catalina Devandas Aguilar, a former United Nations special rapporteur for disability rights. 'But often, it’s because it’s more convenient for the family or the institution that takes care of them.'"
On 1 February 2013, the United Nations Special Rapporteur on Torture issued a report on abusive practices in health care settings that has important implications for LGBT people and people with intersex conditions. In section 88, the SRT says States should:
In May 2014, the World Health Organization, OHCHR, UN Women, UNAIDS, UNDP, UNFPA, and UNICEF issued a joint statement on "Eliminating forced, coercive, and otherwise involuntary sterilization". The report references the involuntary sterilization of a number of specific population groups. They include:
- Women, especially in relation to coercive population control policies, and particularly including women living with HIV, indigenous and ethnic minority girls and women. Indigenous and ethnic minority women often face "wrongful stereotyping based on gender, race and ethnicity".
- * In the United States the funding of mothers on welfare by HEW covers roughly 90% of cost and doctors are likely to concur with the compulsory sterilization of mothers on welfare. Threats to cease welfare occur when women are hesitant to consent.
- Disabled people, especially those with intellectual disability. Women with intellectual disabilities are "often treated as if they have no control, or should have no control, over their sexual and reproductive choices". Other rationales include menstrual management for "women who have or are perceived to have difficulties coping with or managing menses, or whose health conditions or behaviour are negatively affected by menses." Men with intellectual disabilities are also sterilized, sometimes using the justification that it provides greater sexual freedom.
- Intersex persons, who "are often subjected to cosmetic and other non-medically indicated surgeries performed on their reproductive organs, without their informed consent or that of their parents, and without taking into consideration the views of the children involved", often as a "sex-normalizing" treatment.
- Transgender persons, "as a prerequisite to receiving gender-affirmative treatment and gender-marker changes". This being a practice that the United Nations Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment has described as a violation of the Yogyakarta Principles.
As a part of human population planning
Human population planning is the practice of artificially altering the rate of growth of a human population. Historically, human population planning has been implemented by limiting the population's birth rate, usually by government mandate, and has been undertaken as a response to factors including high or increasing levels of poverty, environmental concerns, religious reasons, and overpopulation. While population planning can involve measures that improve people's lives by giving them greater control of their reproduction, some programs have exposed them to exploitation.In the 1977 textbook Ecoscience: Population, Resources, Environment, authors Paul and Anne Ehrlich, and John Holdren discuss a variety of means to address human overpopulation, including the possibility of compulsory sterilization. This book received renewed media attention with the appointment of Holdren as Assistant to the President for Science and Technology, Director of the White House Office of Science and Technology Policy, largely from conservative pundits who have published scans of the textbook online. Several forms of compulsory sterilization are mentioned, including the proposal for vasectomies for men with three or more children in India in the 1960s, sterilizing women after the birth of their second or third child, birth control implants as a form of removable, long-term sterilization, a licensing system allotting a certain number of children per woman, economic and quota systems of having a certain number of children, and adding a sterilant to drinking water or food sources, although the authors are clear that no such sterilant exists nor is one in development. The authors state that most of these policies are not in practice, have not been tried, and most will likely "remain unacceptable to most societies."
Holdren stated in his confirmation hearing that he no longer supports the creation of an optimum population by the U.S. government. However, the population control policies suggested in the book are indicative of the concerns about overpopulation, also discussed in The Population Bomb a book written by Paul R. Ehrlich and Anne Ehrlich predicting major societal upheavals due to overpopulation. As this concern about overpopulation gained political, economic, and social currency, attempts to reduce fertility rates, often through compulsory sterilization, were results of this drive to reduce overpopulation. These coercive and abusive population control policies impacted people around the world in different ways, and continue to have social, health, and political consequences, one of which is lasting mistrust in current family planning initiatives by populations who were subjected to coercive policies like forced sterilization. Population control policies were widely critiqued by women's health movement in the 1980s and 1990s, with the International Conference on Population and Development in 1994 in Cairo initiating a shift from population control to reproductive rights and the contemporary reproductive justice movement. However, new forms of population control policies, including coercive sterilization practices are a global issue and a reproductive rights and justice issue.
