I.V. v. Bolivia decision: Forced sterilization is based on harmful gender stereotypes

March 29, 2017

Many thanks to Christina Zampas, a Reproductive and Sexual Health Law Fellow at the University of Toronto’s Faculty of Law, for summarizing this decision of the Inter-American Court of Human Rights.  She also presented oral expert testimony in this case during its hearing on 2 May 2016 in San Jose, Costa Rica, focusing on international and regional human rights standards in relation to informed consent to sterilization, and on gender discrimination and stereotyping. (Overview of her testimony.)

Caso I.V. v. Bolivia,   Sentencia de 30  Noviembre de 2016 (Excepciones Preliminares, Fondo, Reparaciones y Costas) Corte InterAmericana de Derechos Humanos  Decision in Spanish.

I.V. v Bolivia concerns the involuntary sterilization in 2000 of an immigrant woman from Peru in a public hospital in Bolivia during a caesarean section.   In its first case alleging forced sterilization and indeed, its first case on informed consent to a medical procedure, the Inter-American Court of Human Rights struck at the heart of such practices by addressing underlying causes of such violations: gender discrimination and stereotyping.

The Court held that the State violated the woman’s rights to personal integrity, personal freedom, private and family life, access to information and rights to found a family, and to be free from cruel, inhuman and degrading treatment contrary to the dignity of a human being, all contained in the American Convention on Human Rights.  The State had also violated its duties to condemn all forms of violence against women under the Convention of Belem do Pará.   In finding these violations, the Court recognized that sterilization without consent annulled the right to freely make decisions regarding one’s body and reproductive capacity, resulting in loss of control over one’s most personal and intimate decisions, with lasting implications.

While generally agreeing with decisions about forced sterilization of Roma women issued by the European Court of Human Rights and the CEDAW Committee , the Inter-American Court’s decision is groundbreaking in that it uniquely highlighted the transcendent role of state obligations to respect and guarantee the right to non-discrimination in the context of women’s human rights violations. Thus, the Court recognized that the freedom and autonomy of women in sexual and reproductive health, generally, has historically been limited or annulled on the basis of negative and harmful gender stereotypes in which women have been socially and culturally viewed as having a predominantly reproductive function, and men viewed as decision-makers over women’s bodies. The Court recognized that non-consensual sterilization reflects this historically unequal relationship. The Court noted how the process of informed decision-making operated under the harmful stereotype that I.V., as a woman, was unable to make such decisions responsibly, leading to “an unjustified paternalistic medical intervention” restricting her autonomy and freedom.  The Court thus found a violation of the right to non-discrimination based on being a woman. It also stressed the particular vulnerability to forced sterilization facing certain women, based on other characteristics such as socioeconomic status, race, disability, or living with HIV.

The Court ordered both individual reparations and general measures, including ensuring education and training programs for healthcare and social security professionals regarding informed consent, gender-based violence, discrimination and stereotyping.  The Court’s unequivocal articulation of the right of women to make decisions concerning reproductive health, without being subjected to discrimination based on stereotypes or power relations, is important in this first case by an international or regional tribunal addressing this in the context of sterilization.  It could also apply to other reproductive health care contexts, such as the case for abortion.

Links for this case:
Caso I.V. v. Bolivia,   Sentencia de 30  Noviembre de 2016 (Excepciones Preliminares, Fondo, Reparaciones y Costas) Corte InterAmericana de Derechos Humanos  Decision in Spanish
Report on the Merits (2014) in English.
Amicus Curiae brief by Ciara O’Connell, Diana Guarnizo-Peralta and Cesar Rodriguez-Garavito:  in English.

Related decisions, alluded to above:
V.C. v. Slovakia, European Court of Human Rights (Decision 8 November 2011)
N.B. v. Slovakia,  European Court of Human Rights (Decision 12 June 2012)
VC and NB decisions, summarized by Andy Sprung
I.G. and others v. Slovakia  European Court of Human Rights (Decision 13 November 2012).
IG decision, summarized by Andy Sprung

UN Committee on the Elimination of Discrimination against Women (CEDAW)
A.S. v. Hungary  (Decision online).
Summary  and documents from CRR.
Analysis by Simone Cusack, OP CEDAW blog.
Compiled by the Coordinator of the International Reproductive and Sexual Health Law Program, reprohealth*law at utoronto.ca.   For Program publications and resources, see our website, online here.     TO JOIN THIS BLOG: enter your email address in upper right corner of this webpage, then check your email to confirm the subscription.

