Last week, details of a decision by the Family Court to approve gender assignment surgery on a five-year-old intersex child were released to the public. The decision highlights a largely unnoticed human rights issue in Australia—the forced surgeries and sterilisations of intersex people.
As an infant, ‘Carla’, who is genetically male but was born with genitals that "resembled that of a female", underwent surgery to “enhance the appearance of her female genitals”. Now five, Carla’s parents went to the Family Court to approve the more complex surgery of removing the child's internal gonads.
The court heard multiple justifications for the surgery, including a potential increased cancer risk, and that Carla “enjoys toys and colours that are stereotypically female, for example, having pink curtains, a Barbie bedspread and campervan, necklaces, lip gloss and ‘fairy stations’”.
Carla’s case is not uncommon. Research suggests that at least 60% of intersex people have undergone some form of medical intervention based on sex characteristics, with half the procedures being performed before the age of 18.
SBS spoke to Alex David, who had her first gender assignment surgery when she was a baby, with doctors removing her internal gonads. At the same time, Alex says, doctors also wanted to “chop off all her sensitive bits”, but her mother stopped them.
“The next surgery I had was when I was seven years old, and that was to tuck everything in and essentially make a vagina, but a man-made one,” Alex explains.
It was not until Alex was seventeen she found out she had an intersex variation. This created significant mental anguish, with Alex being forced to find ways to deal with how she had been treated, commenting that sometimes she describes her surgeries impersonally, because that’s how her brain “copes with it”.
Bonnie Hart's story is similar. As a child, Bonnie had multiple medical interventions, including surgery to remove her testis, hormone therapy and a process of vaginal dilation that started at age thirteen. Bonnie said this had long term impacts, noting that although she had signed her consent for the procedures, she "didn't consent for the life that [she] ended up having as a result of that”.
“I have health complications now that are the direct effect of the treatments I received because of my intersex variation," she continued. "I have to take hormone replacement therapies and then there's indirect mental health stuff that has gone along with it.”
Morgan Carpenter, the co-chair of Organisation Intersex International Australia, explains that interventions like those experienced by Carla, Alex and Bonnie have a long history. In a paper written for Reproductive Health Matters, he argues that medical interventions are a way to force intersex people to meet social norms. Current medical protocols for intersex paediatric management were set out in the Chicago “consensus” statement of 2006. The statement frames intersex as 'disorders of sex development’, and Carpenter notes that it recommends "interventions to minimise 'family concern and distress'," as well as "the risks of stigmatisation and gender identity confusion", and suggests that surgical procedures will "facilitate parental bonding".
This ‘consensus’ is largely accepted in Australia. In 2013, a Senate Committee report found that medical interventions are widespread, with surgeries often occurring for social, rather than therapeutic, reasons. Victorian guidelines cite the reduction of ‘psychosocial risks’ as justification for surgeries. These risks include children not being accepted by parents, social disadvantage to the child, and the potential “reduced opportunity for meaningful employment and capacity to earn an income”.
This is felt on a personal level. Bonnie says she felt like she "was in heteronormative sexual training from a really early age, too young."
She continues: "I think a lot of these surgeries happen in order to justify social stigma or as the result of a fear of difference. There's social reasons why these surgeries happen. And they don’t offer social remedies for them, they offer surgical remedies. That's not fair on the intersex person. That's putting all the responsibility back on that individual.”
Bonnie notes the way in which this differs from other medical practices, saying: “There’s a paradox about female genital mutilation not being legal in Australia and many hospitals do not do routine or religious circumcision because of fear of indemnity. Yet intersex genital mutilation or intersex surgeries in general still occur.”
It is these personal impacts that have caused anger over Carla’s case, and are now slowly forcing change.
In 2013, the Senate Inquiry made a list of 13 recommendations to the Federal Government to reduce the prevalence of normalising surgeries, and to increase accountability when these surgeries occur. Despite the unanimity of these recommendations, in 2015 the Government refused to implement them.
However, international moves are afoot. Coinciding with Intersex Awareness Day in October this year, the United Nations published a powerful statement on intersex human rights, demanding that states “as as a matter of urgency, prohibit medically unnecessary surgery and procedures on intersex children.”
Earlier this year, the Australian Human Rights Commissioner - Ed Santow - also stated that ending the forced or coerced sterilisation of intersex people will be one of his core priorities. After identifying current medical practices Santow told the SBS the AHRC would work to implement a consistent national model:
“The Commission will then develop a best-practice model that jurisdictions can implement to ensure that decisions about medical interventions involving people with intersex variations are aligned with human rights," he said, adding that "the model will be informed by international best practice and guidance from international experts and UN treaty bodies and agencies, as well as input from people in the Australian community who have lived experience of these issues.”
In pursuing change, advocates are fighting for a basic principle: the right to bodily autonomy. People should not be forced to change their bodies to conform to social norms. As Greens Senator Janet Rice said: ‘love of pink is no justification for gender assignment surgery’.