The involuntary sterilisation of marginalised women: power, discrimination, and intersectionality

ABSTRACT

This article demonstrates that involuntary sterilisation procedures are generally a manifestation of intersectional discrimination and the medical profession’s use and abuse of power. Accordingly, the article uses the example of involuntary sterilisation to illuminate the multiple forms of discrimination experienced by society’s most marginalised and vulnerable people and to discuss the role of social hierarchy and existing power structures in compounding and perpetuating the expression of discrimination. It begins by referencing the power of law before considering the power of the medical profession in the context of society in general. It then analyses the gendered dimension of this power, specifically considering the example of involuntary sterilisation and discussing the importance of adopting an approach which views this issue through an intersectional lens. Finally, the article invokes a number of specific examples of involuntary sterilisation procedures being performed on marginalised groups of women to make the discussion more tangible.

Notes

¹United States Holocaust Memorial Museum, The Biological State: Nazi Racial Hygiene, 1933-1939, Holocaust Encyclopedia,http://www.ushmm.org/wlc/en/index.php?ModuleId=10005143, 19 April 2013.

²Drouard (1999), pp 265–267.

³Silver (2004), p 872 and McSherry and Somerville (1998), p 112.

⁴Stuart Gietel-Basten, ‘Why Scrapping the One-Child Policy Will Do Little to Change China’s Population’, The Conversation, 30 October 2015, http://theconversation.com/why-scrapping-the-one-child-policy-will-do-little-to-change-chinas-population-49982.

⁵Chen (2009), pp 45–52.

⁶See Section 5 for further discussion of this case study and of the doctrine of informed consent more generally.

⁷Motejl (2005).

⁸Emanual et al (2011), p 581 and Friedman (1995), p 581.

⁹See, for example, Cassell (2005) and Goodyear-Smith and Buetow (2001), pp 453–455.

¹⁰Cochrane, ‘Nine Women Share Their Personal Stories of Abortion’, The Guardian (United Kingdom), 27 October 2006, G2 p 9.

¹¹ Abortion Act 1967 (UK).

¹²See, for example, Freidson (1970a, 1970b): Freidson to a large extent attributed the prestigious position of the medical profession to the reality that modern medicine is based on scientific knowledge. In terms of its dominance within the healthcare industry, Freidson attributed the power of medicine to its autonomy (meaning its propensity for self-regulation) and its dominance (meaning its control of the work of others involved in health care). Further, Freidson predicted that the medical profession would maintain its position of dominance in the future despite significant challenges. As to the doctor–patient relationship, Freidson viewed the prestige of the doctor as contributing to a power dynamic in which the patient is the passive recipient of the doctor’s service, deferring to the doctor’s opinions and feeling too intimidated to question the doctor. This sense of deference and intimidation is not applicable to all doctor–patient relationships but the greater the gap in social status between doctor and patient the greater the likely power imbalance between doctor and patient.

¹³Dingwall (2008), Ch 10.

¹⁴For information about the Victorian Mental Health Tribunal, see State Government Victoria, Mental Health Review Tribunal, http://www.mht.vic.gov.au/. For a discussion of the evolution of the rights-based movement in mental health law reform and criticisms of it, see McSherry and Weller (2010).

¹⁵See, for example, discussion in Cassell (2005), p 329.

¹⁶Pilnick and Dingwall (2011), p 1379.

¹⁷Pilnick and Dingwall (2011), p 1374.

¹⁸Capolingua, ‘Doctors Must Respect the Power They Wield over Patients’ Australian Medical Association (WA), http://www.amawa.com.au/blog/doctors-must-respect-the-power-they-wield-over-patients/.

¹⁹Cassell (2005), p 329.

²⁰Wolinsky (1993), p 13, poses the question: how can the profession be trusted not to ‘misuse its autonomy and abuse its clientele’? This is perhaps the key question.

²¹Turner (1995), p 12.

²²Turner (1995), p 12.

²³Foucault (1973), p 39 (emphasis added).

²⁴Foucault (1973), p 89 (emphasis added).

²⁵Downing (2008), p 37.

²⁶Turner (1995), p 13 (citations omitted).

²⁷Ussher (2006), p 15.

²⁸Foucault (1984), p 104.

²⁹Turner (1995), p 138.

³⁰Ehrenreich and English (2005), p 113.

³¹Ehrenreich and English (2005), p 111.

³²Ehrenreich and English (2005), p 112.

³³Ehrenreich and English (2005), p 112.

³⁴Ehrenreich and English (2005), p 112.

³⁵Ehrenreich and English (2005), pp 112–113.

³⁶Ehrenreich and English (2005), p 154.

³⁷Ussher (2006), p 16.

³⁸Ussher (2006), p 16.

³⁹Ussher (2006), p 17.

⁴⁰Ussher (2006), p 17.

⁴¹Ussher (2006), p 17.

⁴²Ussher (2006), p 18.

⁴³Lorbner and Moore (2002), p 139.