Using Human Rights to Require African States to Implement Abortion Laws

February 11, 2016

Congratulations to Prof. Charles Ngwena, whose new article has just been published in the Journal of African Law.

Charles G. Ngwena, “Taking Women’s Rights Seriously: Using Human Rights to Require State Implementation of Domestic Abortion Laws in African Countries with Reference to Uganda,” Journal of African Law 60.1 (Feb 2016): 110-140. 

Abstract:  This article is constructed around the premise that women’s rights to safe abortion give rise to obligations that the state has a positive duty to implement. Using Uganda as a case study, it frames failure by a state to implement its abortion laws in ways that render the rights tangible and accessible to women as a violation of human rights. The article develops a normative human rights framework for imposing on a state the obligation to take positive steps to implement abortion laws that the state, itself, has adopted. The framework does not depend on requiring the state first to reform its substantive laws or broaden the grounds for abortion. Rather, it focuses on the implementation of existing domestic laws. The article draws its remedial juridical responses partly from conceptions of women-centred rights to procedural justice, equality and health, and partly from jurisprudence developed in recent years by United Nations treaty-monitoring bodies and the European Court of Human Rights.

The full text of this article is available from the printed journal, or online here through subscribing libraries.

“Reforming African Abortion Laws and Practice: The Place of Transparency” by Charles G. Ngwena

September 24, 2015


Charles G. Ngwena, “Reforming African Abortion Laws and Practice: The Place of Transparency” Abortion Law in Transnational Perspective: Cases and Controversies ed. Rebecca J. Cook, Joanna N. Erdman, and Bernard M. Dickens (University of Pennsylvania Press, 2014) pp 166-186, notes 419-422.  A Spanish edition was published in August, 2016.  Ahora disponible en español.

Unsafe abortion that is linked to criminalization of abortion remains a major public health and human rights challenge in the African region despite the liberalization of laws over the past few decades. In this ninth chapter of Abortion Law in Transnational Perspective, Charles Ngwena draws principally on decisions of United Nations treaty bodies and also references decisions of the European Court of Human Rights to illustrate the potential of the procedural turn for facilitating access to lawful abortion in Africa. He sets out a case for how rendering states accountable for lack of effective implementation of existing legal grounds can be an important juridical tool to secure access to safe abortion for African women. He finds that states no longer satisfy individuals’ human rights by simply broadening the grounds for lawful abortion, but must actively create identifiable means by which women can access, and providers deliver, lawful services. He explores whether the guidelines on safe abortion promulgated by ministries of health in certain African countries meet the procedural standards. The legitimacy of such guidelines would be more substantial if they had the support of ministries of justice and offices of attorneys general, and their assurances that there will be no prosecutions where abortions are procured safely with due regard to the rights and dignity of women.

The final sections of this chapter evaluate how international requirements of transparency apply to the African region, highlighting its transformative potential as well as its limits within a post-colonial environment where, long after attaining Independence, abortion is still criminalized and patterned on colonial laws in several states. Ultimately, transparency serves a pragmatic jurisprudential strategy for working within a largely constraining legal environment that has yet to concede radical reform of abortion law, or allow mid-level health care professionals to provide abortion services.

Abortion Law in Transnational Perspective: Cases and Controversies was published in August 2014 by the University of Pennsylvania Press’s Studies in Human Rights Series.   Table of Contents and other information online.    A Spanish edition was published in August, 2016.  Ahora disponible en español.

