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.

Forced sterilization case against Bolivia: expert testimony by Christina Zampas

June 15, 2016


I.V. v Bolivia is the first case the Inter-American Court of Human Rights has heard on informed consent to medical treatment and the first case alleging forced sterilization. It is only the second reproductive rights case considered by this Court.

This case concerned the involuntary sterilization in 2000 of an immigrant woman from Peru in a public hospital in Bolivia during a caesarean section.  The doctors decided that a future pregnancy would be dangerous for I.V. and performed a tubal ligation, claiming that this was necessary in order to prevent a future pregnancy. They also noted that they had obtained I.V.’s consent while on the operating table. When I.V. learned that she had been sterilized she felt devastated, and has been seeking justice ever since.

In 2015, the Inter-American Commission on Human Rights referred this case to the Inter-American Court for a decision, after having concluded that Bolivia was responsible for the violation of Articles 5.1, 8.1, 11.2, 13, 17, and 25 of the American Convention on Human Rights, and Article 7 of the Inter-American Convention on the Prevention, Punishment, and Eradication of Violence against Women (Convention of Belém do Pará). The Commission’s report is online here.

Christina Zampas, a Reproductive and Sexual Health Law Fellow at the University of Toronto’s International Reproductive and Sexual Health Law Program, presented oral expert testimony before the Court during its hearing on 2 May 2016 in San Jose, Costa Rica. Christina Zampas has studied forced sterilization issues since 2002, when at the Center for Reproductive Rights, she worked with the Center for Civil and Human Rights (Poradňa), Slovakia, to document the forced sterilization of Roma women in Slovakia, and co-authored Body and Soul: forced sterilization and other assaults on Roma reproductive freedom in Slovakia, online here.   Since then, she has engaged in advocacy and litigation before UN and regional human rights and intergovernmental bodies, calling for accountability on the issue. She has also co-chaired Open Society Foundation’s Working Group on Sterilization and has been instrumental in the development of health and medical association standards on the topic, including the World Health Organization (WHO) UN Inter Agency statement on forced and coerced sterilization (2014) online here, and the International Federation of Gynecology and Obstetrics’  guidelines on female sterilization (2011), pages 122-126.

In her recent testimony before the Inter-American Court of Human Rights, Zampas focused on international and regional human rights standards in relation to informed consent to medical care generally, and to sterilization specifically.  In her presentation, she explained United Nations and European Court of Human Rights standards and case law on the subject, including on the numerous cases against Slovakia concerning forced sterilization of Roma women, as well as international health and ethical standards.  She emphasized that international and regional health and human rights standards are clear: sterilization for prevention of future pregnancy cannot be justified on grounds of medical emergency, which would permit departure from the general principle of informed consent.  Even if a future pregnancy might endanger a person’s life or health, alternative contraceptive methods can be used to ensure that the individual does not become pregnant immediately. The individual must be given the time and information needed to make an informed choice about sterilization. The provision of information, counseling and sterilization under the stressful conditions of childbirth are not only a violation of the right to information but also violate the right to privacy, physical integrity and human dignity and are a gross disregard for an individual’s autonomy, rising to the level of inhuman and degrading treatment.

Zampas’s testimony also urged the Court to address the gender stereotypes and the intersectionality of gender with other characteristics, such as race and ethnicity, disability, HIV and migrant status, often underlying the practice. These stereotypes deem women incapable of making rational decisions about their reproductive capacity, stripping them of decision-making regarding their own bodies and lives. They assume that men and people in positions of authority—such as doctors who perform medical procedures, male family members, or society at large—are better positioned to make decisions for women. Human rights bodies have recognized the power imbalances in doctor-patient relationships and how this can lead to serious abuses, including in the use of the medical necessity doctrine. She noted that such notions, prevalent in society, can lead to violations of the right to be free from discrimination.

Zampas’s testimony set forth potential individual and structural (general) remedies, including compensation and an apology, law and policy reform that is in line with human rights standards, training and education of all health care staff, adoption of ethical guidelines to address informed consent and gender stereotyping, and monitoring of public and private health centers to ensure accountability, and guarantee an effective remedy when violations do occur.

Amicus briefs in this case were filed by Women’s Link Worldwide and the Allard K. Lowenstein International Human Rights Clinic, Yale Law School, Ciara O’Connell and Diana Guarinzo-Peralata at University of Sussex, and the Human Rights and Gender Justice Clinic at CUNY Law School and Women Enabled International. Expert written testimony was provided by Luisa Cabal, in her capacity as a lawyer and expert on sexual and reproductive health and rights, and Ana G. Cepin, MD, Fellow of the American College of Obstetricians and Gynecologists.

The decision is expected within the next year.

Relevant publications:

Christina Zampas is co-author with Adriana Lamačková, a former LLM student in the program, of “Forced and Coerced Sterilization of Women in Europe,” International Journal of Gynecology and Obstetrics (2011), Forced and Coerced Sterilization.

Sterilization: list of program resources, including articles, theses, and further reading .   Sterilization resources.

Ethical and Legal Issues in Reproductive and Sexual Health, written or edited by Rebecca Cook and Bernard Dickens, published in the International Journal of Gynecology and Obstetrics – Ethical/Legal articles  online.