Discrimination against intersex people
people are born with sex characteristics, such as chromosomes, gonads, or genitals that, according to the UN Office of the High Commissioner for Human Rights, "do not fit typical binary notions of male or female bodies". "Because their bodies are seen as different, intersex children and adults are often stigmatized and subjected to multiple human rights violations".
Discriminatory treatment includes infanticide, abandonment, mutilation and neglect, as well as broader concerns regarding the right to life. Intersex people face discrimination in education, employment, healthcare, sport, with an impact on mental and physical health, and on poverty levels, including as a result of harmful medical practices.
United Nations, African Commission on Human and Peoples' Rights, Council of Europe, Inter-American Commission on Human Rights, and other human rights institutions have called for countries to ban discrimination and combat stigma. Few countries so far protect intersex people from discrimination.
Protection from discrimination
A 2013 first international pilot study, Human Rights between the Sexes, by 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 United Nations states that intersex people suffer stigma on the basis of physical characteristics, "including violations of their rights to health and physical integrity, to be free from torture and ill-treatment, and to equality and non- discrimination." The UN has called for governments to end discrimination against intersex people:
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.
- Since then, several countries in Southeastern Europe have prohibited discrimination based on sex characteristics of intersex status: Albania, Bosnia and Herzegovina, Greece, and Serbia currently prohibit discrimination based on "sex characteristics", while Montenegro prohibits discrimination based on "intersex characteristics" since 2017.
- Iceland bans employment discrimination based on sex characteristics since 2018. The Netherlands, Belgium and Denmark also prohibit discrimination based on sex characteristics.
- Pakistan prohibits discrimination against intersex people since 2018. India also prohibits discrimination against "person with intersex variations" since 2020.
- Since 2022, Chile is the first Latin American country that provide legal protection from discrimination based on sex characteristics.
United Nations Human Rights Council resolution
Enhance efforts to combat discrimination, violence and harmful practices against persons with innate variations in sex characteristics and address their root causes, such as stereotypes, the spread of misconceptions and inaccurate information, stigma and taboo, and to work to realize the enjoyment of the highest attainable standard of physical and mental health for persons with innate variations in sex characteristics.In addition, the resolution also requests that the UN High Commissioner for Human Rights publishes a report "examining in detail discriminatory laws and policies, acts of violence and harmful practices against persons with innate variations in sex characteristics, in all regions of the world." The resolution, passed with twenty-four votes in favour and twenty-three abstentions, has been praised by various human rights and intersex advocacy organizations, including ILGA, Human Rights Watch, OII Europe and InterACT.
Right to life
Intersex people face genetic de-selection via pregnancy terminations and preimplantation genetic diagnosis, as well as abandonment, neglect, infanticide and murder due to their sex characteristics. In 2015, the Council of Europe published an Issue Paper on Human rights and intersex people, remarking:In 2015, Chinese news reported a case of abandonment of an infant, thought likely due to its sex characteristics. Hong Kong activist Small Luk reports that this is not uncommon, in part due to the historic imposition of a policy of one child per family. Cases of infanticide, attempted infanticide, and neglect have been reported in China, Uganda and Pakistan.
Kenyan reports suggest that the birth of an intersex infant may be viewed as a curse. In 2015, it was reported that an intersex Kenyan adolescent, Muhadh Ishmael, was mutilated and later died. Ishmael had previously been described as a curse on his family.
Medical
In places with accessible healthcare systems, intersex people face harmful practices including involuntary or coercive treatment, and in places without such systems, infanticide, abandonment and mutilation may occur.Physical integrity and bodily autonomy
Intersex people face involuntary or coerced medical treatment from infancy. Where these occur without personal informed consent, these are "violations of their rights to health and physical integrity, to be free from torture and ill-treatment, and to equality and non-discrimination."A 2016 Australian study of 272 people born with atypical sex characteristics found that 60% had received medical treatment on the basis of their sex characteristics, half receiving such treatments aged under 18 years, "most commonly genital surgeries and hormone treatments", and the "majority experienced at least one negative impact". Overall, while some parents and physicians had attempted to empower participants, the study found "strong evidence suggesting a pattern of institutionalised shaming and coercive treatment" and poor information provision. 16% of study participants were not provided with information on options of having no treatment, and some were provided with misinformation about the nature of their treatment, and information about peer support was also lacking. OII Europe reports:
Rationales for medical intervention frequently focus on parental distress, or problematize future gender identity and sexuality, and subjective judgements are made about the acceptability of risk of future gender dysphoria. Medical professionals have traditionally considered the worst outcomes after genital reconstruction in infancy to occur when the person develops a gender identity discordant with the sex assigned as an infant. Human rights institutions question such approaches as being "informed by redundant social constructs around gender and biology".
Decision-making on any cancer and other physical risks may be intertwined with "normalizing" rationales. In a major Parliamentary report in Australia, published in October 2013, the Senate Community Affairs References committee was "disturbed" by the possible implications of current practices in the treatment of cancer risk. The committee stated: "clinical intervention pathways stated to be based on probabilities of cancer risk may be encapsulating treatment decisions based on other factors, such as the desire to conduct normalising surgery... Treating cancer may be regarded as unambiguously therapeutic treatment, while normalising surgery may not. Thus basing a decision on cancer risk might avoid the need for court oversight in a way that a decision based on other factors might not. The committee is disturbed by the possible implications of this..."
Despite the naming of clinician statements as "consensus" statements, there remains no clinical consensus about the conduct of surgical interventions, nor their evidence base, surgical timing, necessity, type of surgical intervention, and degree of difference warranting intervention. Surgery may adversely impact physical sensation and capacity for intimacy; however, research has suggested that parents are willing to consent to appearance-altering surgeries even at the cost of later adult sexual sensation. Other research shows that parents may make different choices with non-medicalized information. Child rights experts suggest that parents have no right to consent to such treatments.
Clinical decision-making is frequently portrayed as a choice between early or later surgical interventions, while human rights advocates and some clinicians portray concerns as matters of consent and autonomy.
Medical photography and display
Photographs of intersex children's genitalia are circulated in medical communities for documentary purposes, and individuals with intersex traits may be subjected to repeated genital examinations and display to medical teams. Sharon Preves described this as a form of humiliation and stigmatization, leading to an "inability to deflect negative associations of self" where "genitalia must be revealed in order to allow for stigmatization". According to Creighton et al, the "experience of being photographed has exemplified for many people with intersex conditions the powerlessness and humiliation felt during medical investigations and interventions".Access to medical services
Adults with intersex variations report poor mental health due to experiences of medicalization, with many individuals avoiding care as a result. Many Australian study participants stated a need to educate their physicians. Similar reports are made elsewhere: reports on the situation in Mexico suggests that adults may not receive adequate care, including lack of understanding about intersex bodies and examinations that cause physical harm.In countries without accessible healthcare systems, infanticide, abandonment and mutilation may occur. Access to necessary medical services, for example due to cancer or urinary issues, is also limited.