June 12, 2014

The Catch-22 of the WHO Statement on Forced Sterilization (W101)

I failed! Oh, I so failed. I have allowed work and life to get in the way of the Daily Challenge. In my defense, this is one of the four hardest weeks of my job each year, in terms of workload, stress, and late nights. I intend to catch up, however! Beginning with Tuesday …

June 10, 2014 — Write a post based on the contrast between two things — whether people, objects, emotions, places, or something else.

This one is interesting. In fact I do have two things I want to contrast. Not two people, or two things, but two conflicting views in my own head: what to think about the recent World Health Organization’s statement on transgender people and forced castration.

The statement, Eliminating Forced, Coercive, and Otherwise Involuntary Sterilization, is actually an interagency statement written by not only WHO, but several UN organizations. The statement is not solely centered on transgender issues, but it has earned notice in the trans community because it does include transgender people in its larger message, which is, as the title suggests, a statement against sterilization requirements — which includes GRS requirements for gender marker changes on legal documents. The statement reads:

Some groups, such as transgender and intersex persons, also have a long history of discrimination and abuse related to sterilization, which continues to this day. Such violations are reflected, for example, in the various legal and medical requirements, including for sterilization, to which transgender and intersex persons have been subjected in order to obtain birth certificates and other legal documents that match their preferred gender (15, 16, 63). Intersex persons, in particular, have been subjected to cosmetic and other nonmedically necessary surgery in infancy, leading to sterility, without informed consent of either the person in question or their parents or guardians. Such practices have also been recognized as human rights violations by international human rights bodies and national courts (15, 64).

Which is definitely true. In most states in the United States, either GRS or some lesser but no-less permanent procedure is a legal requirement for getting a gender marker change. Here in Michigan, I do not need to have full GRS, but I do need to have an orchiotomy — less extreme than GRS but no less effective in terms of sterilization. It’s not forced, but its definitely enforced, as I’m being told that I can only have this life-affirming legal identity change if I undergo the procedure.

Here’s the problem. The WHO statement very much paints GRS in a negative light. Think for a moment about the contrast at work here.

On the one hand, the trans community at large wants to gain support for GRS as a medically necessary part of the larger treatment options available to us. We want it to be viewed as a viable treatment option, as “medically necessary” is the crowbar that leverages the coverage of GRS by insurance policies. It is a positive, even life-saving procedure.

On the other hand, if we celebrate the WHO’s statement, then we are casting what is, for many, a life-affirming surgery as coerced sterilization. We are turning around and casting this positive, even life-saving procedure in a decidedly negative light. “Yeah! Don’t make us do that horrible, horrible thing … that our doctor says we NEED in order to treat us! And that many of us really want!”

This is the potential Catch-22 of being trans in many countries. Can we say, on the one hand, that GRS is an important — nay, vital! — part of GD treatment regimens, and then turn around and say, “But it’s also evil and wrong”? And by acknowledging that GRS requirements amount to “coerced sterilization,” couldn’t we be interpreted as drifting uncomfortably close to the kinds of verbiage transphobes use to dismiss GRS? They love to say things like “You’re mutilating your genitals!” and “You’re just removing healthy organs!” They cast something that’s meant to heal as something that causes unnecessary harm — which is akin to the WHO’s statement.

We want it, but we want to decry its requirement, but we need it to be medically necessary in order to have any hope of getting it paid for, but we don’t want to be told that we can only be ourselves legally if we get it. It’s a bit of a Gordian Knot, at least rhetorically. On a day-to-day level, this means that when we talk about this WHO statement we need to make sure that we do so with nuance. It’s not the surgery that we find offensive or oppressive; it’s the burdensome requirement for legal recognition that’s the problem. And we need to be sure that we frame it that way.

Of course, all of this is only a problem because of legal gender. Really, why does gender need to be something that is stamped for approval by the government? I suppose its purpose is to determine how some laws, ordinances, and private policies apply to individuals. For example, have an M on your birth certificate? You can only get married to someone with an F on theirs, at least in most states. Have an F on there? At my workplace you couldn’t choose to wear a three-piece suit, even if you looked awesome in it.

The truth is, all we would need to do is change a relatively small number of laws and this whole conundrum about legal gender and surgery requirements would go away. In that better world, gender would cease to be a legal marker at all, for any purpose, and GRS would be only one of several possible “medically necessary” (and therefore insurance-covered) options for treating GD. Until then, we must try to navigate this contrast, this contradiction, as we work our way towards living as our authentic selves.



  • It’s great to see you’re back – I thought you’d given up on the challenge, or become bored … but if this is one of your busiest times in the year, it’s impressive that you still find time for writing. 🙂

    That being said, I have to admit I have huge problems understanding what your post is actually about. English is not my first language and I need Wikipedia and a lot of abbreviations webpages to even understand the meaning of the acronyms … which doesn’t mean I understand all the implications.

    I found GRS = Gender Reassignment Surgery. Okay, so far, so good. Then Wikipedia says this is performed on people during childhood, often without their consent. An operation performed without my consent is a violation in my view (and the WHO statement also calls it that). It makes me think of one documentation I saw on TV where a boy was born with only one testicle and the doctor insisted the child was actually a girl and the “abnormal” (in his eyes) testicle should be removed to make the child “symmetrical” or whatever. Apparently his view of reality was challenged by this biological asymmetry. The mother refused to allow the surgery and took the child home, but went back to the clinic later for a checkup. The doctor took the opportunity to remove the child’s testicle against the mother’s wishes and without her knowledge. The boy (for it was a boy) when he entered puberty became listless and apathetic. His lack of energy could only be remedied by administering testosterone, meaning that he was dependent on substitute hormones for the rest of his life in order to lead a more or less normal, active life.

