Breakthrough: Challenging Coercive Sterilisations of Romani Women in the Czech Republic

15 December 2004

Claude Cahn¹

The week beginning September 13, 2004 caught the ERRC and partner organisations off-guard for what it is now clear has been among its most significant actions to date – the effort to challenge the coercive sterilisation of Romani women in the Czech Republic. That week saw publication of an article by the Czech Press Agency, the state wire service, stating that the ERRC alleged coercive sterilisations of Romani women were ongoing in the Czech Republic. That article began what would soon amount to an avalanche of domestic media attention to the issue, significantly moving the justice agenda along.

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. This policy was decried by the Czechoslovak dissident initiative Charter 77, and documented extensively in the late 1980s by dissidents Zbynek Andrs and Ruben Pellar. Helsinki Watch (now Human Rights Watch) addressed the issue in a comprehensive report published in 1992 on the situation of Roma in Czechoslovakia, concluding that the practice had ended in mid-1990. A number of cases of coercive sterilisations taking place in 1990 or before then in the Czech part of the former Czechoslovakia have also been recently documented by the ERRC. Criminal complaints filed with Czech and Slovak prosecutors on behalf of sterilised Romani women in each republic were dismissed in 1992 and 1993. No Romani woman sterilised by Czechoslovak authorities has ever received justice or even public recognition of the injustices to which they were systematically subjected under Communism.

During 2003 and 2004, the ERRC and partner organisations in the Czech Republic undertook a number of field missions to the Czech Republic to determine whether practices of coercive sterilisation have continued after 1990, and if they were ongoing to the present. The conclusions of this research indicate that there is significant cause for concern that to the present day, Romani women in the Czech Republic have been subjected to coercive sterilisations, and that Romani women are at risk in the Czech Republic of being subjected to sterilisation absent fully informed consent.

During the course of research, researchers found that Romani women have been coercively sterilised in recent years in the Czech Republic. Cases documented include:

• Cases in which consent has reportedly not been provided at all, in either oral or written form, prior to the operation;
• Cases in which consent was secured during delivery or shortly before delivery, during advanced stages of labour, i.e. in circumstances in which the mother is in great pain and/or under intense stress;
• Cases in which consent appears to have been provided (i) on a mistaken understanding of terminology used, (ii) after the provision of apparently manipulative information and/or (iii) absent explanations of consequences and/or possible side effects of sterilisation, or adequate information on alternative methods of contraception;
• Cases in which officials put pressure on Romani women to undergo sterilisation, including through the use of financial incentives or threats to withhold social benefits;
• Cases in which explicit racial motive appears to have played a role during doctor-patient consultations.

Before the events of September, officials in the Czech Republic acknowledged privately to the ERRC (but not yet publicly) that there is a serious problem of a lack of patients rights culture in the Czech medical community.

Coercive sterilisation is a very serious form of human rights abuse. Coercive sterilisation is a violation of the bodily integrity of the victim and can cause severe psychological and emotional harm. In addition, coercive sterilisation restricts or nullifies the ability of a woman to bear children, and does so without her having been able to participate fully in a decision of such evident import, the consequences of which are in many cases irreversible.

The ERRC first presented the results of preliminary research at an OSCE meeting in Vienna in April 2003. The ERRC also presented substantial parts of its research results to the UN Committee Against Torture, timed for that body's review of the Czech Republic's compliance with its international law obligations in the area of torture and inhuman or degrading treatment or punishment. In June 2004, on the basis of the material presented, the UN Committee Against Torture recommended to the Czech government that it "investigate claims of involuntary sterilisations, using medical and personnel records, and urge the complainants, to the extent possible, to assist in substantiating the allegations".

