The Inter-American Court of Human Rights has, for the first time, addressed the all-too-common practice of sterilizing women without their informed consent. In its judgment concerning I.V. v. Bolivia, released on December 22, 2016, the court determined that forced sterilization generally violates a core set of human rights, including the right to dignity, and may also constitute cruel, inhuman or degrading treatment and violate the right to judicial protection (as it found to be the case here). Its decision was a positive conclusion to I.V.’s 16-year fight for justice and puts in motion significant advances toward providing her with some measure of reparation and ensuring that Bolivia’s health care system recognizes and respects the human rights of women, including their right to exercise full, free, prior, and informed consent to any medical procedure. The International Human Rights Clinic at Santa Clara University and the International Justice Resource Center intervened before the Inter-American Court as amici curiae in the case with the support of 22 law professors, experts, and organizations (other amicus curiae briefs submitted in the case are also available online). We write here to outline the analysis presented in our brief and share the court’s conclusions, particularly because the judgment is only available in Spanish.
In our capacity as amici, we argued that the court should adopt a rights-based definition of forced sterilization and treat it as an autonomous complex human rights violation that affects the rights to dignity, private and family life, personal integrity and humane treatment, freedom of expression, protection of the family, and to be free from discrimination and from acts of violence against women. We argued that a framework that recognizes the indivisibility and interrelatedness of the human rights violations associated with forced sterilization better reflects its complex nature and will assist other bodies tasked with analyzing cases of forced sterilization as a human rights violation. This approach would be in line with the court’s conceptualization of other complex human rights violations that are not specifically mentioned in the American Convention on Human Rights. Such was the case of enforced disappearances, where the court’s characterization as an autonomous and complex violation was instrumental for the development of a more appropriate normative framework.
Although the court did not adopt in its entirety the holistic framework we proposed, it analyzed the alleged rights violations in three groups: 1) the rights to personal integrity, liberty, dignity, family and private life, access to information, to start a family, and recognition of legal personhood; 2) the right to personal integrity and the prohibition on torture and cruel, inhuman or degrading treatment; and, 3) the rights to due process and judicial protection. It concluded that forced sterilization raised all the rights in the first group, and that these rights were violated in I.V.’s case. It separately determined that, in the circumstances of I.V.’s sterilization, she was subjected to cruel, inhuman or degrading treatment and had been denied due process and judicial protection.
In our brief, we also took the opportunity to encourage the court to expand on its analysis of the human right to dignity, protected by Article 11(1) of the American Convention on Human Rights, which it has very rarely addressed in the past. We emphasized that the right to dignity is separate and distinct from the more general right to privacy, and has been recognized by various regional and universal human rights bodies. Violence against women and interference with their sexual and reproductive choices undermines women’s dignity in these bodies’ views.
In its judgment, the Inter-American Court confirmed that Article 11(1) is based in the principle of personal autonomy and equal treatment of individuals with regard to their life decisions. In its understanding, respect for personal autonomy must guide the government in its actions and is particularly relevant in the context of healthcare, where autonomy must be respected by obtaining a patient’s informed consent to any procedure. In finding that I.V. had not given her prior, free, full and informed consent to the sterilization, and that the procedure interfered with her reproductive choices, the court concluded that her right to dignity had been violated.
The court ordered a number of reparations, including medical and psychological treatment for I.V. and a public acknowledgment of its responsibility in this case. Other measures were aimed at guaranteeing non-repetition of this type of violation, and included publication of a pamphlet clearly explaining women’s rights in relation to sexual and reproductive health and the requirement of informed consent. As amici, we had urged the court to order training for medical professionals on these topics, as well. The court directed Bolivia to establish educational and training programs for medical students, professionals, and staff on informed consent, gender discrimination, and gender based violence.
As we noted in our brief, forced sterilization is a widespread problem affecting women in the Americas and around the world. It is a practice with permanent, life-altering consequences for a woman and for her family, and it raises multiple human rights concerns. The Inter-American Court’s judgment in I.V. is a welcome recognition of this reality and provides clear instruction to States on how they can, and must, act to prevent the commission of forced sterilizations within their territories.