By country
International law
The Istanbul Convention prohibits forced sterilization in most European countries.Widespread or systematic forced sterilization has been recognized as a Crime against Humanity by the Rome Statute of the International Criminal Court in the explanatory memorandum. This memorandum defines the jurisdiction of the International Criminal Court. It does not have universal jurisdiction, with the United States, Russia and China among the countries to exclude themselves. Rebecca Lee wrote in the Berkeley Journal of International Law that, as of 2015, twenty-one Council of Europe member states require proof of sterilization in order to change one's legal sex categorization. Lee wrote that requiring sterilization is a human rights violation and that LGBTQ-specific international treaties may need to be developed in order to protect LGBTQ human rights.
Bangladesh
Poverty
Bangladesh has the highest population density in the world among countries having a population of at least 10 million people. The capital Dhaka is the fourth most densely populated city in the world, and ranked as the world's second most unlivable city in 2015 according to the annual "Liveability Ranking" by the Economist Intelligence Unit.Bangladesh has a long-running government-operated civilian sterilization program as a part of its population control policy, which aims at women and men living in poverty. The government offers 2,000 Bangladeshi Taka for women who are persuaded to undergo tubal ligation and for men who are persuaded to undergo vasectomy. Women are also offered a sari and men are offered a kurta to wear for undergoing sterilization. The referrer, who persuades the woman or man to undergo sterilization gets 300 Bangladeshi Taka.
In 1965, the targeted number of sterilizations per month was 600–1,000 in contrast to the insertion of 25,000 IUDs, which was increased in 1978 to about 50,000 sterilizations per month on average. A 50% rise in the amount paid to men coincided with a doubling of the number of vasectomies between 1980 and 1981.
One study conducted in 1977, when incentives were only equivalent to US$1.10, indicated that between 40% and 60% of the men chose vasectomy because of the payment, who otherwise did not have any serious urge to get sterilized.
The "Bangladesh Association for Voluntary Sterilization", alone performed 67,000 tubal ligations and vasectomies in its 25 clinics in 1982. The rate of sterilization increased 25 percent each year.
On 16 December 1982, Bangladesh's military ruler Lieutenant General Hussain Muhammad Ershad launched a two-year mass sterilization program for Bangladeshi women and men. About 3,000 women and men were planned to be sterilized on 16 December 1982. Ershad's government trained 1,200 doctors and 25,000 field workers who must conduct two tubal ligations and two vasectomies each month to earn their salaries. The government wanted to persuade 1.4 million people, both women and men to undergo sterilization within two years. By January 1983, 40,000 government field workers were employed in Bangladesh's 65,000 villages to persuade women and men to undergo sterilization and to promote usage of birth-control across the country.
Food subsidies under the group feeding program were given to only those women with certificates showing that they had undergone tubal ligation.
There are reports that often when a woman had to undergo a gastrointestinal surgery, doctors took this opportunity to sterilize her without her knowledge. According to Bangladesh governmental website "National Emergency Service", the 2000 Bangladeshi Taka and the sari/lungi given to the persons undergoing sterilizations are their "compensations". Where Bangladesh government also assures the poor people that it will cover all medical expenses if complications arise after the sterilization.
For the women who are persuaded to have an IUD inserted into their uterus, the government also offers 150 Bangladeshi Taka after the procedure and 240 Bangladeshi Taka in three followups, where the referrer gets 50 Bangladeshi Taka. For the women who are persuaded to have an etonogestrel birth control implant placed under the skin in their upper arm, the government offers 150 Bangladeshi Taka after the procedure and 210 Bangladeshi Taka in three followups, where the referrer gets 60 Bangladeshi Taka.