DifferenTakes Issue #71, Summer 2011
Recent years have seen a disturbing increase in violence against Romani people in Europe, along with other groups of people considered socially marginalized. Police brutality and forced relocations of Romani communities have received some coverage in the United States – but far less attention has been paid to the issue of forced sterilization. In this issue of DifferenTakes, human rights activist Gwendolyn Albert writes about the history of reproductive violence against Romani communities in the Czech Republic, Slovakia and Hungary, and shares new International Federation of Gynecology and Obstetrics (FIGO) guidelines on sterilization for reproductive justice activists to publicize and use.
DifferenTakes Issue #71, Summer 2011
Recent years have seen a disturbing increase in violence against Romani people in Europe, along with other groups of people considered socially marginalized. Police brutality and forced relocations of Romani communities have received some coverage in the United States – but far less attention has been paid to the issue of forced sterilization. In this issue of DifferenTakes, human rights activist Gwendolyn Albert writes about the history of reproductive violence against Romani communities in the Czech Republic, Slovakia and Hungary, and shares new International Federation of Gynecology and Obstetrics (FIGO) guidelines on sterilization for reproductive justice activists to publicize and use.
DifferenTakes Issue #71, Summer 2011
Recent years have seen a disturbing increase in violence against Romani people in Europe, along with other groups of people considered socially marginalized. Police brutality and forced relocations of Romani communities have received some coverage in the United States – but far less attention has been paid to the issue of forced sterilization. In this issue of DifferenTakes, human rights activist Gwendolyn Albert writes about the history of reproductive violence against Romani communities in the Czech Republic, Slovakia and Hungary, and shares new International Federation of Gynecology and Obstetrics (FIGO) guidelines on sterilization for reproductive justice activists to publicize and use.
By Gwendolyn Albert Editors Note: Recent years have seen a disturbing increase in violence against Romani people in Europe, along with other groups of people considered socially marginalized. Police brutality and forced reloca- tions of Romani communities have received some coverage in the United States but far less attention has been paid to the issue of forced sterilization. In this issue of DierenTakes, human rights activist Gwen- dolyn Albert writes about the history of reproductive violence against Romani communities in the Czech Republic, Slovakia and Hungary, and shares new International Federation of Gynecology and Obstetrics (FIGO) guidelines on sterilization for reproductive justice activists to publicize and use. Co-editors Katie McKay Bryson and Betsy Hartmann most accurately represents the power dynamic involved when individuals are manipulated to produce an outcome they did not desire. The experience of Romani women in Europe is a case in point. With a conservatively estimated population of 10 million people, 4 the Romani are Europes largest ethnic minority. Their forebears are posited to have come to Europe from India more than a mil- lennium ago, when they were defeated in war- fare against the Ghaznavid rulers of Persia around 1000 CE. After being brought to Armenia and Anatolia as soldiers and servants, they migrated further west and were enslaved between the 14th and 19th centuries in present-day Romania. The Roma also emigrated to the Americas and Australia with other Europeans. 5 Tubal ligation, a surgical technique rst proposed in early 19th century England, has been pro- moted as a permanent birth control method ever since. 1 While voluntary sterilization is an impor- tant contraceptive option, tubal ligation has also been forcibly performed upon women in margin- alized populations worldwide, motivated all too often by frankly eugenic considerations. 2 Ster- ilizations performed against the will or without the knowledge of the patient go by many names: forced sterilization (when a patient is never consulted or informed about the sterilization); co- ercive sterilization (when patients are threatened or oered incentives to undergo sterilization); and involuntary sterilization, which is sometimes used to speak about both forced and coerced sterilization. 3 I prefer the term forced steriliza- tion to describe all of these circumstances, as it NO. 71 SUMMER 2011 A publication of the Population and Development Program CLPP tHampshire College t Amherst, MA 01002 413.559.5506 t http://popdev.hampshire.edu Opinions expressed in this publication are those of the individual authors unless otherwise specied. Think. Act. Connect. For people, environment and justice. DIFFERENTAKES http://popdev.hampshire.edu No. 71 - Summer 2011 The 20th century saw them racially targeted by Nazi Germany for annihilation, and many perished during the Holocaust. In the postwar period, most Romani people in Europe lived under communist rule throughout the Soviet bloc. Since 1989, when most countries in that re- gion began a transition to democratic governance and market economies, members of the Romani minority have experienced a profound degradation in life expec- tancy, social status, and standard of living. 