Sterilisations at delivery or after childbirth: Addressing continuing abuses in the consent process

Abstract

Non-consensual sterilisation is not only a historic abuse. Cases of unethical treatment of women around the time of a pregnancy continue in the Twenty-First Century in five continents. Sterilisation is being carried out by some healthcare professionals at the time of delivery, or soon afterwards, without valid consent. A range of contemporary examples of such practices is given. Respecting women's autonomy should be the touchstone of the consent process. Avoidance of force, duress, deception and manipulation should go without saying. Ethnic minority communities and women living with HIV, in particular, are being targeted for this kind of abuse. Attempts have been made in various countries and by international professional organisations to introduce clinical guidelines to steer health professionals away from this malpractice. Survivors have sought justice in domestic and international courts. This paper critically assesses the evidence on the practical, ethical and legal issues around the handling of consent for these procedures. Suggestions are made about possible regulatory responses that address abuse, whilst maintaining access for those individuals who freely elect to undergo these procedures.

<p>Mandatory Waiting Periods Before Abortion and Sterilization: Theory and Practice</p>

“…72 In the USA, as part of 1978 guidance designed to prevent coercion, Medicaid-funded female sterilization cannot be carried out until 30 days after consent has been taken. 73,74 This waiting period has been shown to work against individual autonomy, by causing delays and obstructing access to care, and to be discriminatory when applied to marginalized groups. [75][76][77] The 1978 guidance was written with the admirable intention of protecting marginalized groups from coerced sterilization but has been shown in practice to be a barrier to access to permanent fertility control for the very same groups.…”

The ethics of state-sponsored and clinical promotion of long-acting reversible contraception

“…The possiblility of harm should not be used as a basis for inflicting actual harm on that same individual. 4 HCPs should focus on and prioritise the protection and promotion of current patient interests -including respect for self-determination and governancerather than speculative concern about future possible risk(s). These wider concerns might be valid considerations for SSAs, but HCPs have to be careful not to prioritise consequential benefits, jeopardising their professional obligations and the trust placed in them by individual service users.…”

“…However, care needs to be taken to ensure that the woman has the capacity, freedom and information to make these decisions at the material time. 4 Ideally, the issue of contraception should be canvassed in advance of delivery and decisions reaffirmed in the postpartum period.…”

“…Widespread coercive practices using reversible contraception and sterilisation [2][3][4] have arguably produced a legacy of suspicion in some communities about the intentions of promoters and providers of contraceptive services. This review examines two ethical aspects of LARC provision and promotion.…”

Prácticas de salud de dominación y exclusión: visiones de activistas, profesionales e investigadoras sobre situación de esterilizaciones forzadas en mujeres y niñas con discapacidad en España

“…Evidence supports that it has been exercised on vulnerable populations, such as people with disabilities, indigenous peoples and ethnic minorities, people with HIV, transgender or intersex people, among others. However, women and girls with disabilities have been the priority target of these procedures in the world (OHCHR et al, 2014;Rowlands;Wale, 2019;Sifris, 2016).…”