Some Czech authorities objected to the ERRC's use of international fora to publish research results, and urged us to use domestic procedures for seeking justice. We were, however, for a number of reasons reluctant to file criminal complaints with police or prosecutors in the cases of which we were aware. Among those reasons were awareness of the legacy of action to challenge coercive sterilisations of Romani women in Slovakia. There, throughout 2003, after a number of Romani women filed complaints with police, police investigators undertook insensitive or harassing investigations, in some cases causing women to withdraw complaints and in all cases causing trauma. The ERRC was also constrained from turning over research material to Czech authorities due to the confidentiality in which Czech Romani women had provided information to the ERRC. At the urging of a number of persons in the Czech human rights community, we opened discussions with the Public Defender of Rights – "the Ombudsman" – as to the possibility of filing complaints with that instance. In June 2004, we traveled to Brno to meet personally with the Ombudsman to discuss the matter.

The ERRC then returned to the field with partner organisations League of Human Rights², Life Together³ and IQ Roma Service⁴ and, in September 2004, facilitated complaints by ten Romani women coercively sterilised by Czech doctors during the period 1994-2001. During the same week in which we filed the ten complaints, we also sent a letter to the Ombudsman, copied to the Czech government's Human Rights Commissioner, in which we noted that the ten complaints filed were not the only cases of which we were aware, and that the nature of the issue mitigated in favor not only of justice in the ten individual cases, but also of the establishment of a procedure which might make it possible for other victims of coercive sterilisations to come forward. The substantive parts of that letter to the Ombudsman follow here:

"Your office should by now have received complaints filed on behalf of ten Romani women whom we believe have been coercively sterilized. These are not the only cases of coercive sterilization of Romani women in the Czech Republic of which we are aware. They are rather ten cases in which a convergence of factors including but not limited to the willingness of the victim to pursue legal measures under present conditions, our independent assessment of the victim's ability to endure difficult legal proceedings, as well as a number of other factors, have converged to make formal complaints possible. We are confident that your office will handle these complaints with all due sensitivity and regard for the best interests of the victims and their right to a just remedy.

"As discussed during our meeting in Brno, in order for justice to be done and to be seen to be done for all victims of these practices however, we believe the nature of the issue is such that it will ultimately require a law establishing (i) recognition that practices of coercive sterilization have been prevalent in the Czech Republic; (ii) procedures (including all relevant safeguards for the safety and privacy of the complainant) specific to the issue of coercive sterilization, under which victims of such practices may come forward and claim due compensation."

Due to the sensitivity of the issue, the organisations undertaking the action agreed that they would not seek media attention to the issue while filing the complaints. However, either because material concerning the earlier UN Committee Against Torture review remained on the ERRC website or (more likely) because of a leak, the article mentioned above appeared in the Czech Press Agency wire. This claimed that the ERRC had presented a statement about the issue at an OSCE meeting on racism in Brussels on September 13. This was not true (our statement at that meeting was on Roma rights in Russia), but has since taken on the status of established fact, repeated widely in a number of media. In any case, the cat was now out of the bag.

Media coverage of the issue early in the week of September 13, following the initial Czech Press Agency article covered the action more-or-less as an issue of "International Organisation Makes Ludicrous and Ill-Founded Claims against the Good Name of the Czech Republic", quoting a number of public officials. However, by mid-week, media coverage changed. In the first place, the Ombudsman's office confirmed that that instance had ten serious complaints by Romani women concerning the sterilisation of Romani women. Also, the ERRC and the three partner organisations issued a joint press release on September 16 clarifying the nature of the action and our views on the dimensions of the problem. By the end of Friday, September 17, the story was "NGOs Raise Serious Concerns Related to Czech Medical Practice".

As public discussion of the issue grew more serious, the role of race in the matter came under scrutiny. The ERRC had presented ten cases of Romani women coercively sterilised to the Ombudsman. Other Romani women who alleged that they had been coercively sterilised had begun to come forward and speak with journalists. However, some non-Romani women also began writing into the Czech press that they too had been sterilised without their informed consent by Czech doctors. Some began to frame the issue as a patients' rights issue drained entirely of its racial character. Our position was and remains: all women in the Czech Republic have been under threat of coercive sterilisations in the Czech Republic; for a number of reasons including the complex role of racism infecting Czech medical practice, Romani women are under particular threat of coercive sterilisation.

