Covers controversial issue of the sterilisation of women under the age of 18 with an intellectual impairment.

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This assignment covers the controversial issue of the sterilisation of young women under

the age of 18 with an intellectual impairment. All information in this assignment has been

based on Australian literature, legislation and statistics.

The issues concentrated on within this assignment will be based on procedures being

performed on children without the appropriate authorisation. Involved are the decisions

made on sterilisation within the legal system, family concerns, reasons why sterilisation

is sought, types of sterilisation procedures, statistics on practice and a case study on a

woman who has had the procedure performed.



Sterilisation is defined as a surgical operation or any other process that induces sterility in

men or women. In this case being is a surgical procedure which results in the permanent

loss of reproductive capacity (Oxford, 1994)

In Australia sterilisation on minors must go through the legal system of the courts and

tribunals to be approved.

Within the laws jurisdiction the court can only give its consent

if satisfied that the procedure is necessary to save the Childs life or to prevent serious

damage to her health, this meaning it is unlawful to conduct the procedure if it is not a

by-product of surgery appropriately carried out to treat malfunction or to remove disease

i.e. cancer.

Sterilisations are only to be performed based on the benefits or overall health of the child,

this being for "therapeutic" reasons, meaning in the child's best interest.

Sterilisation procedures are being performed on children as young as 12 without the

proper authorisation from the courts and tribunals. In majority of cases the procedure is

being performed for illegitimate reasons this being "un-therapeutic" meaning not in the

child's best interest. This is seen as a breach of human rights and the well being of

children who are subject to this procedure. It has been established in law for many years

that, (emergencies aside), medical treatment in the absence of valid and effective consent

is civil and criminal assault.

Within the AIHW (Australian institute of health and welfare) and the HIC (health

institute commission) data there is evidence that some of the sterilisation procedures

being performed on girls are being disguised as other procedures in order to get through


the medical system, this making it hard to estimate the true numbers of girls who have

had the procedure performed.

Parents/guardians and doctors have no legal authority to consent to sterilisation

procedures, as they can only refer the case to get consent from the legal system prior to

going through the hospital system.

Due to the continual practicing of these procedures without taking the appropriate

measures there is the urgent need for heightened accountability that requires the

sterilisation of young children to be unlawful unless authorised by the courts whatever

the purpose of the operation. Practitioners may now be subject to criminal liability if not

authorizing these procedures in the appropriate manner.


The reasons for the sterilisation procedures have been put into these five categories:

1.Moods and behavioral problems

Moods and behaviour are said to be associated with pre-menstrual tension. Hysterectomy will

not resolve mood swings or behaviour unless both ovaries are removed this resulting in the

early onset of menopause and can drastically effect both the short and long term health and well

being of the girl.

In majority of cases it has been shown that after a hysterectomy the moods and

behavioral problems of the individual have not significantly changed. This suggesting

that moods and behaviours are more often than not given an excuses for their

existence instead of looking at the underling problems in the persons life that may be


causing the behaviour.

2.Management of Epilepsy

Sterilisation may not improve epilepsy, as hormonal fluctuations do not cause epilepsy, but

may cause recurring seizure activity. The Increased chances of seizure recurring is likely to be

insignificant if both the ovaries are not removed. There is a few differences in opinion on this

matter, some saying that statistics prove that ovulation and menstruation heighten the number

of seizures a person has and others saying it has little or no effect.

3.Resolving pain and physical discomfort

This is to remove pain and discomfort such as cramps and heavy bleeding associated with


4.Menstrual management

Menstruation is often something that the child with an intellectual impairment can have

difficulties with if not independent or capable of self care. The obstacles are often pad

changing, difficulties with functional hand activities and behaviors in inappropriate displaying

of bodily fluid such as smearing

5.Sexual abuse and the risk of pregnancy

Sterilisation will not overcome vulnerability to sexual abuse, only pregnancy as one possible

consequence. Sexual abuse is something every woman is at risk of regardless of age or

disability, sterilisation leaves the doors open for sexual abuse to go undetected. Further more

there is no data to confirm that pregnancy is a significant risk in this population.


Research with families indicates that most families do not want to subject their daughter to

invasive surgery, quiet often it is a situation which they feel is beyond their control and most are

completely unprepared for it. Parents experience a variety of mixed feelings such as

powerlessness, helplessness, vulnerability, anger, despair and grief.

Parents often find it difficult to access information about menstrual and fertility management

and are often not aware of either the alternatives to sterilisation or its implications including the

possibility of unknown long term effects.

Issues can often be addressed and managed without needing to resort to sterilisation as there

are almost always less invasive alternatives of both medical and non-medical kinds.

The medical being alternatives such as the contraceptive pill and Depo-Provera injections.

