Bodily autonomy is the inherent right of every individual to make decisions about their own body without coercion or violence from others. This right is closely tied to a person’s power, agency, and dignity, encompassing the freedom to make choices in three key dimensions: sex, contraception, and healthcare. Within these realms of bodily autonomy, individuals should have the ability to engage in or refuse sexual intercourse, decide whether to use contraception (and which type), and have access to healthcare services (and the right to consent to or refuse medical treatments).
Unfortunately, the right to bodily autonomy for women (and individuals whose identities do not conform to society’s accepted gender constructs) is often compromised or disregarded due to violence, coercion, or circumstances beyond their control. The UN Population Fund (UNFPA) surveyed 57 countries and found that only 55% of women aged 15–49 can make independent decisions regarding sex, contraception, and healthcare. This percentage varies across countries, ranging from 7% in Niger and Senegal to 87% in Ecuador. When examined by the dimensions of bodily autonomy, the percentages range from 19% (Senegal) to 95% (Ecuador and Panama) for the sex dimension, 71% (Comoros) to 98% (Myanmar and Rwanda) for the contraception dimension, and 21% (Niger) to 100% (Ecuador) for the healthcare dimension.
Differences in women’s ability to make independent decisions and enjoy bodily autonomy are strongly influenced by at least four factors. First, socioeconomic conditions, including education level, wealth, media access, and living environment. Second, interpersonal relationships, comprising family hierarchy, quality of communication, and family members’ opinions. Third, societal roles, encompassing norms, stigmas, and beliefs that prioritize men and force women to be submissive. Lastly, barriers in the health system, involving access to health facilities, the quality of these facilities and medical services, and potential bias among health workers.
Those factors contribute to the vulnerable position many women find themselves in, limiting their ability to exercise full bodily autonomy. To some extent, women’s decisions are often influenced by men or the male-dominated system. This creates a paradox in society: gender norms place the burden of responsibility on women for their bodies (particularly regarding their reproductive systems, such as menstruation, pregnancy, and other hormonal mechanisms) while denying them the freedom to make decisions about these very matters. Ironically, men, who do not experience or understand these unique aspects, are the ones wielding the power to make decisions concerning women’s bodies.
The power disparity between men and women in areas that are fundamentally related to bodily autonomy puts women’s personal security at risk, making it a threat to human security in the form of reproductive violence. Reproductive violence is defined as any form of harassment, coercion, discrimination, exploitation, or violence committed intentionally to control someone’s, especially women’s, reproductive choices or interfere with their reproductive autonomy. Reproductive violence includes (but is not limited to) rape, intentional transmission of sexually transmitted diseases (STDs), forced genital mutilation, restriction of sexual expression, forced marriage, forced pregnancy, forced abortion, forced contraception, forced sterilization, and restrictions on access to reproductive health services. These acts can be committed and/or enabled by individuals (e.g., partners, families, and healthcare providers), communities (through social norms that dictate who should and should not become parents), and governments (through policies or institutions involved in the politics of reproduction). Regardless of who commits or enables it, reproductive violence can generally be categorized based on its intention: to promote or prevent pregnancy.
Forced sterilization is an example of reproductive violence that aims to prevent pregnancy. It is the act of removing a person’s ability to reproduce without their free and informed consent, whether temporarily (through the use of menstrual suppression regimens or contraception) or permanently (through medical procedures, e.g., endometrial ablation, hysterectomy, oophorectomy, and tubectomy). This definition includes circumstances where sterilization is proposed and approved only by third parties, such as parents, legal guardians, and courts.
The practice of forced sterilization has been ongoing since the late 19th century as part of population control and public health efforts in many countries, including Germany, Japan, and the U.S. The governments of these countries have issued policies permitting or even promoting forced sterilization of specific population groups, such as those living with HIV, persons with disabilities, indigenous peoples, ethnic minorities, as well as transgender and intersex persons. In order to support the implementation of such policies, governments provided incentives (including offers of food, money, land, and housing) or employed coercive methods (including threats, fines, punishments, and misinformation) directed not only at the target groups but also at the health workers who would perform the procedure.
National, regional, and international human rights bodies have deemed forced sterilization a violation of multiple fundamental rights as defined in the Universal Declaration of Human Rights (UDHR). These rights include freedom from torture and degrading or inhumane treatment (Article 5), the right to privacy (Article 12), the right to start a family (Article 16), the right to receive information (Article 19), and the right to healthcare (Article 25). Moreover, forced sterilization violates at least three core principles of medical ethics: autonomy, beneficence, and non-maleficence.
