Leading international ob-gyn organization issues new ethical guidelines on sterilization

The International Federation of Gynecology and Obstetrics (FIGO) has issued its first new ethical guidelines on the performance of sterilizations in 10 years. The revised guidelines address the conditions under which it is ethical for doctors to perform sterilizations. So far the guidelines have been translated into Romanian, a country where allegations have been made of the involuntary sterilization of Romani women, which has also occurred in Hungary and in communist Czechoslovakia and its successor states. Why have these guidelines been issued, and do they have a real chance of influencing medical practice in the countries where sterilizations are performed? News server Romea.cz interviewed human rights expert Gwendolyn Albert on these developments.

Q: What in your view started this essential, widespread discussion about the sterilization of Romani women?

A: A joint report of the Center for Reproductive Rights in the USA and the Counseling Center for Human and Civil Rights (Poradňa pre občianske a ľudské práva) in Slovakia. That publication, called “Body and Soul”, summarized the situation and the stories of Romani women in Slovakia. The report greatly impressed the Council of Europe’s first-ever Human Rights Commissioner, Alváro Gil-Robles, and he endorsed its conclusions. That basically led to complaints being filed by Romani women in the Czech Republic to then-ombudsman Otakar Motejl. On the basis of the ombudsman’s investigation, published in 2005, various international bodies such as the Helsinki Commission in the USA, the Council of Europe, and various human rights committees at the UN began to call for victims in the Czech Republic to be compensated.

Q: When Elena Gorolová, spokesperson for the Group of Women Harmed by Forced Sterilization in the Czech Republic, presented on this issue at the Council of Europe, was that more than just symbolic? Why?

A: The presentations made not only by Elena Gorolová but also by other Romani women from the Czech Republic who had been forcibly sterilized and who described what happened to them – and they presented not only at the Council of Europe, but also at the UN and elsewhere – were much more than a symbolic effort. They and other women who are unable to have children thanks to unwanted medical interventions have already achieved a certain satisfaction in that the International Federation of Gynecology and Obstetrics (FIGO) agreed that what happened to them was not and is not ethical. On the basis of testimony made on behalf of these women at a FIGO panel in 2009, that organization has, after 10 years, updated its ethical guidelines detailing the conditions under which sterilizations are to be performed and how. The fact that Romani women are speaking up internationally about what happened to them has so far resulted in the fact that the world’s leading professional organization in the field of gynecology and obstetrics has decided their colleagues must improve, which is no small decision. This is a victory for women everywhere.

Q: What was the contribution to that effort of the FIGO panel you organized thanks to support from the Council of Europe and Open Society Institute in 2009? Experts from Asia, Europe, and North and South America presented evidence of forced sterilization there from various countries worldwide.

A: The panel presented various perspectives on the issue. The situation of Romani women in various European countries such as the Czech Republic, Hungary and Slovakia was discussed. The environment in India, where financial and other incentives for sterilization are still being offered, as was done in communist Czechoslovakia, was also discussed. The situation in various countries of South America was also discussed, where not only indigenous people but HIV+ women have been subjected to forced sterilization. The situation in Africa is similar. With respect to North America, where we have long known this was perpetrated against indigenous people and the members of various minorities, the topic of discussion was the fact that disabled people have the right to decide about their capability to have children and should not be automatically sterilized. Since the person who reported about practices in North America then became the chair of FIGO’s Ethics Commission, it was much easier for the new guidelines to be adopted. Many people from various organizations, international organizations in particular, submitted motions concerning the new ethical guidelines and the Executive Board of FIGO then adopted them.

Q: What are the essential changes introduced by FIGO’s new ethical guidelines, how will they prevent forced sterilizations?

A: For the Czech Republic the most important change is that the guidelines emphasize the fact that sterilization may never be considered an emergency procedure and that no deviation from the fundamental principles of free and informed consent to such surgery should be tolerated. Consent to sterilization cannot be sought from women in vulnerable positions – for example, if they are seeking an abortion, if they are in labor, or if they have just given birth. Doctors proposing or discussing sterilization must inform women that the surgery is irreversible and permanent, that it will not protect them from sexually transmitted diseases, and that birth control options exist which are not permanent. Doctors must communicate this information to patients in a way they can understand, simply, not using technical language, and that effort to communicate should be assisted, for example, by interpretation into the native language of the woman concerned. The new guidelines also emphasize that only the women themselves may consent to being sterilized – no one else can consent for them. If there is a program or a strategy designed by the government of a country that does not reflect the fact that consent to sterilization must be voluntary, doctors should not perform sterilizations under such circumstances because it would not be ethical. Doctors also should not initiate court proceedings to have their patients sterilized or serve as witnesses during such proceedings.

Q: Can these new guidelines influence medical practice in countries where forced sterilizations have reportedly occurred – i.e, Bulgaria, the Czech Republic, Romania, Slovakia? How?

A: Certainly! I believe the vast majority of gynecologists everywhere want to do their work ethically and professionally. These guidelines are very clear, after reading them, doctors should have a very clear idea of what is ethical and what isn’t. I know the guidelines have been translated into Romanian and that at least one gynecologist there is working together with a Romani organization to make sure that not only doctors but also patients learn about these guidelines.

Next year FIGO will have another professional meeting in Rome, and I hope all the doctors and other representatives of the medical profession (hospital administrators, midwives, nurses, etc.) who attend will be able to learn more about these stricter standards and pass the information on. In July the European Roma Rights Centre sent the guidelines to medical associations and ministries of health in the Czech Republic, Hungary and Slovakia. If the medical associations and ministries follow important developments in medicine and take an interest in ethical behavior, then they should certainly know about these new guidelines. It’s important that organizations supporting the rights of patients and of women also draw attention to them.