“The Procedural Turn: Abortion at the European Court of Human Rights” by Joanna Erdman

September 3, 2015

In Abortion Law in Transnational Perspective: Cases and Controversies (U Penn Press, 2014),  Part I, “Constitutional Values and Regulatory Regimes,” flows logically into Part II, “Procedural Justice and Liberal Access,” which develops the relationship between abortion law and practice, focusing on the prospects of procedural justice to secure women’s access to lawful services. Legality of services is a necessary precondition to service accessibility. However, unless women are aware of their legal rights and have the means to exercise them, the services to which they are lawfully entitled will remain beyond their reach. The historical proposition of the Common law that substantive legal rights emerged within the interstices of procedure remains relevant today. Women’s access to safe, lawful abortion depends on two factors: (1) women and service providers must actually know the legal grounds and the conditions under which abortion services may lawfully be rendered and (2) there must be legal procedures of timely review and appeal in the event of disagreement on whether the grounds are met in an individual case. The authors of Part II explore the promises and uncertainties of procedural justice in abortion law from three different geographic vantage points.

Joanna Erdman, “The Procedural Turn: Abortion at the European Court of Human Rights,” Abortion Law in Transnational Perspective: Cases and Controversies ed. Rebecca J. Cook, Joanna N. Erdman, and Bernard M. Dickens (University of Pennsylvania Press, 2014) pp. 121-142, notes 410-415A Spanish edition was published in August, 2016.  Ahora disponible en español.

In this sixth chapter of the book, Joanna Erdman explores the procedural turn at the European Court of Human Rights, asking whether and how procedural abortion rights can serve the substantive end that advocates claim for them: access to services. She begins with a complicating factor of discretion in abortion law, through which women may be denied services to which they are entitled, or granted services to which they are not. When discretion is challenged in the latter case, procedural claims for standards, review, and oversight threaten to restrict rather than enlarge access and thereby to confound the liberalizing promise of the procedural turn. Erdman looks to redeem this ambivalence by shifting focus, asking about the procedural turn from the perspective not of the advocate, but of an international court seeking to engender change on an issue of deep democratic conflict. Procedural rights may serve as a means for the European Court to respect the plurality of rights-based norms on abortion in Europe by working through rather than against the state, enlisting its democratic forces and its institutions in the effective protection of abortion rights. In a final shift of perspective, Erdman tests this theory in practice, asking about the impact of procedural rights on access to services as mediated through the ambitions and actions of legislatures, doctors, and women themselves, using Ireland as her case study.

Abortion Law in Transnational Perspective: Cases and Controversies was published in August 2014 by the University of Pennsylvania Press’s Studies in Human Rights Series.   Table of Contents and other information online. A Spanish edition was published in August, 2016.  Ahora disponible en español.


REPROHEALTHLAW Updates: Developments, Calls, Resources and News

June 6, 2014


SUBSCRIBE TO REPROHEALTHLAW:  To receive these updates monthly by email, enter your address in upper right corner of this webpage, then check your email to confirm the subscription.


United Kingdom:  Doctors will be able to approve abortions after conducting consultations over the phone or by Skype, according to new guidance  News article.

United Kingdom: A British high court judge ruled that a 13-year-old girl was mentally capable of deciding to abort her baby  News article.


Call for Abstracts: Overcoming Obstacles – Towards the effective implementation of the rights of women with disabilities in Africa, Center for Human Rights, University of Pretoria, South Africa, Tues/Wed Nov 4-5, 2014, Submit abstract by June 15, 2014.    Call for abstracts online.

“Abortion: The Unfinished Revolution”
August 7-8,  2014 at the University of Prince Edward Island, Charlottetown, PEI, Canada  preliminary program   more info.


Harvard Course on Sexual and Reproductive Health and Rights Litigation. 3-day intensive course Nov. 3-5, plus invitation to “Sexual and Reproductive Rights ‘Lawfare’ in International Tribunals,” 2-day international symposium,  on November 6-7, 2014.  Apply by July 1, 2014.  Course details online.