Close Your Eyes, I’m Sterilizing1 Testimonies of women who have been involuntarily deprived of their fertility by Jan Kovalik It sounds like news from the days of totalitarianism: involuntary sterilization of women seems to be taking place in obstetrical wards. The Ombudsman ‘s office is currently trying to confirm the shocking information, but the specific stories of the women and the doctors’ responses which have been made available to Respekt show that the allegations are evidently true. It is significant that 10 of the aggrieved women have found the courage to report their cases to the Ombudsman and to fight the obstetrical wards. For the time being their names and the names of the specific hospitals are being kept strictly under wraps in order to prevent any tampering of evidence or influencing of witnesses. I will not stop fighting One of these 10 brave women is 27-year-old “Jana”, whose tragedy began seven years ago. When she was wheeled into the operating room in great pain, a nurse gave her a form to fill out. “I had just had three injections and I thought I was signing my consent to a Caesarian. At that moment I would have signed anything to get it over with,” Jana says. Her joy at the birth of her little girl drove the memory of that signature into the back of her mind. She did not find out what she had actually signed until she visited a doctor after unsuccessfully attempting to have another child. “ I was completely shocked, because we had so looked forward to another child. I didn’t understand, I didn’t know what to do. I had no idea I could seek help for such a personal matter,” recalls Jana. Her only chance to have another child today is artificial insemination – a CZK 52 000 (EUR 1 700) procedure for which there is no guaranteed result. She and her partner tried for another child, but the fetus was not viable. “We can try two more times, in January we will try again. I know it can work and I will not stop fighting for another child,” Jana says. Jana’s friend Gisela Pacenova has lived through a similar story: When the doctors placed her newborn little boy in her arms six years ago, they simultaneously told her that they had had to sterilize her. Pacenova did not realize that she had signed the consent form just before giving birth. “As a woman I felt like I had no value. The doctors told me that after six months they would reverse the sterilization and that I would be able to have another child,” Pacenova says. This hope comforted her when her little boy died several days later of a severe heart defect. However, when she visited the hospital six months later to reverse the sterilization, she was given the crushing news. “They told me it was irreversible. We didn’t want to give up, and when we read about artificial insemination in a magazine, we wasted no time,” Pacenova says. Having sold their car to pay for the funeral of their son, they used the remaining money for the operation. Their efforts were rewarded with success, and their healthy little boy is two and half years old today. What is most arresting in Pacenova’s case is that the doctors knew several weeks prior that they were going to have to perform a Caesarian due to the mother’s narrow pelvis. Despite this, they gave her a paper to sign agreeing to both a Caesarian and sterilization right before the birth was to be performed. Pacenova explains why she is preparing to join the 10 women whose cases are being investigated by the Ombudsman: “I signed that paper, but I couldn’t really take in any information. I didn’t even read it. Why didn’t someone speak with me about it earlier? This must not be allowed to happen to anyone else.” The burden of proof The European Roma Rights Center was the first to come forward with the information about these unwanted sterilizations. Together with the League of Human Rights, IQ Roma Servis and Living Together, the Center mapped the practices of obstetricians in this country during this year and last year. “Of course, we have available more testimonies than the 10 that are mentioned, but for the time being only these 10 women have agreed to have their cases publicized,” says Jiri Kopal of the League of Human Rights. The organizations submitted this topic to the Ombudsman and intentionally did their best to keep it from the media and the public. “We wanted to keep it secret so that documentation would not be destroyed,” says Kumar Vishwanathan of Living Together. According to Anna Sabatova, the Ombudsman’s representative, the investigation of specific cases will take months. As the examples above show, evaluating the dubious steps of the physicians will be difficult, because the women did sign their consent to the procedure. The question is whether a signature put to paper during birth pangs, under stress and the influence of sedative drugs can be considered informed consent. “Look, when a woman signs something, then she probably understands it. And I don’t believe that a woman is so altered by giving birth that she doesn’t know what she is signing,” says the head of Ob/Gyn at the Fifejda Hospital in Ostrava, Richard Spousta. His ward will probably be one of those which will have to explain its practices to the Ombudsman. Spousta confirms that in acute cases, women in his ward sign their consent to a Caesarian or sterilization on their way to the operating table. “And why not? A second Caesarian would be a risk, and therefore sterilization is an option,” says the head obstetrician. However, not all obstetrical clinics agree. “I have not performed sterilization in such a case for 10 or maybe 15 years. Today, which modern equipment, a second classic Caesarian is not a medical reason for sterilization,” says former head of the Physicians’ Chamber Bohuslav Svoboda, who today is the head of the Ob/Gyn ward of Charles University’s Teaching Hospital III. Race matters Despite the fact that all 10 cases being investigated by the Ombudsman concern Roma women – against whom the state pursued racially motivated sterilization prior to 1989 – even the initiators of this investigation reject a merely racial motive today. “This is not primarily a racial problem. This primarily concerns respecting human dignity and allowing people to decide about such crucial matters for themselves,” says Vishwanathan. Sabatova is of the same opinion; she insists that the common denominator of these cases is the half-baked medical view of sterilization. “A doctor cannot take responsibility for the patient away from the patent and make such a decision. The psychological side of the matter must also be considered,” says Sabatova. According to her, the decision to sterilize should be preceded by a patient interview with an expert and should not be for the doctor to decide. It is head obstetrician Spousta who pushes the case into the racial area all on his own when he says: “We are not racists here, but Roma are really noisy and 10 of them at a time come here to visit their relatives. You can’t come to any sort of agreement with that particular group of citizens.” This article appeared in the Czech weekly Respekt on September 27, 2004. Translation into English provided voluntarily by Gwendolyn Albert.