6 They have also been the targets of deadly pogroms committed by neo-fascist and neo-Nazi groups, and forced evictions involving police brutality throughout Europe. 7 Forced sterilizations occurred during and after communist rule in the Czech Republic and Slovakia and during the past decade in Hungary. Czech Republic In communist Czechoslovakia, Romani women were forcibly sterilized beginning in the 1970s, a practice continuing after the 1989 transition to democracy and the 1993 breakup of the country into the Czech Republic and Slovakia. 8 The Czech ombudsman has estimated that, since the 1980s, as many as 90,000 women may have been aected throughout the former Czechoslovakia. 9 During communism, tubal ligation was disproportion- ately promoted to Romani women by social workers to address what was ocially termed their high, unhealthy reproduction rate compared to non-Romani women using either the promise of nancial incen- tives or the threat of various sanctions to coerce or force compliance. 10 After the Czechoslovak Prosecutor-Gen- eral reviewed these incidents post-1989, incentive pay- ments for sterilizations were discontinued. 11 Subsequent instances of forced sterilizations didnt involve social workers; instead, doctors sterilized Romani women during C-section deliveries, often telling them that not only the C-section but the sterilization itself had been emergency, life-saving measures. 12 In November 2009, the Czech Government expressed regret for individual failures in the performance of sterilizations by tubal ligation. 13 The practice had been described as genocidal by dissidents with the Charter 77 organization in communist Czechoslovakia, and fol- lowing 1989, complaints about the program were led with the ombudsman (the Public Defender of Rights). After ordering a Czech Health Ministry investigation, he critiqued the ministry for failing to conclude that the documented procedures violated not only human rights, but the law. The ombudsmans report became the basis for interna- tional human rights bodies 14 recommendations that the Czech state take urgent action to redress the victims of forced sterilization. Yet criminal investigations into these incidents were shelved and none of the perpetrators have been subjected to civil, criminal or professional sanction. Civil lawsuits brought by individuals have only rarely resulted in compensation awards due to statutes of limitations. Slovakia Romani women were also forcibly sterilized in the Slovak part of Czechoslovakia starting in the 1970s. Dissidents monitoring these incidents reported that in the region of East Slovakia, more than 1,000 Romani women and girls were sterilized during a single year in the 1980s. 15 By 2002, Romani women were still being sterilized without their informed consent, according to human rights activists. 16 The government investigated for genocide and found no evidence of it; yet inter- national observers, including the U.S. Commission on Security and Cooperation in Europe, called the investi- gation awed because human rights activists and po- tential victims were threatened with criminal charges for speaking out. In that same year, the Council of Europes Commissioner for Human Rights said he found the al- legations credible, recommending that the government oer a speedy, fair, ecient, and just redress to the victims. 17 The Slovak Government has yet to act upon these recommendations, though they have revised the conditions under which sterilization may be performed and instituted high fees for tubal ligations meaning this birth control method is now eectively out of reach for low-income women who desire it in Slovakia. In 2006, the Slovak Constitutional Court ruled that the governments report had not adequately claried the facts and ordered the investigation into forced steriliza- tion re-opened. However, in 2007, after interrogating the alleged perpetrators and victims, the Slovak Pros- ecutor announced no crime had been committed or rights violated, and discontinued the proceedings. Var- ious international human rights bodies are still calling on the government to investigate the allegations, com- pensate the victims, and punish the perpetrators. A case is also currently pending before the European Court for Human Rights. Hungary Compared to the Czech and Slovak examples, far fewer forced sterilizations of Romani women have 2 DIFFERENTAKES http://popdev.hampshire.edu No. 71 - Summer 2011 3 been reported in Hungary. The apparently anomalous, isolated nature of these incidents may be why demands for redress were eventually met in the case of A.S., a Romani woman who was sterilized without her consent by tubal ligation during emergency obstetrical ser- vices in a public hospital in 2001. The Hungarian courts acknowledged that the surgery had been performed without her informed consent, but claimed that her reproductive capacity had not been harmed, as the ster- ilization was purportedly reversible. In 2004, A.S. led a complaint with the Committee for the Elimination of Discrimination against Women (CEDAW), and two years later it found Hungary in breach of the Convention. In 2009, the state compensated A.S. after extensive civil society pressure. 