Bill to criminalize forced sterilization sparks debate over reproductive justice and medical practice

A controversial bill that would criminalize forced and coerced sterilization procedures across Canada is now well on its way to becoming law.Bill S-228 completed its second reading in the House of Commons on Feb. 26. If passed, it will amend the Criminal Code to include the “severing, clipping, tying or cauterizing, in whole or in part, of the fallopian tubes, ovaries or uterus” or any other procedure performed without consent “that results in the permanent prevention of reproduction,” regardless of whether the procedure is reversible.The bill would make clear the practice qualifies as aggravated assault; medical practitioners performing sterilization procedures without sufficient consent could face up to 14 years in prison.While there are existing provisions in the Criminal Code that deal with assault, to date they have not been used to prosecute forced sterilization, which has deep roots in Canada, originating largely from the eugenics movements in the early 20th century. Under the eugenics movement, more than 3,000 Canadians were legally sterilized, most notably under the sexual sterilization acts of Alberta (1928) and British Columbia (1933) that often required the forced sterilization of those considered “mentally defective,” particularly as a condition of release from mental institutions.At the time, sterilization legislation also included those deemed to possess “undesirable elements” or to be a part of “unfit groups.” Inuit, First Nations and Metis people were often and increasingly targeted for sterilization.While the eugenics-inspired practice was assumed by many to have ended with the repeal of these laws in the 1970s, there is concern that it persists today. The precise number of Indigenous women who have been sterilized is unclear. Health Canada does not routinely collect data on sterilization, particularly the circumstances under which sterilization procedures occur, nor documents the ethnicity of patients.However, Alisa Lombard, the legal counsel in a class action lawsuit filed against the Saskatchewan Health Authority, noted in a Senate report that her firm had been contacted by approximately 100 Indigenous women who alleged they were pressured into sterilization between 1970 and 2018. In 2018, Lombard told the CBC, “I think that the problem is quite a bit larger than we know it to be.”Senator Yvonne Boyer re-introduced Bill S-228 after its predecessor died when Parliament was prorogued last year. She told AP News in 2023 that her office is collecting the limited data available and estimates that at least 12,000 women have been affected since the 1970s.A 2018 United Nations committee noted that Canada should adopt legislative and policy measures to “prevent and criminalize the forced or coerced sterilization of women.” The committee was specifically “concerned at the lack of information regarding the implementation of the calls to action included in the final report” regarding an external review of the Saskatoon Health Region.However, despite a consensus that forced and coerced sterilization is a practice that should not occur, there is some debate about whether explicitly criminalizing the medical procedure is the best tool to address the issue.Advocates have raised concerns over access to elective reproductive health procedures and the potential for criminalization to impact other marginalized groups such as the disabled or trans people.We asked experts whether they thought that Bill S-228 was a step in the right direction.Harmony RedSkyExecutive director of the Survivors Circle for Reproductive JusticeWe work with First Nation, Inuit and Metis survivors from across the country to support their quest for reproductive justice. Many have carried deep wounds from the traumatic experiences that impacted the course of their lives, their families’ lives and community. While many Indigenous survivors can no longer reverse the harm that has been done to their bodies, they are steadfast in their commitment to protect young women and men from being harmed by forced and coerced sterilization ever again.Bill S228 will solidify the importance of learning, understanding and operating with the knowledge of free, prior and informed consent within all healthcare systems in Canada. This is a globally recognized standard that is enshrined in the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP). Informed consent in the healthcare system is also addressed in various reports including the Truth and Reconciliation Commission Report and the 94 Calls to Action and The Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls and the Calls for Justice.Once it becomes law, Bill S228 will educate not only physicians and nurses, but it will also inform the other systems that play a role in forced and coerced sterilization to strengthen their policies around informed consent, whether it be child welfare, corrections or others. It will teach physicians that consent is not simply a signed piece of paper but a relationship between doctor and patient that includes respect, dignity and trust. There is much work to be done to prevent forced and coerced sterilization from happening again and survivors are key to