    Is this what GRS is? Making people who don’t fit the norm more “acceptable” biology-wise? Or is it surgery that people actually want and approve of because they want to change the gender they were born with, or were defined as? It’s hard to see what the contrast is if you don’t understand all the terms and implications … and yeah, I couldn’t find “orchiotomy” but Wikipedia gives me “orchiectomy” which translates as “a surgical procedure to remove one or both testicles”. You say that’s “less extreme than GRS” … and now I’m totally confused, because I think that IS extreme, considering the effect the removal of the one testicle had on that boy. So what would be the more extreme procedure? And what is “GD”? Genetic Disorder? Gender Discrepancy? Google only turns up “Gangsta Disciples” … so I’m stumped for that one. Please have a little mercy on your readers who are neither experts in the field nor US citizens or even native speakers of English. 😉 Write a glossary …

    One thing I gathered from your post is that people are made to have surgery whether they want to or not, in order to get certain legal documents. Isn’t that unconstitutional? It’s definitely against human rights …

    BTW, I did a trans-related take on the Day 7 assignment. I wrote it as a dialogue so it’s simpler and lighter in tone than your article (at least that’s what I intended). I would love to hear your feedback if you want to take a look: http://wp.me/p35f3o-lE

    Heartfelt greetings 🙂
    and I’m looking forward to your next post (learning so much from them 😉 )

    • I can see how someone who speaks English as a secondary language, and is also not well versed in trans politics in the US, might struggle a bit. Kudos for your effort, though.

      The WHO document as a whole speaks on things much further reaching than transgender GRS in the United States. There are places in the world where people are actually FORCED to be sterilized or castrated, where it’s even a PUNISHMENT. And yes, in the past it has been the common step with intersex babies to perform the surgery to assign a gender after birth. WHO is generally calling for all of them to stop.

      Where my post was concerned was with one specific case: the case that says that, in many states of the US, gender reassignment surgery is required prerequisite to being legally recognized as the gender one identifies with. This is actually a desirable surgery for many trans people; however, it is very expensive and generally not covered by insurance, and so men and women who want it can live years or even decades in their identifying gender before they can afford it; and all that time, they’re living with a legal marker that says they are the gender other than the one they appear. For these people, requiring surgery is burdensome at best and cruel at worst.

      There are also trans people who don’t want the surgery, as well as those who cannot get it for medical reasons even if they want it. Those people may live their whole lives with a discongruent gender marker. Or, they may feel forced to get the surgery just to obtain the legal recognition. Again, burdensome at best and cruel at worst.

      WHO is saying, “Don’t require the surgery before recognizing the gender.” I’m saying, “Wouldn’t it be better just to stop building laws around gender at all?”

  • Thanks for taking the time to elucidate this for me. 🙂 Gradually I am getting my head around all this stuff. Today I was hit by Google inspiration and found out that GD means “gender dysphoria”, and I found a great article – at a Mormons’ site, of all places! – that explains what it is and what treatment options exist. They also cover some questions relating to the role of a transgender person in the Mormon church.*lol* It’s actually a quite helpful article, GD for dummies, so to speak: http://northstarlds.org/blog/2013/11/transgender-awareness-month-treatment-options-for-those-who-experience-gender-dysphoria/

    The WHO statement seems like a step in the right direction, at least. The other option might be to subsidize surgery costs if there is a medical diagnosis that full surgery is the option that promises the highest rate of success in relieving the person of GD-related pain and depression.

    I’ve done a short Google seach and it seems that here in Germany the healthcare provider will cover the costs of surgery for transgender persons if the person’s doctor and therapist testify that they need the surgery to relieve the dysphoria. Before this is granted, they must have lived as a person of their desired gender and been in therapy for a while to make sure that they really want this and won’t change their mind after some years. Also the therapy serves to prepare them for their new (post-surgery) life. According to this article, you can change your name even without undergoing full surgery. After you have taken hormones for a while and your outer appearance changes to reflect your desired gender, you can then change your first name to a gender-neutral name like Kim, or a name that denotes the gender you identify with. It seems things are a bit more liberal here than in the US in that regard.

    Somewhere I also found a statement that hormonal therapy will make you sterile in the long run, so forced sterilization for transgender people would seem completely unnecessary – but that brings up other issues like marriage and adoption etc. (and unwelcome associations of Nazi Germany where women were force-sterilized if they belonged to ethnic groups considered “inferior” by the Nazis) so I better stop writing about this topic …

    The gender marker on the ID card is probably just a practical thing, so potential employers will know if you can get pregnant and they may have to pay maternity benefits and stuff like that. And for your healthcare provider so they know whether you need preventive screening for breast cancer and the like. ‘Which can be a pain in the ass, too. I’ve received “invitations” for breast screening for the last two years now because apparently I’m now in the “risk group” age-wise … but I always dump them in the trash. *lol* They should leave it up to me whether I want this, and if yes, to which place I will go to get it.

    Thanks for commenting on my dialogue! 🙂 I will reply to that later – I’m already two days behind on the writing challenge …

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