Sexual health human rights and the law

26 | Sexual health, human rights and the law
surgery has been specifically addressed by
international and regional human rights and
professional bodies (121, 175, 243, 244).
An increasing number of countries have revised
or are revising laws and regulations relating to
accessing transition-related services. In Argentina,
for example, the 2012 Law includes provisions for
coverage of all medical costs related to procedures
and treatment for transgender people based on
their informed decision-making without additional
requirements (245).
Furthermore, legal gender recognition has an
impact on people’s ability to live in accordance with
their self-identified gender, including being able
to change their name and legal gender if they so
wish. Identification is required for many activities in
life, from accessing health services and applying for
housing, to travelling across borders and applying
for employment or education (121, 175, 201, 246).
Human rights bodies recognize that obstructing
legal determination of gender identity and imposing
arbitrary requirements, such as sterilization, is
contradictory to human rights, including the right
to privacy and the right of transgender people to
personal development and to physical and moral
security (121, 175, 178, 247, 248). They urge states
to recognize the right of transgender persons
to change their legal gender by permitting the
issuance of new birth certificates (249–251).
Some countries only allow legal change of gender
identity if certain requirements are met, such as
a mental health diagnosis, unmarried status (or
divorce) and body modifications, which often
include surgical procedures, hormonal therapies,
and chemical or surgical sterilization (121, 175, 201).
In several parts of the world, such requirements
have been found to be a violation of human
rights, and have been successfully challenged by
national human rights and legislative bodies (e.g.
Austria, Germany, Italy and New Zealand; 252–256).
Increasingly, countries are adopting laws without
any such requirements (e.g. Argentina, Denmark and
Malta; 245, 257, 258).
Some transgender and gender variant people do
not identify as male or female, but as a third gender.
Recognizing such phenomena, legal recognition of
a third gender has been implemented in a number
of countries throughout the world (e.g. Nepal and
Pakistan; 201, 259–261).
3.4.9 Intersex people 7
Intersex people may face discrimination and stigma
in the health system, in many cases being subjected
to lack of quality of care, institutional violence and
forced interventions throughout their lifetime (178,
262, 263).
A major concern for intersex people is that so-called
sex normalizing procedures are often undertaken
during their infancy and childhood, to alter their
bodies, particularly the sexual organs, to make them
conform to gendered physical norms, including
through repeated surgeries, hormonal interventions
and other measures. As a result, such children
may be subjected to medically unnecessary, often
irreversible, interventions that may have lifelong
consequences for their physical and mental health,
including irreversible termination of all or some
of their reproductive and sexual capacity. Medical
procedures may sometimes be justified in cases of
conditions that pose a health risk or are considered
life-threatening. Such procedures, however, are
sometimes proposed on the basis of weak evidence,
without discussing and considering alternative
solutions (178, 262, 264–270).
Increasingly, concerns are being raised by intersex
people, their caregivers, medical professionals
and human rights bodies that these interventions
often take place without the informed consent of
the children involved and/or without even seeking
the informed consent of their parents (178, 262,
264, 270–273). Parents often consent to medical
intervention for their children in circumstances
where full information is lacking and without any
discussion of alternatives (263, 274).
According to human rights standards, intersex
persons should be able to access health services
on the same basis as others, free from coercion,
7
The health and human rights concerns faced by
intersex people may be similar to those faced by
transgender people, and in other respects their
concerns may be different. See also section 3.4.8.