guiding the preventative measures that can be taken to end forced and coerced sterilization.Modupe Tunde-ByassAssociate professor at the University of Toronto, Obstetrics and GynecologyI do support the intent of the bill, which is to be protective. Sterilization without consent is wrong and must not be allowed to happen or continue in any society.But as an OBGYN, it’s difficult because some of the work that we do is in emergency situations in which decisions have to be made within a split second. The threat of a criminal prosecution may cause physicians to hesitate during that critical moment. We have seen this south of the border with the overturn of Roe vs Wade. Criminalization and legal uncertainty have led to confusion, physician hesitancy, delayed care and lack of available women’s health providers and has led to maternal deaths. We do not want that to happen in this country.The other concern I have is that over the past decade, more than 50 per cent of medical school admissions and more than 80 per cent of our OBGYN residents are women. The profession used to be mostly male dominated, but now women’s care in women’s hands has been safer and led to better documented outcomes. Criminalizing something like sterilization will go against the very population that we actually want to protect.As an OBGYN, I have been approached by younger women who have determined that they do not want to have children and want sterilization. This kind of law could prevent physicians from offering those services because they worry about going to jail for 14 years.Furthermore, no one in obstetrics and gynecology has heard about this bill coming. Waking up one day with a law criminalizing sterilization is going to go against what we all practice. Medicine has changed over the years because we have put in place education and collaboration with regulatory bodies and medical protection associations to ensure that professional standards are met and provide support for practitioners who are providing care for women.We need to have a framework from the United Nations or Amnesty International and put in place a robust consent that will protect women as well as allow practitioners to do the work they are trained to do. We need to dismantle the barriers that prevent women from receiving high-quality care.For me as a physician, we need to protect women’s rights and autonomy, and I truly believe that coercion and forced civilization has no place in our society. At the same time, women’s reproductive rights and justice should be kept away from politics.Fred ChabotExecutive director at Action Canada for Sexual Health and RightsIt is important that Parliament is examining the issue of forced and coerced sterilization. In Canada, this practice has deeply affected some communities, particularly Indigenous, racialized and disabled people, often in situations where individuals were already experiencing profound vulnerability within the healthcare system. There is a documented history that Canada must acknowledge and take responsibility for as well as ongoing reports that show the issue has not been fully resolved.Addressing forced sterilization requires centering reproductive justice, an approach that combines human rights, bodily autonomy and social justice. It means recognizing that reproductive autonomy is shaped by broader inequalities, including racism, ableism, colonialism and unequal power dynamics within health systems.While recognizing the harm that forced sterilization represents, we have concerns about relying primarily on Bill S-228, or more broadly, criminal law as a remedy. Criminal law can be a blunt instrument that does not necessarily address the systemic conditions that allowed these violations to occur in the first place. Medical care without appropriate consent, especially surgical procedures, is already understood as assault under Canada’s Criminal Code. Strengthening accountability, consent practices, oversight and patient protections ultimately may do more to prevent harm.There is also a need for careful consideration of how legislation criminalizing a common procedure in Canada could affect access to voluntary sterilization, which remains an important and legitimate form of reproductive healthcare. It could continue to make access to reproductive healthcare more difficult for people already having a hard time accessing the services they need. The goal must be to protect people from coercion while safeguarding reproductive autonomy for everyone.Ultimately, meaningful change will require addressing the discrimination, power imbalances and systemic racism that continue to shape people’s experiences in the healthcare system.Karen StoteAssociate professor of Women and Gender Studies at Wilfrid Laurier UniversityI’ll preface this by saying I don’t want to dismiss the tireless work being done by many to bring attention to the coerced sterilization of Indigenous women, who are equally invested in stopping the practice.I also acknowledge the survivors of coerced sterilization who deserve to have those responsible held accountable. I’ll also say that Bill S-228, which clarifies that sterilization without informed consent is a form of aggravated assault in the Criminal Code, isn’t without limitations—it’s a carceral remedy