Throughout history, forced sterilization has predominantly targeted women. This risk is amplified for women with disabilities, who may have their medical decision-making rights transferred to a third party under specific circumstances. The forced sterilization of women with disabilities in Australia stands as one of the most contentious and widely debated cases.
Since the 1980s, forced sterilization has been a topic of debate in Australia due to numerous cases of women and children with disabilities undergoing sterilization without their consent. This has prompted advocacy groups nationally and internationally to call for comprehensive reforms by the Australian Government to cease and criminalize coercive sterilization practices conducted without consent. Furthermore, the Australian Government is urged to develop policies and programs that guarantee the fulfillment and safeguarding of human rights for persons with disabilities.
The forced sterilization of women with disabilities has come under increasing scrutiny following a court case known as “Marion’s Case.” In June 1990, the parents of Marion (pseudonym) sought permission from the Family Court of Australia to perform a hysterectomy and oophorectomy on their teenage daughter, who had intellectual disabilities, deafness, epilepsy, ataxia, and behavioral disorders. These procedures aim to eliminate potential issues related to menstrual cycles, pregnancy, and hormonal instability. What makes Marion’s Case unique is that, in addition to the Family Court of Australia (which handles matters within the family sphere), the High Court of Australia (responsible for cases related to the interpretation and application of the constitution) also became involved.
Two years after the application was submitted, the High Court of Australia issued a ruling stating that (a) sterilization procedures for persons with disabilities can only be undertaken with the court’s permission, unless the procedure is a byproduct of treatment for a specific disease or disorder; and (b) the court can only grant permission if sterilization is deemed the best course of action after all alternative options have been exhausted or are guaranteed to fail. This ruling represents a significant advancement for human rights in Australia, affirming the rights of persons with disabilities to bodily autonomy and equal treatment under the law, as well as recognizing their inclusion as citizens.
Despite the significant milestone, forced sterilization continued to occur in Australia. Between 1992 and 1997, the court approved 17 sterilization applications for persons with disabilities. However, during the same period, Health Insurance Commission (HIC) data indicated 1,045 Medicare claims for endometrial ablation, hysterectomy, and tubectomy procedures, and 856 claims for ovarian procedures, including oophorectomy. The Australian Institute of Health and Welfare (AIHW) also reported 98 hysterectomy procedures, 565 tubectomy procedures, and 1,276 ovarian procedures during 1995–1996. The disparity between the number of court-approved applications and the procedures reported by the HIC and AIHW suggests that a significant number of sterilization procedures, likely affecting women with disabilities, are being carried out illegally and without consent.
The practice of forced sterilization of women with disabilities has persisted until today. According to data from the Australian Guardianship and Administration Council (AGAC), there have been 68 approved cases of sterilization applications for persons with disabilities since 2016. These include 12 cases in 2016–2017, three cases in 2017–2018, eight cases in 2018–2019, eight cases in 2019–2020, nine cases in 2020–2021, 14 cases in 2021–2022, and 14 cases in 2022 until the second quarter of 2023. Similar to the cases in the 1990s, the official numbers appear to be relatively low. However, health and human rights organizations are concerned about the potential for a higher number of unreported cases and the fact that forced sterilization is still permitted in Australia.
Regardless of its legality, the primary concern in this matter should be why forced sterilization of women with disabilities takes place in Australia. In general, there are six rationalizations used to justify this form of reproductive violence. The first rationalization is eugenics. Eugenics is a set of beliefs and practices that seek to enhance the quality of humankind by eliminating ‘undesirable’ characteristics, such as diseases, physical and mental defects, specific physical features, as well as ‘unusual’ social behaviors and sexual preferences. Eugenic policies have been abandoned since the end of World War II due to their association with genocide and ethnic cleansing carried out by the Nazis. However, remnants of eugenics can still be found in some countries, including Australia. Concerning the issue of forced sterilization of women with disabilities, the eugenics rationalization highlights the potential genetic defects that children of persons with disabilities may inherit.
The second rationalization is for the good of the State, community, and family. Women with disabilities (and their offspring) are perceived as placing an additional ‘burden’ on the resources and services provided by the State and community, especially in the management of menstruation and contraception—responsibilities that are automatically shifted to families or professionals. This rationalization also underlines how the inability to manage menstruation independently can lead to a loss of dignity and a decrease in the quality of life, subsequently impacting the psychological well-being of women with disabilities.
