Need for Reporting in Country Reports on Human Rights Practices interACT: Advocates for Intersex Youth is a U.S.-based NGO and the largest intersex-led advocacy organization in the world solely committed to intersex civil and human rights. We were delighted to see intersex inclusion in President Biden’s February 4, 2021 memorandum on LGBTQI+ human rights, and we applaud the progress in reporting on the human rights of intersex people in several 2020 country reports. We respectfully urge that posts be directed to strengthen their engagement with intersex activists and NGOs and report comprehensively on these issues for 2021 and future years.

It is imperative that future reporting include information on the rights of intersex persons, who make up nearly 2% of the global population—roughly equal to the entire population of Japan.1 Intersex individuals may experience discrimination in health care, education, sport, and employment on the basis of their characteristics or intersex status. Intersex infants and young children are particuarly vulnerable to horrific human rights abuses, including harmful medically unnecessary surgeries without their consent (referred to as intersex genital mutilation or IGM), and in some countries, even infanticide. We commend the reporting progress reflected in several 2020 country reports, and urge that posts be directed to report comprehensively on intersex issues for 2021 and future years.

Nonconsensual early surgeries. We applaud the inclusion in the 2020 report on Russia of civil society reports “that medical specialists often pressured intersex persons (or their parents if they were underage) into having so-called normalization surgery without providing accurate information about the procedure or what being intersex means.” Unfortunately, such practices—including clitoral reductions and gonadectomies—are widespread in many countries. Evidence is increasingly showing the harms of performing these surgeries on intersex children without their informed consent, which include pain, nerve damage, loss of sensitivity, scarring, incontinence, and even sterilization, as well as PTSD, an increased risk of suicide, and the risk that sex assigned will not match one’s identity.2 Because of these risks, intersex genital surgeries have been condemned, and their prohibition urged, by multiple committees and bodies of the United Nations,3 the World Health Organization,4 Amnesty International,5 Human Rights Watch,6 Physicians for Human Rights,7 other medical groups,8 and the Yogyakarata Principles +10.9 In 2020, over 30 countries from all regions called on the Human Rights Council to urgently protect intersex persons’ bodily autonomy and right to health.10

Social and economic barriers. We applaud the inclusion in the 2020 report on Kenya of findings from a government study regarding social and economic barriers for intersex people, including disparities in access to education and identity documents. Similar barriers are widespread in other countries as well. For example, a 2020 EU report found nearly two-thirds of intersex respondents reported experiencing discrimination in some area of life in the prior year, from bullying in school to denials of government services.11

Presence or absence of legal protections. We applaud the inclusion in several 2020 country reports of reporting on whether or not countries’ nondiscrimination laws expressly included sex characteristics or intersex traits. A growing number of countries, such as Iceland, Malta, and the Netherlands, have adopted such express protections, while most have not. In addition, a growing number of countries have prohibited or limited intersex genital surgeries through legislation, rules, or judicial decisions, including Chile, Colombia, Malta, Germany, and Portugal.

1 ______

1 United Nations, Free & Equal Fact Sheet: Intersex, https://www.unfe.org/wp-content/uploads/2017/05/UNFE-Intersex.pdf 2 National Academies of Sciences, Engineering, and Medicine (NASEM), Understanding the Well-Being of LGBTQI+ Populations, 12-16–12-24 (National Academies Press, 2020) (concluding that like conversion therapy, “elective genital surgeries on children with intersex traits who are too young to participate in consent are dangerous to the[ir] health and well-being”); UN OHCHR, Background note on human rights violations against intersex people (2019), https://www.ohchr.org/EN/Issues/Discrimination/Pages/BackgroundViolationsIntersexPeople.aspx. 3 United Nations Office of the High Commissioner for Human Rights, : End violence and harmful medical practices on intersex children and adults, UN and regional experts urge (26 October 2016), available at https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=20739&%3BLangID=E; Public statement of UN and regional human rights experts, “End Violence and Harmful Medical Practices on Intersex Children and Adults, UN and Regional Experts Urge”, http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=20739&LangID=E; Report of the Special Rapporteur on Torture, Juan E. Mendez, UN Doc. A/HRC/22/53 (2013). 4 WORLD HEALTH ORGANIZATION, Eliminating forced, coercive or otherwise involuntary sterilization: An interagency statement (OHCHR, UN Women, UNAIDS, UNDP, UNFPA, UNICEF and WHO) (2014), available at: http://apps.who.int/iris/bitstream/10665/112848/1/9789241507325_eng.pdf?ua=1 5 Amnesty International, First, Do No Harm: Ensuring the Rights of Children Born Intersex (2017), available at https://www.amnesty.org/en/latest/campaigns/2017/05/intersex-rights/ 6 Human Rights Watch, “I Want to be Like Nature Made Me”: Medically Unnecessary Surgeries on Intersex Children in the US (2017), available at https://www.hrw.org/report/2017/07/25/i-want-be-nature-made-me/medically-unnecessary-surgeries-intersex-children-us 7 Physicians for Human Rights, Unnecessary Surgery on Intersex Children Must Stop (Oct. 20, 2017), available at: https://phr.org/news/unnecessary-surgery-on-intersex-children-must-stop/#:~:text=%E2%80%9CPhysicians%20for%20Human% 20Rights%20calls,meaningful%20consent%20to%20such%20surgeries 8 GLMA: Health Professionals Advancing LGBTQ Equality, Medical and Surgical Intervention of Patients with Differences in Sex Development (Oct. 3, 2016), available at: http://glma.org/index.cfm?fuseaction=document.viewdocument&ID=CEB9FEE4B8DD8B7F4F7575376BD476C3A433379DD8 53BEA17913AFCCB8270299C0731320B03D2F5E1022F1C15602FBEA 9 , Principle 32 (YP+10), available at: https://yogyakartaprinciples.org/principle-32-yp10/. 10 Daniele Paletta, Protect Intersex Persons’ Rights, 36 States Tell the United Nations (Oct. 1, 2020), available at: https://ilga.org/protect-intersex-rights-33-States-tell-UN#:~:text=Geneva%2C%201%20October%202020%20%E2%80%93%20I n,health%2C%208%20NGOs%20said%20today 11 Eur. Union Agency for Fundamental Rights (FRA), EU-LGBTI II: A long way to go for LGBTI equality (2020).

2