The non-medial kinds can be in the form of support and education such as menstrual preparation

training for young women, protective behaviour programs, skills development programs, respite

care and recreational options, home help, aids and appliances and family counseling.

In all, these things can make a huge difference in a families life dealing with the maturing of a

young child coming into puberty and can make the difference between management of issues or

the resorting to sterilisation procedures.


There is no fully accurate statistics to go by on the illegal commencement of procedures being

Performed. This is due to so many information sources, some of which not taking every incidence

into consideration. It has now been proved that there have been sterilisation procedures going

undetected due to being put through the hospital system as other procedures. This is suggesting the


actual numbers are far greater than stated below given all the facts.

The statistics provided in this assignment cover the legally authorised procedures and the

estimated illegal procedures given within available information.

This chart estimates the incidence of sterilisation in females as private patents aged between 0 -

20 years of age with an intellectual disability, along with the type of procedure performed during

the period of 1987 to 1997.

ProcedureIncident rate per year87-8888-8989-9090-9191-9292-9393-9494-9595-9696-97

Hysterectomy-Removal of the uterus And in some cases also the cervix, ovaries and fallopian tubes. This being a total hysterectomy.383733313536303494

Tubal ligation-The Blocking of the fallopian tubes to stop the female egg from moving to the position of being fertilised.323424222726252679

Endometrial ablation-Laser to remove the lining of the uterus. This ceasing menstrual bleeding.-----18419620116098

In total this works out to be an alarming 1387 procedures performed between 1987 to 1997.

The total number of sterilisations of girls with an intellectual disability authorised by the courts

and tribunals in Australia between 1987 and 1997 was 25, the youngest being only 12, several of

these involved children who had not begun to menstruate. (HIC)


The most recent information was, there has been an estimated total of 1045 sterilisation

procedures performed on children and a further 856 ovarian procedures performed since

1992. (WRANA).

There are approximately 2,300,000 girls under the age of 18 in Australia. Of these around

40,000 have some form of intellectual impairment this means that these 40,000 girls could be

potential candidates for sterilisation procedures. The reasons only being because they are at risk

of pregnancy or may require extra care in dealing with issues involving menstruation.


This case study has been added to give a person's individual view and feelings after an illegal

sterilisation procedure.

Sue (alias) is a woman considered as having a mild to moderate intellectual disability, She is

currently 37 years of age and was sterilised at the age of 18 in 1980. Her tubes were cut and tied

in a procedure, which is believed to be irreversible. The procedure was performed without her

consent. She was taken from the special accommodation in which she was living and told

that she had to have an operation, without any explanations.

The reasons for the procedure are thought to be due to the assumption that she would not be

capable of looking after a child, when in fact she provides care for her 4 nieces and 3 nephews

on regular basis.

Sue is devastated by what happened and she has an enormous amount of grief about not having

children. This issue is constantly a part of her life, especially when she sees other people with



She has a partner with whom she lives. They both live independently in the community and he

has a full-time job while she receives a pension and does voluntary work with a disability

advocacy organisation.

Sue decided to seek medical compensation for the operation performed through the courts. The

outcome of this was the court stating that in this case she was taken to the hospital under duress

and that the operation was performed without her lawful and /or informed consent. The hospital

failed to ensure that she understood the nature and consequences of the operation, including that

it was irreversible and that consent was provided by some one who was not lawfully empowered

to give it. In 1994 she was awarded a settlement of $90,000 from the hospital where the

operation was performed in 1980.


The girls subject to sterilisation procedures do not all have severe intellectual disabilities and have

varied capabilities. This makes it hard for anyone to predict the final outcome on the ability to deal

with issues before the commencement of sterilisation procedures.

The main issue in this assignment was that reports show that the number of sterilisations far

exceeded those authorised by courts and tribunals, and the consequences that can follow i.e. long

term health and well being. Studies also have shown that parents and guardians are not well

informed of the alternatives to sterilisation, as issues can often be managed given less invasive

measures. Women with disabilities have the right to bodily integrity to make informed choices

about their health and reproductive activity, as it is fair to say that these views are not embraced by


the disability community. The question often asked is would sterilisation be recommended in the

same circumstances for a girl without an intellectual impairment?

In all this reflects societies continuing inability to deal with the issue of sexuality and people with




Australian Institute of Health and Welfare, (on line) Available

Brady, S, & Grover, S, The Sterilisation of Girls and Young Women in Australia, A legal, medical and social context, (on line) Available

Health Insurance Commission, (on line), Available

Second Edition, 1994, oxford dictionary of nursing, (no author), p78-89

Women's Rights Action Network Australia, (on line) Available

Women With Disabilities Australia, (on line), Available