18 As of this writing, the European Roma Rights Centre reports that Hungarys Public Health Act still maintains that sterilization by tubal ligation may be performed on the basis of a doctors medical indication alone. There is no requirement for informed consent. The law also requires that patients receive information about tubal ligations chances of reversibility phrasing that suggests doctors in Hungary view sterilization as potentially reversible. The European Roma Rights Centre is currently litigating another case of a Romani woman sterilized in Hungary without her consent, which came to light in 2008. Romani Womens Resistance Romani survivors of forced sterilization have played a key role in bringing it to light and building a movement for justice. In the Czech Republic, Elena Gorolov, spoke- , spoke- sperson for the Group of Women Harmed by Forced Ste- rilization, has been an outspoken advocate for Romani victims. 19 Sterilized during the C-section delivery of her second child in 1990, Gorolov cannot bring a civil suit because the statute of limitations has expired, as it has for many other women. This has not stopped her and other survivors from pursuing justice locally, nationally and internationally. Survivors of forced sterilization in the Czech city of Ostrava demonstrated outside the hos- pital most known for having sterilized Romani women in their community. They have also raised these viola- tions in face-to-face meetings with maternity ward sta, courageously confronting some of the very doctors who sterilized them against their will. Such public activism by survivors is an exception, and local tabloid publications have attempted to smear many of the women who have come forward. Some Romani members of Gorolovs community have warned her that her cause is in vain, but she has not given up hope that one day the government will com- pensate the survivors of forced sterilization. In Hungary and Slovakia, while survivors have taken legal action, they have been very careful to keep their identi- ties private for a number of reasons. In the A.S. case, there were fears that publishing the amount of any eventual compensation could expose her to violent extortion attempts. In Slovakia, women who were pregnant and sterilized before reaching ocial adult status were thre- atened that they or their partners would be criminally prosecuted for statutory rape if they came forward. New Guidelines On Sterilization The International Federation of Gynecology and Obstet- rics (FIGO) has recently adopted new ethical guidelines on female contraceptive sterilization as a result of these cases and numerous others around the world involving imprisoned women, Indigenous women, women of color, and transgender people in the Americas; women with disabilities in Australia; HIV positive women in Chile and Namibia; and lower-caste men and women in India. 20 The guidelines are innovative because they emphasize that: - Sterlllzatlon should be consldered lrreverslble and patients must be so informed. - Consent to sterlllzatlon should never be a condltlon for access to medical care, HIV/AIDS treatment, natural or cesarean delivery, abortion, or to benets such as medical insurance, social assistance, employment or release from an institution. - Sterlllzatlon for preventlon of future pregnancy cannot be ethically justied on grounds of medical emergency and is not an emergency procedure. - Artlcle 23(l) of the UN Conventlon on the Plghts of Persons With Disabilities imposes the duty upon states to ensure that persons with disabilities, in- cluding children, retain their fertility on an equal basis with others. Reproductive justice activists can strengthen these guidelines by spreading knowledge about them. Bring them to the attention of local, regional and national governments, and demand the institution of safeguards to prevent forced sterilizations from being perpetrated. Bring them to the attention of medical associations, hospital administrators, and other providers, and ask that medical professionals join lobbying and publicity eorts. Bring them to the attention of academics and policymakers, and encourage research into current DIFFERENTAKES http://popdev.hampshire.edu No. 71 - Summer 2011 4 sterilization practices and procedures in health care facilities, particularly those operating in low-resource settings or in institutions such as prisons. Forced sterilization is a serious human rights abuse that has gone unacknowledged and underreported for over a century. It represents an ultimate violation of a womans right to determine her own reproductive des- tiny. The women of the world deserve doctors who will protect their rights as well as their health. Reproductive justice activists are crucial in holding doctors account- able to the professions ethical standards, and govern- ments accountable to their human rights obligations. Gwendolyn Albert is a human rights activist and ally of Romani survivors of forced sterilization in the Czech Republic in their ght for redress of these human rights violations. She is a consultant to the Council of Europe Commissioner for Human Rights, the European Roma Rights Centre, and the Open Society Institute as part of its Campaign to Stop Torture in Health Care. Her work includes direct outreach to the medical profession through the International Federation of Gynecology and Obstetrics (FIGO). Notes 1. For a history of the development of tubal litigation, see Medscape Reference, Tubal Sterilization, by Robert K Zurawin, MD, (22 April 2011), http://emedicine.medscape.com/article/266799- overview#a0101. 