⁴⁴Lorbner and Moore (2002), p 139.

⁴⁵Center for Research on Gender in the Professions (2013), p 10.

⁴⁶Center for Research on Gender in the Professions (2013), p 10.

⁴⁷Center for Research on Gender in the Professions (2013), p 10.

⁴⁸For a more in-depth discussion of ‘working within the system’ versus ‘challenging the system’ in the context of the gendered nature of international law, see Sifris (2014), ch 1.

⁴⁹See, for example, Trombley (1988), Shapiro (1985), Chen (2009).

⁵⁰See examples in Section 5.

⁵¹Eriksson (2000), pp 256–257, Hartmann (1995), p 244. It should be noted that India’s sterilisation campaign of the 1970s disproportionately affected men but that following international outrage the focus shifted to the sterilisation of women. See Moore, ‘Teeming India Engulfed by Soaring Birthrate’ Washington Post (Washington, DC), 21 August 1994, A1, A32.

⁵²Cook and Cusack (2010), p 85.

⁵³Hartmann (1995), p 55.

⁵⁴Abrams (1996), p 11.

⁵⁵Bond (2004), p 906 (citations omitted).

⁵⁶Such a ‘matrix of domination’ is not only applicable in the context of involuntary sterilisation. For example, Kimberlé Crenshaw considers the question of intersectionality and hierarchies of power in the context of the incarceration of African-American women in the United States. When discussing the case of Kemba Smith, who almost spent 24 years in prison for playing a minor role in her boyfriend’s drug dealing operation, Crenshaw notes that:

Smith’s story represents compelling evidence of the matrix of domination that Patricia Hill Collins articulates. Here, institutional structures, gender relations, and discretionary decisionmaking all converged to erect a cage in which Kemba Smith may well have spent twenty-four years of her life.

See Crenshaw (2012), pp 1440–1441 (citations omitted).

⁵⁷See, for example, Shapiro (1985), Trombley (1988), Corrêa (1994), p 30, Dean et al (2000), Getgen (2009), Parker and Aggleton (2007), Chen (2009), and Bond (2004).

⁵⁸[1993] 1 SCR 554 at 645–646 (citations omitted).

⁵⁹For a discussion of the notion that, whereas Kimberlé Crenshaw originally discussed the concept of intersectional discrimination in the context of the experiences of African-American women, it may apply in a number of other contexts such as in relation to the experiences of lesbian women, for example, see Carbado (2013).

⁶⁰Crenshaw (1989), p 149.

⁶¹Cook and Cusack (2010) (emphasis added, citation omitted).

⁶²Goodyear-Smith and Buetow (2001), pp 454–455.

⁶³Butt (2004), p 222.

⁶⁴(1992) 175 CLR 479.

⁶⁵Nelson (2013), pp 15–16.

⁶⁶Murphy (2013), p 53.

⁶⁷Committee on the Elimination of Discrimination against Women, Communication No 4/2004, UN Doc A/61/38 (14 August 2006).

⁶⁸For a discussion of the involuntary sterilisation of Romani women, see Section 5.2.

⁶⁹For a discussion of supported decision-making in the mental health care context, see Gooding (2013), Davidson et al (2016).

⁷⁰Ehrenreich (2008a), p 9.

⁷¹Ehrenreich (2008b), p 397 (emphasis added).

⁷²Getgen (2009), p 33, Miranda and Yamin (2004a), p 68, Amnesty International (2004a). It should be noted that there is no consensus as to the number of women subjected to involuntary sterilisation in Peru. See, for example, Knudsen (2006).

⁷³Coe (2004), p 59.

⁷⁴Knudsen (2006), p 85.

⁷⁵Coe (2004), p 62.

⁷⁶Coe (2004), p 62.

⁷⁷Knudsen (2006), p 82.

⁷⁸Coe (2004), p 62 and Knudsen (2006), p 82.

⁷⁹Coe (2004), p 62.

⁸⁰League of Human Rights (Czech Republic) (2007), p 8.

⁸¹Motejl (2005), p 1.

⁸²Motejl (2005).

⁸³Motejl (2005).

⁸⁴Gorolova (2009).

⁸⁵Gorolova (2009).

⁸⁶League of Human Rights (Czech Republic) (2007), pp 8, 12.

⁸⁷International Federation of Gynecology and Obstetrics (2011) ‘Female Contraceptive Sterilization’, http://www.figo.org/search?cx=%27006260962696807358306%3Ack4j2ap-l1u&cof=FORID%3A11&ie=ISO-8859-1&query=ethical+guidelines+on+sterilization.

⁸⁸ VC v Slovakia (2011) Eur Court HR 18968/07; NB v Slovakia (2012) Eur Court HR 29518/10; IG and Ors v Slovakia (2012) Eur Court HR 15966/04.

⁸⁹Article 3 states that ‘[n]o one shall be subjected to torture or to inhuman or degrading treatment or punishment’.

⁹⁰Cahn (2006), p 70 and Bond (2004), p 905.

