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Shadow Report to the 5th and 6th National Report of the the Republic of Costa Rica on the United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), 27.06.2011

>>> Download as PDF (238 kb)

Compiled by:
IGLHRC
MULABI
Natasha Jiménez

This Shadow Report was considered by the 49th Session of the Committee on the Elimination of Discrimination against Women (CEDAW) in New York, July 11-29 2011.

The entry on Intersex Genital Mutilation on p. 8-11 of the shadow report:

Intersex People (9) and the Right to Health:

An intersex condition is much more common than most people are aware. For instance, 1.7% of the world population is intersex; 1 of every 200 births is of an intersex person; and there are as many intersex people in the world as people with red hair. (10) The typical medical response to an intersex condition is medical intervention. Yet, sex assignment surgeries performed in intersex persons create feelings of betrayal, mistrust and depression. (11)

In the past, the prevailing opinion in medical circles was that it was best to assign a sex to an intersex child as soon as possible, often on the basis of the child’s external genitalia and not even related to their chromosomal make-up. Parents were instructed that there should be no ambiguity in their minds about their child’s sex. Surgery was quickly scheduled to extirpate the testicular or ovarian tissue of the “undesirable” sex with irreparable consequences in relation to reproductive capacity.

The aim of surgery was allegedly to normalize the genitals and prevent suffering later in life because of lack of conformity with binary sexual standards.

As a general rule, female genitals were considered more easily “rebuildable” than functional male ones, so whenever the “right” choice was not evident, a child was assigned to the female sex.

Most intersex children in Cost Rica undergo surgical intervention before reaching two years of age. The most common manifestation of intersexuality treated at the Hospital Nacional de Niños (National Children’s Hospital) is congenital adrenal hyperplasia, detected through tests performed four days after a baby is born. 12 But in spite of the good intentions of the interdisciplinary team of the National Children’s Hospital, intersex persons suffer as a result of the scars and insensitivity produced by surgery (among other consequences)

In 2006, the American National Academy of Paediatrics recommended that sex assignment surgeries cease to be performed on intersex children.
Yet the Assistant Director of the National Children’s Hospital stated in an interview with newspaper Al Día that the notion that intersex persons could choose their gender and sex when reaching adolescence was inaccurate and solely promoted by extremists. (13) Mulabi / Latin American Space for Sexualities and Rights, the International Gay and Lesbian Human Rights Commission and others are concerned that the hospital has disregarded the recommendation of the national authority on pediatric care and is performing discredited surgeries. Furthermore, these organizations argue for the right to self-determine one's own body and for the need to stop the practice of surgeries that attempt to “normalize” bodies, particularly on children who cannot consent, based on subjective criteria.

Though experts the National Children’s Hospital report that five to ten children per year are born with genital ambiguity, there are few documented cases. However the Urology Journal of San Juan de Dios Hospital, reported the account of 16 year old boy with congenital adrenal hyperplasia (one of many manifestations of intersexuality). Doctors wanted to perform a bilateral orchidectomy (the surgical removal of both testicles) on him and then insert a prosthesis but the boy himself and his family did not allow the procedure. (14)

This kind of interventions for the sole purpose of conforming the bodies of intersex people to social standards of gender binary, and their implications for the reproductive, psychological and physical integrity are a clear violation of Article 12 of the convention.

(9) Intersex Persons: Some babies are born with genitalia and reproductive organs that do not fit with the patterns culturally accepted as defining “female” or “male” anatomy. The older term for this disease –hermaphroditism‐ blends together the names of a Greek god and goddess, Hermes and Aphrodite. Hermes was the god of male sexuality (among other things) and Aphrodite the goddess of sexuality, love and female beauty.
(10) Fausto‐Sterling, Anne (2000) Sexing the body: gender politics and the construction of sexuality. Basic Books. NewYork.
(11) Cabral, Mauro (2009) Interdicciones
(12) Congenital Adrenal Hyperplasia refers to a group of hereditary disorders affecting the adrenal glands. Congenital suprarenal hyperplasia can affect both boys and girls. People suffering this condition lack an enzyme required by the suprarenal gland to produce the cortisol and aldosterone hormones. Without these hormones, the body produces more androgens, a type of male sexual hormone, causing the early (or inappropriate) onset of male characteristics. About 1 of every 10,000‐18,000 children are born with congenital suprarenal hyperplasia.
(13) Interviewed by journalist Franklin Arroyo, from newspaper Al Día. (http://www.mentesana.net/tag/genitalidad‐ambigua/)
(14) Urology Journal at BINASS (Biblioteca Nacional de Salud y Seguridad Social de la Caja Costarricense de Seguro Social) http://www.binasss.sa.cr/revistas/rmcc/563/art11.htm

The recommendation Re: Intersex Genital Mutilation on p. 13 of the shadow report:

That corrective or sex assignment surgeries cease to be the preferred option for treating intersex children at the National Children’s Hospital, and that the parents of these children are supported by specific counselling and orientation groups that will provide them with the necessary tools to deal with this situation in the best way possible, always having the best interests of the intersex person as a guiding principle. One way to achieve this is by implementing a care policy for the intersex population that will allow them to decide in the future the best way to be followed because it is their lives that are being affected.

Note: Unfortunately, in its >>> Concluding Observations (PDF, 68 kb) the Committee only mentioned intersex once, and as a "tail light" to LBT, furthermore criticising "abuse and mistreatment by health service providers" and calling for "appropriate training" to "health service providers, in order to avoid abuse and mistreatment of these women" (CEDAW/C/CRI/CO/5-6, see p. 9 para 40-41).

In September 2012, the UN Office of the High Commissioner for Human Rights (OHCHR) referenced para 40 in its publication >>> "Born free and equal" (PDF 1.7 mb) with regards to the the following statement:

Statement by OHCHR Re: Intersex Genital Mutilation in "Born Free and Equal", p. 51:

"In addition, intersex children, who are born with atypical sex characteristics, are often subjected to discrimination and medically unnecessary surgery, performed without their informed consent, or that of their parents, in an attempt to fix their sex."

>>> OHCHR: "Born free and equal" (HR/PUB/12/06, PDF 1.7 mb)