In the last two decades, the government of Uzbekistan has purposefully rendered tens of thousands of Uzbek women infertile through a policy of forced sterilization. This is a criminal human rights abuse that violates international standards. Yet, this policy is allegedly employed by the federal government to boost Uzbekistan’s international reputation - as a roundabout means of lowering infant and maternal mortality statistics. If this is truly the government’s rationale for sterilization, international awareness and censure may go a long way to halting the abhorrent policy. Unfortunately, the international community has given this issue neither the attention nor outrage that it deserves.
Since the late 1990s, reports from Uzbek healthcare workers, victimized women, and third party organizations operating in the state have repeatedly claimed the existence of a government-run policy of forced sterilization. Uzbek authorities have been quick to deny these claims, and have tightly controlled what information is made available to the rest of the world. According to reports, the preferred form of forced sterilization in Uzbekisan is VSS (“Voluntary” Surgical Sterilization), in which doctors conduct laparoscopic surgery to tie a woman’s fallopian tubes. Hysterectomy, the surgical removal of the uterus, has also been employed. Both methods are irreversible.
The Uzbek government allegedly sets quotas for the number of sterilizations that hospitals and individual doctors must perform each month. Because doctors are held accountable to these quotas, there is an incentive to sterilize at all costs. Many doctors perform the surgeries without suitable equipment, a sterile environment, or patient consent. Any woman of reproductive age who has birthed two or more children is a potential target of this program A survey of Uzbek doctors by the “Expert Working Group”, an NGO operating in Uzbekistan, concluded that as many as 70,000 women were sterilized in 2011 alone, both with and without informed consent.
There are a number of strategies that doctors use to force women into the procedure. Some doctors lie to patients in order to get them to “consent” to sterilization; they will falsely claim that a woman’s health is at risk unless she is surgically sterilized, or tell patients that the procedure is reversible. Others resort to pressure and harassment – they will repeatedly go to woman’s home to “advise” her to undergo sterilization. And many doctors disregard consent altogether. In one reported case, a woman was coerced into signing consent forms while sedated and going into the operating room for a different surgery. Many women are unknowingly sterilized while undergoing unrelated surgeries or C-section births. What all of these strategies have in common is an indifference to the best interests of the patients involved.
And the outcomes of surgical sterilization are often immensely harmful. Most Uzbek hospitals are under resourced and lack basic hygiene and trained doctors. Women have been known to contract Hepatitis B and bacterial infections from surgical sterilization in these conditions. And, because doctors are operating without the proper tools or training, women commonly experience extreme pain, heavy bleeding, headaches, or even death from botched surgeries. In order to avoid the risk of sterilization, an increasing number of women are choosing to give birth at home, a choice that comes with its own dangers.
Sterilization has social implications too. Uzbek culture has a historical and deep-seated preference for large families. For women, having many children is seen as a sign of personal success. And therefore, sterilization can be socially and emotionally harrowing for women who desire more than one or two children. Sterile women are sometimes abandoned by their husbands, or lose the respect of their family and community.
Population control is not unheard of as a government strategy – China’s one-child policy being one of the most notable examples. And, at first glance Uzbekistan’s sterilization policy appears to be a particularly brutal form of population control. But it’s not clear if Uzbekistan is even in need of population control – its last census occurred in 1989 when the population was found to be 20 million people, and the country has experienced mass emigration in the intervening 20 years. Evidence does not suggest urgency for population control to the extent that would justify forcible sterilization. So why is the government pursuing it?
Some believe the government is sterilizing women in order to manipulate Uzbekistan’s maternal and infant mortality rates – as a selfish means for the authoritarian government to court international respect. Uzbekistan’s government has been strongly criticized by the west for its various human rights abuses, but has consistently received praise for lowering its infant and maternal mortality figures. The government heavily promotes these figures, and reproductive health is one of the few areas where the government can generate international legitimacy. If mass sterilization really is occurring for the international audience, than the most obvious way to end the practice is to make sterilization a source of international shame for the government rather than an underhanded way of earning respect. In other words, international leaders need to acknowledge and condemn Uzbekistan’s actions. This is easier said than done.
While systematic, forced sterilization of this kind breaks international human rights law under both the Rome Statute and the UN’s ban on torture, Uzbekistan’s practice of forced sterilization has gone largely ignored by the international community. In fact, Uzbekistan’s relationship with the United States has improved drastically in the past six years due to Uzbekistan’s geopolitical significance in central Asia, even while Uzbekistan has amped up the number of sterilizations. The European Union, another western ally of Uzbekistan, has also turned a blind eye to allegations of sterilization.
Forced sterilization is a revolting violation of human rights and medical ethics, and its practice in Uzbekistan is terrorizing thousands of women a year. Mere awareness or criticism of Uzbekistan’s policy has enormous potential to stop the victimization of Uzbek women, yet the international community has so far overlooked the reports coming out of Uzbekistan. If foreign governments value the principles of informed consent, bodily autonomy, and beneficence within their own borders, this negligence is unacceptable.