⁹¹See, for example, AS v Hungary, Committee on the Elimination of Discrimination against Women, Communication No 4/2004, UN Doc A/61/38 (14 Aug 2006); Committee on the Elimination of Racial Discrimination, Concluding Observations on the Czech Republic (19 February–9 March 2007), para 14.

⁹²Bond (2004), pp 906–909.

⁹³For a more in-depth discussion of the involuntary sterilisation of HIV-positive women as a form of intersectional discrimination, see Sifris (2015).

⁹⁴See, for example, Vivo Positivo and Center for Reproductive Rights (2010).

⁹⁵See, for example, Human Rights Watch (2004).

⁹⁶See, for example, Kendall (2009).

⁹⁷See, for example, Ertürk (2005), para 69.

⁹⁸See, for example, The International Community of Women Living with HIV/AIDS (2009).

⁹⁹See, for example, Lombard, ‘South Africa: HIV-Positive Women Sterilized Against Their Will’, City Press, 7 June 2010.

¹⁰⁰Office of the United Nations High Commissioner for Human Rights and the Joint United Nations Programme on HIV/AIDS (2006), p 78.

¹⁰¹Committee on the Elimination of Discrimination against Women (1990).

¹⁰²Amnesty International (2004b), p 3.

¹⁰³See, for example, World Health Organisation (2013), p 32.

¹⁰⁴Cook and Dickens (2014), p 90.

¹⁰⁵Physical and mental health outcomes which are associated with stigmatisation include depression, hypertension, coronary heart disease, and stroke. See Major and O’Brien (2005).

¹⁰⁶Kendall (2009), p 82.

¹⁰⁷Center for Reproductive Rights, Litigation Briefing Series: F.S. v Chile, http://reproductiverights.org/en/lbs-fs-vs-chile; Canadian Civil Liberties Association, IACHR Hears Case on Forced Sterilization of an HIV Positive Woman in Chile, 9 October 2014, http://www.ccla.org/rightswatch/2014/10/09/iachr-hears-case-on-forced-sterilization-of-an-hiv-positive-woman-in-chile/.

¹⁰⁸ Convention on the Rights of Persons with Disabilities, opened for signature 30 March 2007, 2515 UNTS 3 (entered into force 3 May 2008). Section 23(1)(c) states that:

States Parties shall take effective and appropriate measures 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 … Persons with disabilities, including children, retain their fertility on an equal basis with others.

¹⁰⁹Frohmader and Ortoleva (2013), p 4.

¹¹⁰Senate Community Affairs References Committee, Parliament of Australia (2013).

¹¹¹However, it should be noted that while the ‘best interests’ approach dominates the current discourse, eugenics arguments remain a part of the discourse. See Frohmader and Swift (2013), p 8 and Senate Community Affairs References Committee, Parliament of Australia (2013), p 31.

¹¹² Secretary, Dept. of Health and Community Services v JWB and SMB (1992) 175 CLR 218; (1994) 181 CLR 583.

¹¹³See Tobin and Luke (2013), Frohmader and Swift (2013), and Senate Community Affairs References Committee, Parliament of Australia (2013), p 5.

¹¹⁴[2015] VCAT 2051 (30 December 2015).

¹¹⁵ ZEH (Guardianship) [2015] VCAT 2051 (30 December 2015) [67].

¹¹⁶Tobin and Luke (2013).

¹¹⁷Senate Community Affairs References Committee, Parliament of Australia (2013), p 140.

¹¹⁸Senate Community Affairs References Committee, Parliament of Australia (2013), p 176.

¹¹⁹Senate Community Affairs References Committee, Parliament of Australia (2013), p viii.

¹²⁰Senate Community Affairs References Committee, Parliament of Australia (2013), p 138.

¹²¹Such a ‘best protection of rights test’ would require a decisionmaker to take the course of action which most satisfactorily protects the individual rights of the person with the disability. See Senate Community Affairs References Committee, Parliament of Australia (2013). However, it should be noted that this approach too is not without its critics. For example, in its submission to the Senate Inquiry, Women With Disabilities Australia recommended that Australia prohibit any sterilisation procedure performed without full free and informed consent except whether there is a threat to life. See Women With Disabilities Australia (2013).

¹²²Frohmader and Ortoleva (2013).

¹²³Frohmader and Swift (2013), p 13.

¹²⁴[2015] VCAT 2051 (30 December 2015).

¹²⁵Committee on the Elimination of Discrimination against Women, Communication No 4/2004, UN Doc A/61/38 (14 August 2006).

¹²⁶(2011) Eur Court HR 18968/07.

¹²⁷(2012) Eur Court HR 29518/10.

¹²⁸(2012) Eur Court HR 15966/04.

¹²⁹Coomaraswamy (2001), para 2.

¹³⁰This is a play on words from two of the seminal articles addressing the issue of intersectional discrimination: Crenshaw (1989), pp 139–167 and Crenshaw (1991), pp 1241–1299.

¹³¹Crenshaw (2012), p 1452.