Abortion Care, ed. Sam Rowlands, forthcoming, Cambridge University Press,  August 2014.  Paperback.  Further details.   Chapters include:
~  Abortion in international human rights law, by Joanna N. Erdman
~  the Australian experience, by Kerry Petersen
~  Stigma and issues of conscience, by Kelly R. Culwell and Caitlin Gerdts

Abortion Law in Transnational Perspective:  Cases and Controversies,  ed. Rebecca J. Cook, Joanna N. Erdman and Bernard M. Dickens, 16 chapters.  Forthcoming, University of Pennsylvania Press, August 2014.  To receive details when it is published, email reprohealth. law\at/ utoronto. ca with subject “abortion book flyer”.

[abortion – adolescents] “Sixteen and Pregnant: Minors’ Consent in Abortion and Adoption,” by Malinda L. Seymore. Yale Journal of Law & Feminism 25.1 2013. Abstract and Article.

[abortion advocacy strategy] “Using Aikido to Change the Abortion Conversation” (using quotes from bible & saints for pro-choice purposes)   by Valerie Tarico, RH Reality Check article.

[abortion – European Court of Human Rights]    “[The Judgement A, B and C v. Ireland and the Question of Abortion: A ‘New Departure’ in the European Court of Human Rights on Consensus and Margin of Appreciation?] 
= La sentencia A, B y C contra Irlanda y la cuestión del aborto: ¿Un ‘punto de inflexión’ en la jurisprudencia del Tribunal Europeo de Derechos Humanos en materia de consenso y margen de apreciación nacional?”   by Francisco Javier Mena Parras,  Anuario de Derechos Humanos No. 8, 2012, pp. 115-124.   Abstracts in Spanish and English,   Article in Spanish.

[abortion – sex selection.] “Replacing Myths with Facts: Sex-Selective Abortion Laws in the United States.”  by the International Human Rights Clinic of the University of Chicago, in partnership with National Asian Pacific American Women’s Forum (NAPAWF) and Advancing New Standards in Reproductive Health (ANSIRH). (2014)   Abstract and 46-page report.

[conscience] “Religion as a Legal Proxy” by Micah Schwartzman, forthcoming,  San Diego Law Review,  Abstract and article online.

“Conscientious objection and refusal to provide reproductive healthcare: A white paper examining prevalence, health consequences, and policy responses,” by Wendy Chavkin, Liddy Leitman, and Kate Polin, for Global Doctors for Choice  69-page paper in English. now also in Spanish.
—“ ‘Dishonourable disobedience’ – Why refusal to treat in reproductive healthcare is not conscientious objection” by Christian Fiala and  Joyce H. Arthur, forthcoming  in Woman – Psychosomatic Gynaecology and Obstetrics, proofs online
—Followup blogpost: “Competing Rights: Exploring the Boundaries of ‘Conscientious Objection” by Wendy Chavkin online at RH Reality Check.

[divorce – Philippines] “Reintroduction of Divorce in the Philippines,” LL.M. thesis by Jihan Jacob.  Abstract online, with author’s contact information

Ethical and Legal Issues in Reproductive Health – 65 articles published in the International Journal of Gynaecology and Obstetrics  available online, including Reducing Stigma in Reproductive Health, and  Noninvasive pre-natal genetic diagnosis .

[Poland] 6th Congress of Women, May 9-10, 2014, Warsaw, Poland, 10 demands include:  “Recognition of women’s rights to make decisions concerning reproduction, including right to sex education for everyone introduced in primary school.” presented to Polish Prime Minister Donald Tusk.  Demands online.

[sterilization] Eliminating forced, coercive and otherwise involuntary sterilization – An interagency statement by OHCHR, UN Women, UNAIDS, UNDP, UNFPA, UNICEF and WHO, May 2014, 17 page report

[women’s rights] “Women’s Charters and Declarations: Building Another World,” by Rashida Manjoo (United Nations Special Rapporteur on violence against women)  (London: Women Living Under Muslim Laws (WLUML), 2013)  89-page report 

[wrongful birth – Canada] “Supressing Damages in Involuntary Parenthood Actions: Contorting Tort Law, Denying Reproductive Freedom, and Discriminating Against Mothers” by Bruce Feldthusen, (working paper, May 5, 2014).


