ERRC Concerns: Coercive Sterilisation of Romani Women in Slovakia

30 January 2003

Throughout autumn 2002, the ERRC undertook field missions to Slovakia to investigate reports that coercive sterilisations -- contraceptive gynaecological procedures absent full and informed consent -- continue to be performed on Romani women. On the basis of this research, we believe such reports are well founded.

From the 1970s until 1990, the Czechoslovak government sterilised Romani women programmatically, as part of policies aimed at reducing the "high, unhealthy" birth rate of Romani women. The policy was condemned by the Czechoslovak dissident initiative Charter 77, and documented in the late 1980s by dissidents Zbynek Andrs and Ruben Pellar. Human Rights Watch addressed the issue in a comprehensive 1993 report on the situation of Roma in Czechoslovakia, concluding that the practice had ended in mid-1990. Criminal complaints filed with Czech and Slovak prosecutors on behalf of groups of sterilised Romani women in each republic were dismissed in 1992 and 1993.

Throughout the late 1990s, there have been periodic indications that the practice may be continuing. In Slovakia in particular, the purported high birth rate of Roma is a regular feature in public discourse on Roma, frequently in the context of right-wing rhetoric warning that "they will outnumber us by 2050". In the documentary film "Gypsies of Svinia", a Slovak medical practitioner openly advocates the sterilisation of Roma. Several Finnish nurses alerted Amnesty International in 1999 when all or most of the women in a group of Romani women applying for asylum in Finland appeared to have been subjected to invasive gynaecological procedures; the women were all expelled from Finland before the matter could be investigated further. In 2001, the government was compelled to comment on whether it would take measures to reduce the birth rate of Roma, with Deputy Prime Minister Pal Csaky stating that any measures undertaken would have to be in conformity with international law. The issue of the alleged targeting of Romani women for sterilisation is extremely sensitive in Slovakia; two reports published by OSI in 2001 met with widespread denial by nearly all actors, sympathetic or otherwise.

ERRC Research

During autumn 2002, ERRC undertook field research to investigate the issue. Five ERRC staff members -- including the executive director -- undertook missions with the assistance of local partners. On the basis of those missions, we believe that there is a serious issue in Slovakia of racially-based contraceptive sterilisations of Romani women, taking place absent acceptable -- and in many cases even rudimentary -- standards of informed consent. In addition, there may be other abuses of the rights of Romani women in the context of obstetric and gynaecological medicine. For example, the ERRC documented one case in which a Romani woman had apparently been maliciously recommended for abortion by a local doctor on possibly as many as four occasions, due to a purported defect in the foetus; during a fifth pregnancy, she sought a second opinion in Bratislava (after again being told that the foetus was defective), and was told that in fact the foetus was healthy (after which she gave birth to a healthy child). In addition, on the basis of our preliminary research we believe that a disproportionate number of Romani women may be being recommended for caesarean sections, even after factors such as the youth of some prospective Romani mothers -- and therefore their small physical size -- are discounted.

In the case of abusive sterilisations, we believe we are looking at a very wide variety of factual issues, broadly within the following parameters:

• Cases in which consent has been secured, and such consent meets medical, ethical and legal standards of full and informed consent; we believe such cases constitute approximately 10-20% of the ones we have seen.
• At the other end of the spectrum, cases in which there may be criminal malpractice: a woman has been sterilised, although she has not given any form of consent. We believe such cases constitute no more than 10% of all sterilisations of Romani women. We also believe that even in such cases, there is the possibility that -- given the evident presence of ill will and malicious intent on the part of some members of the Slovak medical community -- forged consent signatures may exist.
• Cases in which some form of consent has been given for sterilisation, but consent has not been to the standard of "informed": misinformation, manipulative information, pressure, tricks, bluster, etc. have been applied in order for authorities to secure "consent", or a lack of clear and understandable information has been provided to patient prior to seeking her consent. The overwhelming majority of the cases we have seen fall into this "grey zone".

Finally, on the basis of preliminary research, we have reason to believe that there are similar concerns in the Czech Republic and Hungary. Indeed, given the high levels of anti-Romani sentiment throughout Central and Eastern Europe, as well as the strength of doctrines of paternalism in medical practice in the region, we have no compelling reasons to believe that the issue is absent elsewhere. Slovakia is of particular concern due to the extent and frequency with which the idea of coercive contraceptive measures have emerged as part of public discourse on Roma in the country. However, we have reason to believe that if all facts could be known, differences between Slovakia and other countries of the region would be ones of degree rather than kind.

The issue was raised in the first series of OSI's EU Accession Monitoring reports, wherein it was unfortunately presented with no substantiating information and supported by a footnote stating "Zoon, 2001, (forthcoming)". The second OSI publication, Ina Zoon's On the Margins -- published several weeks later -- presents a balanced account of what could be presented at the time:

• That there were pre-1989 sterilization campaigns;
• That a disturbing discourse about sterilising Romani women has continued throughout the 1990s;
• That there are post-1990 allegations of coercive sterilisations of Romani women.

However, at the press launch for the event, all or nearly all local players took issue with the report.

The ERRC partner organisation NEKI is currently involved in litigation on behalf of a Romani woman who "consented" to contraceptive sterilisation after she was offered a procedure by medical practitioners which she now contends she believed was related to cleaning. In early January 2003, ERRC undertook preliminary research in the Czech Republic, in the city of Ostrava. Of 35 sterilisation cases of Romani women documented, approximately 25 appear to have involved inadequate levels of information as to possible consequences, and a number of the issues of pressure, misinformation and outright trickery appear similar to the cases documented in the course of research in Slovakia.