2. Matthew Connelly, Fatal Misconception, (Cambridge, MA/London, England: Belknap Press of Harvard University, 2008) 3. Men have also been targeted for vasectomy in some Asian countries, notably India, where incentive programs promoting tubal ligations and vasectomies still continue; see The Times of India, Get sterilized in Rajasthan, drive home a Nano, Ali, Syed Intishab, Syed Intishab AliJune 30, 2011, http://timesondia.indiatimes. com/india/Get-sterilized-in-Rajasthan-drive-home-a-Nano/ articleshow/9045645.cms, For more on the global nature of this abuse, see www.stoptortureinhealthcare.org 4. According to the Council of Europe Roma and Travellers Division, the average estimate of the Romani population in Europe (i.e., the 47 member states of the Council of Europe area, which includes most of the CIS countries, Russia and Turkey), is 11,256,900, with a maximum estimate of 16,118,700 (August 2009 update). The World Bank provides a map with Romani populations listed as a percentage of country populations based on data from 2007, but this does not include any of the CIS countries; see http://web. worldbank.org/WBSITE/EXTERNAL/COUNTRIES/ECAEXT/EXTROMA /0,,contentMDK:20339787~menuPK:904252~pagePK:64168445~piP K:64168309~theSitePK:615987,00.html 5. Hancock, Ian, The Heroic Present: Romani History and Chronology, in The Romani Diaspora in Canada, course reader for News 343H1: Section 5101, instructor Ronald Lee, Canadian Scholars Press: Toronto (2010) 6. World Bank, Roma in an Expanding Europe, 2005, available at http://siteresources.worldbank.org/EXTROMA/Resources/roma_in_ expanding_europe.pdf 7. Cahn, Claude and Guild, Elspeth, Recent Migration of Roma in Europe, Council of Europe and OSCE, 2008, http://www.osce.org/ hcnm/78034 8. Final Statement of the Public Defender of Rights in the Matter of Sterilisations Performed in Contravention of the Law and Proposed Remedial Measures, Oce of the Public Defender of Rights of the Czech Republic (ombudsman), 2005, http://www2.ohchr.org/ english/bodies/cerd/docs/ngos/Public-defender-rights.pdf 9. According to the ombudsmans estimate, from the 1980s until today, as many as 90,000 women may have been sterilized throughout the territory of the former Czechoslovakia. (Authors translation.) Lidovky.cz, Ministr Kocb: Politovn sterilizovanch en je prvn fze (24 November 2009), http://www.lidovky.cz/ ministr-kocab-politovani-sterilizovanych-zen-je-prvni-faze-pld-/ ln_domov.asp?c=A091124_184921_ln_domov_tai 10. Sokolova, Vera, Cultural Politics of Ethnicity: Discourses on Roma in Communist Czechoslovakia, ibidem-Verlag, Stuttgart, 2008 11. Final Statement of the Public Defender of Rights in the Matter of Sterilisations Performed in Contravention of the Law and Proposed Remedial Measures, Oce of the Public Defender of Rights of the Czech Republic (ombudsman), 2005, http://www2.ohchr.org/ english/bodies/cerd/docs/ngos/Public-defender-rights.pdf 12. Ibid. 13. Czech Prime Minister Apologizes to Victims of Coercive Sterilization, 24 November 2009, Decade of Roma Inclusion press release, http://www.romadecade.org/czech_prime_minister_ apologizes_to_victims_of_coercive_sterilization 14. For the Czech Republic at CEDAW, see UN Committee on the Elimination of Discrimination against Women, Forty-seventh session, 4-22 October 2010, Concluding observations of the Committee on the Elimination of Discrimination against Women, http://www2.ohchr.org/english/bodies/cedaw/docs/co/CEDAW-C- CZE-CO-5.pdf 15. Final Statement of the Public Defender of Rights in the Matter of Sterilisations Performed in Contravention of the Law and Proposed Remedial Measures, Oce of the Public Defender of Rights of the Czech Republic (ombudsman), 2005, pg. 27-28, http://www. ochrance.cz/leadmin/user_upload/ENGLISH/Sterilisation.pdf, 16. Center for Reproductive Rights, Poradna pre obcianske a ludsk prva in consultation with Ina Zoon, Body and Soul: Forced Sterilization and Other Assaults on Roma Reproductive Freedom in Slovakia, 2003, http://reproductiverights.org/sites/crr.civicactions. net/les/documents/bo_slov_part1.pdf 17. RECOMMENDATION OF THE COMMISSIONER FOR HUMAN RIGHTS CONCERNING CERTAIN ASPECTS OF LAW AND PRACTICE RELATING TO STERILIZATION OF WOMEN IN THE SLOVAK REPUBLIC, 17 October 2003, CommDH(2003)12, https://wcd.coe.int/ViewDoc.jsp?i d=979625&Site=CommDH&BackColorInternet=FEC65B&BackColorI ntranet=FEC65B&BackColorLogged=FFC679 18. Reproductive Health Reality Check, Coercively Sterilized Romani Woman Will Receive Compensation, Wilkowska-Landowska, Anna, June 12, 2009, http://www.rhrealitycheck.org/blog/2009/06/11/ coercively-sterilized-romani-woman-will-receive-compensation 19. The story of Elena Gorolov, April 2009, http://www.ohchr.org/EN/ NEWSEVENTS/Pages/ElenaGorolova.aspx 20. Female Contraceptive Sterilization, available at http://www.go. org/les/go-corp/FIGO%20-%20Female%20contraceptive%20 sterilization.pdf