AOM Position Statement on Intersex Child Autonomy

Intersex people, those born with variations of physical sex characteristics, are a diverse group that face discrimination and often experience trauma when engaging with health care providers, beginning in infancy. The midwife, as the baby’s primary health care provider, can have an important role both during the initial newborn exam and in the first six weeks of life. The Association of Ontario Midwives is committed to respecting the human rights of the child.   The AOM represents clinical care providers who have a strong relationship with clients, and are uniquely positioned to help families to advocate for their child, make appropriate referrals, and provide advocacy on a greater community and professional level.  

The AOM is committed to challenging cisnormativity and heteronormativity.  Nonconsensual, cosmetic and medically unnecessary genital or gonadal surgery in order to bring individuals into conformation with the gender binary has many lasting deleterious effects. These surgeries can render an individual physically or psychologically unable to experience sexual pleasure, limits their reproductive choices, and can cause life-long dependency on hormone replacement therapy.  

The United Nations has clearly expressed that medically unnecessary genital surgeries are a violation of the child’s rights and have a scarring, lasting impact which can necessitate repeated surgeries as the child grows. According to the statement from the United Nations:

“Given their irreversible nature and impact on physical integrity and autonomy, such medically unnecessary, unsolicited surgery or treatment should be prohibited. Intersex children and their families should receive adequate counselling and support, including from peers."

As an Association, we believe healthy children should not be subjected to unnecessary and harmful interventions. We are committed to respecting the human rights of all people, including the rights of intersex people.

As primary health care providers, midwives are responsible for providing informed choice and arranging any necessary referrals or consultations during the neonatal period. Midwives can have a tremendous impact as they support families of intersex babies in their journey.

We are committed to supporting and advocating for intersex people. The AOM condemns unnecessary surgeries and supports midwives to provide medically-appropriate, sensitive, supportive, evidence-based care to all families.

References

Intersex Health Evidence Brief. Rainbow Health Ontario. Last updated August 2011. Available at https://www.rainbowhealthontario.ca/wp-content/uploads/woocommerce_uploads/2011/08/RHO_FactSheet_INTERSEXHEALTH_E.pdf

Morgan Holmes. Intersex: A Perilous Difference. Susquehanna University Press. 2008

Morgan Holmes. Critical Intersex. Routledge 2009.

The Canadian Centre for Gender and Sexual Diversity. Intersex Awareness and Allyship. Published October 26, 2017. http://ccgsd-ccdgs.org/intersex/

Mel Thompson, Intersex Coordinator, The Canadian Centre for Gender and Sexual Diversity (in discussion January 2018)

InterACT Advocates for Intersex Youth. https://interactadvocates.org/resources/intersex-resource-topics/ethics-of-surgery-and-decision-making/

North American Society for Pediatric and Adolescent Gynecology. NASPAG Position Statement on Surgical Management of DSD. http://c.ymcdn.com/sites/www.naspag.org/resource/resmgr/pdf's/NASPAG_Statement_on_DSD_PES_.pdf

 

Pediatrics Bodies Support Intersex Child Autonomy: Medical Associations Advise Delay on Non-Emergency Surgery.  Human Rights Watch, New York, November 8, 2017 From https://www.hrw.org/news/2017/11/08/pediatrics-bodies-support-intersex-child-autonomy

Ittelson A, Tamar-Mattis A. Avoiding Liability in the Treatment of Intersex Patients. Journal of Pediatric Urology. http://www.jpurol.com/article/S1477-5131(16)30174-7/fulltext

Snodgrass W, Bush NC. Re-operative urethroplasty after failed hypospadias repair: how prior surgery impacts risk for additional complications. Journal of Pediatric Urology. June 2017 13;3. P.289. http://dx.doi.org/10.1016/j.jpurol.2016.11.012

Demant T.  Director of Gender, Sexuality, and Identity Program at Amnesty International.  Do No Harm: Intersex Rights. Medium. July 24, 2017. https://medium.com/@amnestyusa/do-no-harm-intersex-rights-a37cfd99a12

Larsson N. Is the world finally waking up to intersex rights? The Guardian. February 10, 2016. https://www.theguardian.com/global-development-professionals-network/2016/feb/10/intersex-human-rights-lgbti-chile-argentina-uganda-costa-rica

Ghorayshi A. A landmark lawsuit about an Intersex baby’s genital surgery just settled for $400,000. July 26, 2017. https://www.buzzfeed.com/azeenghorayshi/intersex-surgery-lawsuit-settles?utm_term=.qeMaDXYnP#.cpwRQ7wWV

Consortium on the Management of Disorders of Sex Development. Clinical Guidelines for the management of Disorders of Sex Development in Childhood. Accord Alliance. 2008 available at http://www.accordalliance.org/wp-content/uploads/2013/07/clinical.pdf