Sterilization of women with disabilities is legal in France following a law change introduced in 2001. Despite being prohibited by the Istanbul Convention, it is only criminalized in 9 EU countries.
In a small gynecological office in Paris, the midwife Béatrice Idiard-Chamois receives a new patient. She is a young girl, no more than 25 years old, with autism and non-verbal. It is her mother who accompanies her along with a midwife from the center for people with disabilities where she will soon be admitted. They want her to have her tubes tied even though she has never had sex.
The query runs smoothly. Idiard-Chamois performs an external examination. “We never do vaginal palpation when the patient is a virgin,” she explains. The girl, despite not being able to speak because of her disability, does not express any disagreement. But the midwife is disturbed by the constant presence of the institution’s professional, who is surprised when the request for sterilization is rejected.
Although not officially, “the centers always require that the inmates take some form of contraception,” says Idiard-Chamois. “This is how you avoid problems.”
In more than a hundred of the cases that he has dealt with, the women were under some kind of contraceptive treatment. “The institution itself gives them the pill. It is prescribed by a psychiatrist, not even a specialized doctor. They give everyone the same pill without performing a gynecological examination, ”she denounces.
Idiard-Chamois created in 2015 the only consultation in France adapted to women with disabilities at L’Institut Mutualiste Montsouris in Paris. Since then, she has cared for more than 700 patients and received half a dozen requests for sterilization and some fifty requests for contraception for women with disabilities under guardianship, “the majority from her parents,” she emphasizes.
She always tries to dissuade them and offer “less violent and definitive” alternatives.
In the case of this young woman, her mother and legal guardian accepted one of those alternatives, but this is not always the case. In France, as in the rest of Europe, there are hardly any records of this practice.
“What we suspect is that there are probably sterilizations that are done without really consenting or at the request of the families, arranging it with the gynecologist,” admits the medical advisor of the Île-de-France Regional Health Agency, Dr. Catherine Rey- Quinio.
Rey-Quinio claims to have received an average of two to four requests for sterilization per year in the last decade. Only two in the last four years. Both in 2021 and with a favorable opinion from the regional committee of experts that she coordinates. But this is only one of the eleven French health regions. The rest have not shared their data with this publication.
The only official figures in this regard at the national level date from 1998. According to a report by the General Inspectorate of Social Affairs (IGAS by its acronym in French), each year some 500 women with disabilities were subjected to forced tubal ligation.
The chimera of securing consent
Sterilization of women with disabilities was illegal in France at the time. Now, however, it can be done, albeit in a controlled way. Following a change in the law in 2001, France became one of the 23 countries in the European Union that do not criminalize this practice despite being prohibited by the Istanbul Convention.
The text focuses on consent. As Seban Avocats lawyer Didier Seban explains, the judge must guarantee that the patient has understood the process and agrees with it: “if a woman says no, it means no”.
But the abuses occur in women with disabilities that prevent them from expressing themselves verbally. In these cases, Seban considers that the guardianship judge should not grant her approval, but the opposite is usually the case.
The judge’s decision is supported, although not binding, on the opinion of an expert committee made up of specialists: gynecologists, psychiatrists and representatives of disability associations who evaluate the case, including the contraindication of any other contraceptive method, legal requirement essential for sterilization.
The gynecologist Ghada Hatem, chief physician of the Maison des Femmes de Saint Denis, is part of that committee. In her opinion, “you have to be realistic. When the mental disability is very deep, there are women who do not understand what we say, they do not speak, sometimes they move very little, and we know very well that they cannot give their opinion”. For this reason, she acknowledges, “we contact parents or guardians when it seems reasonable.”
“We cannot dream”, shares Rey-Quinio. The medical decision in these cases is based on “seeing the benefit-risk of the intervention for the patient”.
This is what happened in 2016 to one of the Idiard-Chamois patients. The gynecologist with whom the midwife works signed the recommendation for the guardianship judge to sterilize a girl without the ability to express her will.
It is the only demand for sterilization that they have accepted since they opened the consultation. The midwife assures that she did not agree and did not put her signature. “She was a young woman for whom the contraceptive implant had not worked and her mother did not stop harassing us to sign the authorization,” she recalls, annoyed that they could not obtain the patient’s opinion.
“What would be the idea of doing something that is not irreversible? If we knew that in five years his disability would have been cured and he would be able to take care of his son independently, but this is not true, so why impose something that must be renewed periodically”, defends Hatem.
The spokesperson for the Droit Pluriel association, Faustine Lalle, criticizes that the law “does not provide specific provisions for women who cannot express their consent”, leaving the decision in the hands of the judge. In addition, she denounces that “the sexuality of people with disabilities is a taboo subject”, which means that they lack information about their sexuality that allows them to “understand the procedure and form a free and informed opinion”.
This also leads women with disabilities to be more victims of sexual abuse, especially those in institutions. For this reason, in these cases, Matron Idiard-Chamois sees no point in sterilizing women who, according to her experience, have never had sexual relations before.
A pioneering complaint before the European Court of Human Rights
The young people with mental disabilities Joëlle Gauer, Brigitte Thill, Françoise Gout, Nadège Boudevillain and Carole Gouley were under administration supervision when they were subjected to tubal ligations without their knowledge between 1995 and 1998. They were workers in an employment assistance center (CAT ) in Sens, in the Yonne department.
Their case is paradigmatic and marked the change in legislation in France, because they were the first to denounce this abuse before the European Court of Human Rights in 2008. The lawyer who defended them was Didier Seban. “It had to be their guardian who filed the complaint, and that guardian was the center that sterilized them.”
“The most serious thing is that not only was it prohibited and no woman could be sterilized in France, but also special protection should have been given to those who had no means,” Seban says.
They lost the case as the statute of limitations had expired, but the lawyer found positive that “the existence in France of an important practice of sterilization of young people with disabilities was demonstrated” outside the law and for which no doctor or organization had been sanctioned.
Fifteen years after the decision of the high court, the lawyer wonders what would have happened if it had ruled in his favor. “We expected a lot from this decision for all young women with disabilities in Europe. It would have had a legal impact in all countries.”