vested in the colonial state that depends on the RCMP to investigate and prosecute, and it’s an individualized, after-the-fact intervention that frames coerced sterilization as something stemming only from the doctor-patient relationship.It doesn’t go far enough in preventing violence before it occurs or addressing the context giving rise to it—a context that’s embedded in ongoing relations of colonialism, land theft and systemic racism, within and beyond healthcare. I fear our willingness to hold perpetrators to account may end up reflecting the value we place on victims, as it does in cases of sexual assault, when the devaluation of women and disappearance of Indigenous Peoples is embedded in society.My recent book shows there’s a long history of all levels of government approaching Indigenous reproduction as something needing to be curbed. I know Senator Boyer has said legislation is a tool, that a “huge,” “several-pronged” and “national approach” is needed to eradicate the practice. I agree—it is a tool, and a broad approach is required to address coerced sterilization and the many other forms of violence Indigenous people experience.It will be important to avoid being lulled into thinking that Bill S-228 does anything to address the context that led to coerced sterilization in the first place. And I often wonder, when will we implement the broader systemic change necessary to address violence against Indigenous bodies and lands. So, it’s something, but not enough. And Indigenous women shouldn’t have to compromise in seeking justice for what’s been done to them.Amanda TherrienStaff lawyer, National Association of Women and the LawAs a feminist law reform organization, the National Association of Women and the Law strongly condemns forced and coerced sterilization. It is a grave violation of bodily autonomy that disproportionately harms Indigenous women, disabled individuals and intersex and trans people in Canada. Survivors deserve justice and meaningful change.That said, Bill S-228, as currently drafted, is unlikely to deliver that change and may create new problems.The conduct the bill is trying to address is already illegal under the aggravated assault provisions of the Criminal Code. Bill S-228 does not create a new standalone offence of forced or coerced sterilization. Instead, it adds a “for greater certainty” clause stating that sterilization procedures count as wounding or maiming. The complication lies in how the bill defines “sterilization procedure.” It requires proof that the procedure resulted in the “permanent prevention of reproduction.” Under current aggravated assault law, the Crown does not need to prove permanent loss of function to establish maiming. By adding that requirement, the bill may actually raise the evidentiary bar for survivors seeking accountability.NAWL is also concerned that the bill, as drafted, may dissuade doctors from providing care that results in permanent contraception, including voluntary sterilization for women and gender-affirming care for trans people. Even though consensual procedures are not covered by the act, we fear that the risk of criminalization could result in a chilling effect on the availability of that care, particularly in provinces that have already moved to restrict access to gender-affirming healthcare.Most importantly, criminal law does not address the root causes of forced and coerced sterilization. Survivors and Indigenous organizations have called for culturally safe care, stronger consent practices, professional discipline, data collection, reparations and survivor-led accountability. Those solutions lie largely within healthcare systems and regulatory bodies, not the Criminal Code.As this bill moves through the House of Commons, NAWL will continue to push for systemic, survivor-driven solutions that prevent coercion while protecting reproductive autonomy.Helen KennedyExecutive director at Egale CanadaBill S-228 is an important and overdue step toward accountability for the forced and coerced sterilization of Indigenous and other racialized groups in Canada. Recognizing sterilization without consent under the Criminal Code affirms a basic principle that reproductive autonomy is a human right, and violations of that right cause lifelong harm. If enacted and properly implemented, this amendment can help deter abuse, support survivors seeking justice and signal that Canada is finally confronting a legacy of colonization, racism, and medical paternalism.However, the bill’s definition of “sterilization procedure” includes “any other procedure that results in the permanent prevention of reproduction,” highlighting a gap and broader issue of including intersex people in its description. While this amendment addresses forced sterilization in a targeted way, it leaves untouched the Criminal Code exemptions that currently permit non-consensual and irreversible surgeries on intersex young people. Often framed as “normalizing” interventions, these practices can alter reproductive structures and have lifelong physical and psychological consequences.For this amendment to realize its promise, further measures are needed. The amendment should add the prohibition of non‑essential surgeries on intersex young people until they can provide free and