Contemporary human rights violations in female sterilization care: legal and ethical considerations when coerced patients do consent

TL;DR

The paper explores how coercion in female sterilization can occur even when patients consent, highlighting ethical and legal issues through real-world examples.

Contribution

It introduces a functional approach to measuring coercion in sterilization care, challenging the assumption that coercion is an exception rather than the norm.

Findings

Coercion in sterilization can manifest subtly and persist without accountability.

Examples like ICE detention facilities and Uyghur birth control quotas reveal systemic coercion.

Current legal frameworks may underrepresent the true prevalence of coercive sterilization.

Abstract

In this piece we examine three forms of coercive or otherwise involuntary care that can occur with patient consent. To do so, we examine: (1) uninformed consent, (2) contingency-based consent and (3) constrained-market consent, amongst female sterilization patients. While there is broad recognition that “coercion” in sterilization care can manifest beyond instances of overt force and clarity on what constitutes coercion within clinical care, this has not translated to accountability. The current practice of identifying coercion through discrete civil cases may facilitate a narrow understanding of its contemporary prevalence; one that does not align with definitions of coercion supported by international human rights entities. We use three acute, and widely recognized, examples—hysterectomies in ICE detention facilities, India’s sterilization camp deaths and birth control quotas for Uyghur women—as an entry point to highlight less overt contemporary forms of coercive sterilization care, pairing each example with data that explores prevalence at a broader population level. These data suggest less visible forms of coercion may persist relatively unchallenged—raising the ethical case for a functional approach to the measurement of coercion. In turn, we argue the relevant question may not be “when is coercion ethically justified in public health,” but rather, why is coercion already the status quo?

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