POLICY REPORT Forced Sterilization of Women in Uzbekistan Natalia Antelava December 2013 EXECUTIVE SUMMARY This investigation into an alleged government sterilization program in Uzbekistan has uncovered a pattern of ongoing, systematic forced sterilizations that have affected tens of thousands of women across the country and appears to have intensified in recent years. According to overwhelming testimonial evidence, for the past 13 years the Uzbek government has carried out a program to sterilize women of reproductive age. The program is not based on ad hoc decisions of individual hospitals, but rather is a centrally-regulated policy with the apparent aim of controlling population growth. Spanning a period of two years, this investigation draws on interviews with dozens of victims of forced sterilization, 14 medical professionals, including doctors and 2 officials at the Ministry of Health, and a survey of 53 doctors th 224 West 57 Street, New York, New York, 10019 | TEL +212-548-0600 | FAX +212-548-4600 POLICY REPORT-FORCED STERILIZATION OF WOMEN IN UZBEKISTAN 2 across the country. While the extent of implementation has varied, the government has never abandoned the program entirely. The backbone of this research is a survey of 54 doctors that provides the most extensive testimonial evidence to date of the existence and prevalence of a nation-wide government sterilization program. It shows that the program is not limited to particular geographical areas or institutions and that it takes place across the country’s medical establishment. In Uzbekistan, all women of reproductive age who have delivered two or more children are potential targets of the program. Those most likely to be sterilized are women with lower socio-economic status and members of ethnic minorities, particularly those from the country’s Roma population. While sterilization quotas are set centrally, the vast scale of the sterilization campaign is also due to attempts by local health administrators to outperform one another in order to please their supervisors in the central administration. Medical professionals are under pressure to perform the sterilizations. Uzbekistan’s authoritarian government holds doctors and nurses responsible for fulfilling quotas set by health administrators. Doctors recounted working to fill the quotas, often without the necessary equipment, while being unable to provide proper medical examinations or a sterile environment in which to perform these surgeries. This paper also examines the role of international organizations in reproductive health in Uzbekistan and concludes that while the international community cannot be held responsible for the forced sterilization program, its close cooperation with officials in the sphere of reproductive health, its continual praise for perceived reforms, and its acceptance of the government's denials that forced sterilization is taking place have implicitly encouraged the government to continue the practice. POLICY REPORT-FORCED STERILIZATION OF WOMEN IN UZBEKISTAN 3 Table of Contents ABOUT THE AUTHOR 4 INTRODUCTION 5 THE UZBEK FAMILY, DURING AND AFTER THE USSR 8 SURGICAL STERILIZATION 10 THE STERILIZATION PROGRAM—AN OVERVIEW 13 WHY STERILIZE? 18 THE 2013 DOCTOR SURVEY 22 DOCUMENTING THE RECENT WAVE OF FORCED STERILIZATIONS 25 IMPLEMENTATION OF THE PROGRAM 29 COMPLICATIONS AND CONSEQUENCES 32 INTERNATIONAL ACTORS OVERVIEW 34 CONCLUSIONS 39 POLICY REPORT-FORCED STERILIZATION OF WOMEN IN UZBEKISTAN 4 ABOUT THE AUTHOR Natalia Antelava is an award-winning journalist and longtime BBC correspondent who is currently based in New Delhi. Originally from Georgia, Antelava started her career in West Africa and went on to report for BBC television, radio, and online from Burma, the Caucasus, Central Asia, India, Iran, Iraq, Lebanon, Russia, Syria, and Yemen. Antelava has also written for Forbes, the Guardian, the New Yorker, and the Washington Post. Since first covering the 2005 massacre in Andijan, Uzbekistan, she has returned to the country regularly to report on human rights issues and politics. Antelava’s 2012 BBC investigation into forced sterilizations in Uzbekistan won the Foreign Press, One World Media, and Sony journalism awards. POLICY REPORT-FORCED STERILIZATION OF WOMEN IN UZBEKISTAN 5 INTRODUCTION The Central Asian republic of Uzbekistan is the most populous state of Central Asia and one of the most isolated countries in the world. Marked by a conservative and, in places, a deeply religious society, Uzbekistan is run by the authoritarian government of Soviet-era leader Islam Karimov and in 2013 remains impenetrable to much of the world. Those who are interested in the country, or are for various reasons invested in it, have to rely on fragmented reporting that seeps through the