informed consent. Additionally, Parliament should add “sex characteristics” as a protected ground in the Canadian Human Rights Act and develop national clinical standards and oversight for consent‑based care.Bill S‑228 is progressing in the right direction, but Canada cannot end coerced sterilization while permitting non‑consensual surgeries on intersex children. Protecting bodily autonomy must mean everyone’s bodily autonomy.Krista CarrCEO of Inclusion CanadaInclusion Canada is an organization advancing the human rights and full inclusion of people with an intellectual disability. We’re supportive of Bill S-228, which would clarify that forced and coerced sterilization is aggravated assault. We want to see it receive royal assent. Under Alberta and British Columbia’s eugenic sexual sterilization laws, which were repealed in the 1970s, at least 3000 people were sterilized. Some, now seniors, are following Bill S-228, including a member of our Board of Directors who was sterilized at an institution for people with an intellectual disability.As written, Bill S-228 would protect people with an intellectual disability of all sexes. This is vitally important, because people with an intellectual disability continue to be sterilized today. Ideally, we’d like to see the bill amended to explicitly mention disability, ableism, and male anatomy outright. These amendments wouldn’t change the substance of the bill, but they would make a big difference to people who have been sterilized because of their disability. Bill S-228 offers an opportunity at recognition and closure, and we want as many people as possible to benefit from this opportunity. It was wonderful to hear disability discussed at second reading, for this reason.Bill S-228 exists because of the strong advocacy of Indigenous women, and I am grateful for their leadership. I hope these leaders see our perspective as affirming. Indigenous women were disproportionately likely to be sterilized under sexual sterilization laws. Bill S-228 is worth celebrating.Josie NepinakPresident of the Native Women’s Association of CanadaI believe that Bill S-228 is a step in the right direction and acknowledges the wrongs that were done to Indigenous women in this country. At NWAC, we condemn the practice of forced and coerced sterilization, which has been documented both historically and in recent decades.We know that Indigenous women are targeted through these procedures. Forced sterilization is a form of genocide, racialized and systemic violence against Indigenous women, which leads to many, many harms. This practice takes away the right to free, prior and informed consent, as well as their human rights as women, the right to their own autonomy and to make decisions about their body.I trust that women like Senator Boyer, who is an Indigenous woman herself, have been thorough in the oversight and accountability structures for this bill. I believe that Indigenous women have worked on this document and provided it a path forward, ensuring it has the teeth that it needs.It is critically important to respect the reproductive rights of Indigenous women in Canada. So absolutely, we support Bill S-228.Federation of Medical Women of CanadaAt the heart of the Federation of Medical Women of Canada’s mission is the promotion of well-being for women+ in both the medical profession and society at large. The FMWC supports and shares Bill S-228’s intent to protect reproductive autonomy and ensure a safe, inclusive healthcare environment, particularly in marginalized communities that have been historically wronged. The FMWC unequivocally condemns coerced or forced sterilization.Upon review and consultation, the FMWC is concerned that the Bill S-228 will negatively impact women’s health services. Politicalization and criminalization of women’s health decreases access and results in loss of bodily autonomy and reproductive rights.Women physicians now make up the majority of OBGYN’s in the country, who may now be targeted with this bill. Further, emergency care may be put at risk if doctors feel they must hesitate for fear of criminal prosecution.The FMWC advocates for the opportunity for comprehensive member education on informed consent. We seek to collaborate with regulatory bodies to enhance professional standards and ensure those found guilty of coerced or forced sterilization are brought to justice. Physicians will need to know that robust support systems are in place for providers undergoing College review, as the stress of such accusations can be life changing for physicians.Marginalized women often have little opportunity to speak to a provider alone and let their wishes be known. Fully informed consent can often be difficult due to language and cultural barriers. Their opportunity for bodily autonomy will be compromised if the provider makes decisions that will avoid the threat of criminalization rather than allowing the woman to realize her reproductive wishes. Maddi Dellplain is a Deputy Managing Editor and Staff Writer at Healthy Debate. This article is republished from Healthy Debate under a Creative Commons licence.

Bill to criminalize forced sterilization sparks debate over reproductive justice and medical practice

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