[child marriage – Pakistan] Bill prohibiting child marriage now a law.  News report

Chile Might Change One Of The Most Restrictive Abortion Laws In The World.    News Article.  Later article.

[embryos] European Commission will not stop financing activities that destroy embryos.  Reply to “One of Us” initiative, may 28, 2014.  Press release in many languages.

[Guyana]  Plans being refined to offer abortion service at public hospitals – Chief Medical Officer says.  News article.

Jamaican MP, Dayton Campbell, a medical doctor and lawyer, advocates reform of “ancient” abortion laws –  June 1, 2014  newspaper article.

[polygamy – Kenya]   President Uhuru Kenyatta Signs controversial law legalizing the longstanding customary practice of polygamy.
BBC Report .  CNN Report.

[Senegal]  11-year-old girl, refused abortion after rape, gives birth prematurely to twins. News article.

US-focused news, resources, and legal developments are available on Repro Rights Prof Blog.  View or subscribe.


Links to other employers in the field of Reproductive and Sexual Health Law are online here

Compiled by the Coordinator of the International Reproductive and Sexual Health Law Program, reprohealth*law at utoronto.ca   For Program publications and resources, see our website, online here. TO JOIN THIS BLOG: enter your email address in upper right corner of this webpage,, then check your email to confirm the subscription.



Reprohealth Info & Abortion: Standards developed by the European Court of Human Rights

September 19, 2013

Congratulations and thanks to Johanna Westeson of the Center for Reproductive Rights, for her recently published article, now online here.

Reproductive Health Information and Abortion Services:

Standards Developed by the European Court of Human Rights

International Journal of Gynecology & Obstetrics 122.2 (August 2013): 173-176


In three recent judgments, the European Court of Human Rights addressed the issue of access to abortion and related reproductive health services. In two of the judgments, the Court declared that the state violated women’s rights by obstructing access to legal health services, including abortion. In so doing, it referred to the state’s failure to implement domestic norms on prenatal testing and conscientious objection, and recognized the relevance of international medical guidelines. This illustrates that domestic and international medical standards can serve as critical guidance to human rights courts. In the third case, the Court showed its unwillingness to declare access to abortion a human right per se, which is troubling from the perspective of women’s right to health and dignity. The present article outlines the relevance of these cases for the reproductive health profession and argues that medical professional societies can influence human rights courts by developing and enforcing medical standards, not only for the benefit of abortion rights domestically but also for the advancement of women’s human rights worldwide.

Keywords: abortion rights, conscientious objection law, denial of human rights, European Court of Human Rights, human rights law, Irish abortion law, Polish abortion law

A full PDF text of this article is online here.

Related resources on ECtHR cases discussed in this article

Access to information:  R.R. v. Poland –  Decision online.

Access to reproductive health services for adolescents: P and S v. Poland –  Details and links

Health and/or life exceptions to abortion bans: A, B, and C v. Ireland  Decision online.

More articles on Ethical and Legal Issues in Reproductive and Sexual Health are online here.

Developing Regional Abortion Jurisprudence: Comparative Lessons for African Charter Organs

July 2, 2013

Congratulations to Professor Charles Ngwena of the Center for Human Rights at the University of Pretoria, South Africa, whose useful article was recently published in the Netherlands Quarterly of Human Rights (31.1 (2013): 9-40), and, with kind permission from the publisher, is now available online through SSRN.


This article is constructed around an appraisal of the decision of the European Court of Human Rights in A, B and C v. Ireland. It seeks to extrapolate comparative lessons for African Charter organs for the development of regional jurisprudence on abortion. It is argued that the A, B and C decision offers positive as well as negative lessons. The positive lessons lie in the holding of the European Court that at a procedural level, domestic abortion laws must be transparent in the sense of being formulated clearly and providing an administrative mechanism for review so as to enable women seeking abortion to exercise their rights effectively. The negative lessons lie in the continued reluctance of the European Court to resolutely affirm abortion rights as substantive rights.

Keywords: abortion; equality; gender; human rights; margin of appreciation; transparency

Full Text of article:   online here through SSRN.