government’s firm grip on freedom of information and those who attempt to exercise it. Over the last decade, it was through such fragmented, often courageous, but not always reliable reporting that a disturbing story emerged from Uzbekistan. Dozens of first-hand accounts of doctors, women and, in a very few instances, officials alleged that the Uzbek government was running a widespread program of forced female sterilization. Those who have been affected by the policy and who have decided to speak out despite the risks that such actions carry believe that the practice is driven by President Karimov’s attempt to control Uzbekistan’s population growth and that tens of thousands of women are being subjected to the procedure. The practice of state-enforced sterilization is neither new nor unique to Uzbekistan. Since the start of the 20th century, at various points in history, different governments around the world have forced their people, both men and women, to undergo surgical sterilization. Eugenics programs in the United States, Sweden, and Canada, family planning policies in China and in India under Indira Ghandi’s Emergency Law, and the sterilization of indigenous people in Alberto Fujimori’s Peru are just a few examples of such programs. In Europe, Roma women have been targeted for sterilization for eugenic reasons since the 1930s up to the present according to a 2012 report by the Human Rights Commissioner of the Council of Europe,1 with the most recent occurrences happening in the Czech Republic, Hungary, and Slovakia.2 These post-communist countries had communist-era sterilization programs that are similar to the one that exists in 1 Human Rights of Roma and Travellers in Europe, pp. 93-100, available at: http://www.coe.int/t/commissioner/source/prems/prems79611_GBR_CouvHumanRightsOfRoma_WE B.pdf 2Office of the Public Defender of Rights of the Czech Republic, Final Statement of the Public Defender of Rights in the Matter of Sterilisations Performed in Contravention of the Law and Proposed Remedial Measures at http://www2.ohchr.org/english/bodies/cerd/docs/ngos/Public-defender-rights.pdf; Center for Reproductive Rights and Poradna pre občianske a l’udské práva (Centre for Civil and Human Rights, Slovakia), Body and Soul: Forced Sterilization and Other Assaults on Roma Reproductive Freedom at http://reproductiverights.org/en/document/body-and-soul-forced-sterilization-and-other-assaults-on- roma-reproductive-freedom; and Center for Reproductive Rights, A.S. v. Hungary (United Nations Committee on the Elimination of Discrimination against Women) at http://reproductiverights.org/en/case/as-v-hungary-united-nations-committee-on-the-discrimination- against-women POLICY REPORT-FORCED STERILIZATION OF WOMEN IN UZBEKISTAN 6 Uzbekistan. However, unlike Uzbekistan, all of these countries with the exception of Slovakia have acknowledged existence of the program and have taken steps to eradicate it and compensate some victims.3 According to the United Nations, to this day the sterilization of women living with disabilities remains a problem around the world.4 The Rome Statute, a memorandum that defines the jurisdiction of the International Criminal Court, considers widespread and systematic forced sterilization, when committed as part of a widespread or systematic attack directed against any civilian population,5 a crime against humanity.6 The latest report of the UN Special Rapporteur on Torture, Juan Méndez, states that “Forced sterilization is an act of violence, a form of social control and a violation of the right to be free from torture and other cruel, inhuman, or degrading treatment or punishment.”7 Cruel, inhuman and degrading treatment, as well as torture, is the subject of absolute prohibition under international law, without any exceptions.8 Since the government of Uzbekistan denies the existence of the program, it feels no need to present official explanations for it or for the exact reasoning behind its policy. At the same time, the secrecy that surrounds the program has made it very difficult to accurately determine the scale of the sterilization policy and its impact on the population. 3 In 2009, the Czech Republic expressed regret for illegal sterilizations of women, calling them "very, very significant failures."(http://www.praguepost.com/opinion/2982-unequal-measures.html ). In 2009, Hungary compensated a Roma woman who had been sterilized without her free and informed consent during the course of another obstetrical procedure (Human Rights of Roma and Travellers in Europe, pp. 93 - 100, available at: http://www.coe.int/t/commissioner/source/prems/prems79611_GBR_CouvHumanRightsOfRoma_WE B.pdf). In 2011 and 2012, a total of three judgments were handed down against Slovakia by the European Court of Human