The Three Ws of children’s bodily integrity
The principle of bodily integrity sums up the right of each human being, including children, to autonomy and self-determination over their own body.
What is bodily integrity?
Why do children have it?
When is it important for protecting their rights?
The principle of bodily integrity sums up the right of each human being, including children, to autonomy and self-determination over their own body. In other words, the only person with the right to make a decision about their body is them—no one else.
Practices which violate a person’s bodily integrity are wide-ranging, from seemingly harmless acts like piercing a baby girl’s ears, to forms of violence like sexual abuse, or even medical treatment administered without a patient’s consent or against their wishes.
Children are disproportionately affected by violations of their bodily integrity because these harmful practices are usually performed on people at a very young age, when they are unable to speak up for and defend themselves, or give — or refuse — consent.
Of particular concern are the practices that enjoy majority support or indifference within the countries in which they’re practiced. These are the hardest to root out and expose as harmful to children because it would entail disturbing the status quo. Some of the most abhorrent violations of children’s bodily integrity of our time — which are still widely upheld in practicing communities — are those carried out for no medical reason on the most sensitive and private part of the human body: the genitals.
These include female genital mutilation, forced sex assignment of intersex children, forced or coerced sterilisation of children with disabilities, and routine male circumcision.
Such practices can have health-related consequences ranging from infection and scarring to disfigurement, amputation, and even death. Their impact also goes beyond the physical, as the practices infringe children’s civil rights as well, including their freedom of thought and opinion in the form of consent or its refusal. In cases where a practice is carried out to conform to social expectations or is based on adults’ — not the child’s — religion, culture or tradition, it too amounts to a violation of children’s civil rights.
With the exception of female genital mutilation—which is rightly one of the most widely recognised and challenged harmful traditional practices — the other three customs also involve irreversibly altering children’s genitals through surgery for no justifiable medical reason and without their consent, yet all remain legal in most countries around the world when performed on children and enjoy majority support in the countries in which they’re practiced.
On account of this status quo, under the following headings we make it clear why these three practices amount to a violation of children’s bodily integrity.
Routine male circumcision
Male circumcision is an irreversible procedure to surgically remove the foreskin from the human penis. It’s routinely carried out on newborns and adolescents within Jewish and Muslim communities, respectively; on infants out of social convention among non-religious communities in some Western countries, most notably the United States; and on teenage boys as a rite of passage within some ethnic groups in parts of Africa. When performed for religious or cultural — not medical — reasons, it flatly designates routine circumcision as medically unjustifiable. In fact, there’s growing support within the medical community against male circumcision as a routine practice since its non-therapeutic basis means it does not comply with medical ethics.
In sum, routine male circumcision involves the removal of healthy tissue for no medical reason from one of the most sensitive body parts, unnecessarily exposing a child to the risks of surgery, and usually at an age when they lack the capacity to consent or refuse consent. Recorded complications include bleeding, panic attacks, infection, disfigurement, necrosis and amputation, and even death. Exposing a child to such risks without curative or rehabilitative justification goes against medical ethics, as well as parental responsibilities to protect a child from injury and harm. For all these reasons, the practice is also referred to a male genital mutilation.
Advocates say: the decision to circumcise should not rest with anyone except a boy himself when he’s old enough to give his free and informed consent, or refuse it.
Sex assignment of intersex children
Intersex persons are born with anatomical characteristics that don’t match what’s typically considered either male or female, with surgery sometimes performed on intersex babies to modify their genitals so they appear more male or female. This irreversible procedure, which is done at an age when the patient is too young to consent or refuse consent, isn’t based on medical necessity, but on the paternalistic assumption that it’s better — and easier — for a child to be raised from birth either as a girl or a boy.
This practice disregards the possibility that the ‘assigned’ sex may not correspond with a child’s gender identity as they get older. Besides this, the procedure unnecessarily exposes an intersex child to the risks of surgery and possible permanent consequences, including scarring, incontinence, lack of sexual sensation and infertility. And when testes or ovaries are removed, the surgery amounts to forced sterilisation. Psychological trauma and post-traumatic stress disorder (PTSD) have also been recorded, with intersex adults saying they feel they were mistreated and mutilated.
Advocates say: the decision whether or not to have surgery should rest only with an intersex person themself when they’re old enough to make an informed choice. In 2015, Malta became the first country in the world to ban medically unnecessary sex assignment surgeries on intersex children before they can decide for themselves.
Forced sterilisation of children with learning disabilities
Sterilisation involves surgery to leave a person permanently unable to reproduce. Forced sterilisation occurs when the procedure is done without the affected person’s knowledge, in the absence of their informed consent, or against their express wishes not to be sterilised. People with learning disabilities, including autism and Down’s syndrome, are forcibly sterilised all over the world based on doctors’ recommendations and with the consent of parents or guardians.
The practice isn’t unique to children, but many are affected, especially girls. In Colombia, for example, at least 502 girls and 127 boys with learning disabilities were legally sterilised between 2009 and 2011, according to government figures. But the reasons routinely given by doctors and parents to justify the procedure are not based on medical necessity; instead it’s a paternalistic measure considered ‘for their own good’. Preventing menstruation and unwanted pregnancies are two common reasons, as is the misconception that people with learning disabilities are devoid of sexual feelings or the ability to have a relationship or children. Another claim is that sterilisation prevents sexual abuse, despite the fact that it actually hides the outcomes of the abuse, making the already vulnerable even more vulnerable.
Advocates say: forced sterilisation violates a person’s right to make their own sexual and reproductive choices, and that sterilisation should only be performed strictly on medical grounds and with the informed consent of the patient.
A glossary of bodily integrity
My body, my choice
Autonomy
Self-determination
Forced
Injury and harm
Consequences
Dignity
Privacy
Protection
Sexuality
Gender
Children’s rights
Civil rights
Parental responsibilities
Medical ethics