The third rationalization is the incapacity for parenthood. Because they are perceived to be infantile, asexual, hypersexual, incompetent, or passive—in other words, inadequate for the ‘proper role of women’—women with disabilities are often assumed to be unfit to become parents. This rationalization emphasizes how women’s disabilities, especially intellectual and psychosocial disabilities, are prima facie evidence that they are incapable of being good parents or, worse, may threaten the safety of their children.
The fourth rationalization is the incapacity to develop and evolve. Because their conditions are often permanent with no possibility of recovery or improvement, this rationalization assumes that sterilization is an easier, quicker, and cheaper solution than providing programs, services, and support to help women with disabilities understand matters relating to their bodies, sexuality, intrapersonal relationships, safety, and rights.
The fifth rationalization is the prevention of sexual violence and harassment. Due to various factors—such as discrimination, marginalization, high dependence on others, inadequate protection, inability or difficulty in understanding violence and harassment, social isolation, and barriers to support—women with disabilities are more likely to become victims of sexual violence and harassment. According to a 2016 survey conducted by the Australian Bureau of Statistics (ABS), 25% of women with disabilities and 30% of women with severe or profound disabilities had experienced sexual violence since the age of 15. The percentages are even higher for sexual harassment, with 57% of women with disabilities and 58% of women with severe or profound disabilities experiencing it. These substantial risks are why this rationalization stresses the importance of sterilization as an effort to protect women with disabilities from sexual violence and harassment, as well as its dreadful consequences, such as unwanted pregnancies.
The sixth rationalization is the best interests of all concerned parties. Sterilization is not only considered the most reasonable option to protect women with disabilities, but it also offers a way to lessen the burden of care borne by families or professionals. This rationalization suggests that by eliminating the potential reproductive system-related issues, both women with disabilities and caregivers will benefit. For the former, their quality of life will increase. Meanwhile, the latter will no longer have to worry about extremely personal matters and can focus on providing the best care for disability-related conditions.
The six rationalizations described not only provide context for the practice of forced sterilization of women with disabilities in Australia but also affirm forced sterilization—and reproductive violence in general—as a threat to human security. The concept of human security emphasizes three fundamental elements: freedom from want (availability, fulfillment, and protection of basic needs), freedom from fear (protection from all threats to life and well-being), and freedom to live with dignity (ability to lead a free and dignified life). Forced sterilization threatens these elements because it (a) violates many fundamental human rights, particularly the right to bodily autonomy; (b) is based on eugenic beliefs that compartmentalize humans into “worthy, desirable, superior” and “unworthy, undesirable, inferior” groups; (c) perpetuates transgenerational structural discrimination; and (d) degrades a person’s status to sub-human.
The continued practice of forced sterilization, which is technically legal in Australia, also serves as evidence of the government’s failure to protect women with disabilities. It is ironic, considering that Australia has agreed to the obligations presented by numerous international human rights treaties, including the International Covenant on Civil and Political Rights (ICCPR), the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), the Convention on the Rights of the Child (CRC), and the Convention on the Rights of Persons with Disabilities (CRPD).
Among the international treaties ratified by Australia, the CRPD is particularly pertinent to the issue. The Australian Government has failed to fulfill its obligations under Article 12 of the CRPD, which stipulates that persons with disabilities have the right to equal legal capacity and decision-making, and that these decisions should not be made by third parties. Additionally, the Australian Government has not met its responsibilities under Article 16, which requires States to protect persons with disabilities from all forms of exploitation, violence, and abuse. Furthermore, under Article 23, States are mandated to ensure that persons with disabilities are free from all forms of discrimination in matters relating to marriage and family, including the right to maintain reproductive capacity on an equal basis.
The Committee on the CRPD asserts that forced sterilization of women with disabilities is not only a form of exploitation, violence, and abuse but also a degrading and inhumane act. Similarly, Women With Disabilities Australia (WWDA) argues that forced sterilization, irrespective of the reason, will always violate women’s bodily autonomy, as it (a) permanently deprives them of their ability to reproduce; and (b) causes them long-term physical and psychological pain and suffering.
For over three decades, various advocacy groups have been active at the domestic level, publishing reports and submitting formal complaints to the UN Special Rapporteur to advocate for policy changes. In addition to these efforts, several international organizations, including the UN Treaty Bodies and international medical organizations, have been involved in making formal recommendations regarding the criminalization of sterilization without free and informed consent, particularly targeting women with disabilities. Despite these combined efforts, Australia still does not have a legal framework that prohibits the forced sterilization of women with disabilities, leaving them highly vulnerable to reproductive violence.