In its September 16 press release, the ERRC and partner organisations has presented publicly recommendations to Czech authorities on the matter. These are: 

• Establish an independent commission of inquiry investigating the allegations and complaints of coercive sterilisations. Thoroughly investigate reported cases of coercive sterilisations, and make available – and widely publicised – procedures for women who believe they may have been abusively sterilised to report the issue. These procedures should ensure privacy rights, as well as rights related to effective remedy. Provide justice to all victims of coercive sterilisations, including those coercively sterilised under Communism. Conduct ex officio investigations to ascertain the full extent of coercive sterilisations in the post-Communist period.

• Review the domestic legal order in the Czech Republic to ensure that it is in harmony with international standards in the field of reproductive rights and provides all necessary guarantees that the right of the patient to full and informed consent to procedures undertaken by medical practitioners is respected in all cases.

• Promote a culture of seeking full and informed consent for all relevant medical procedures by providing extensive training to medical professionals and other relevant stakeholders, as well as by conducting information campaigns in relevant media.

• Undertake regular monitoring to ensure that all medical practitioners seek to attain the highest possible standards of consent when undertaking sterilisations and other invasive procedures.

On Friday, September 24, the Czech Ministry of Health announced jointly with the Ombudsman's office that it would establish a commission to assist the Ombudsman with investigations into cases of coercive sterilisations. The ERRC and partner organisations celebrated this announcement. However, it has also been our concern that a commission comprised solely of Czech officials may lack suitable competence on informed consent issues to provide the full range of expertise required. At minimum, a commission comprised solely of Czech officials will be unlikely to be able to persuade all members of the public that it has been entirely independent. As a result, on September 29, the four partner organisations jointly sent a letter to the Czech Minister of Health and the Ombudsman, copied to the Czech government's Commissioner for Human Rights, urging the inclusion of independent experts on the commission, and offering assistance in providing contacts for relevant experts. That letter states:

"We welcomed news reports beginning Friday September 24 that Czech authorities intend to constitute a commission to assist with investigations into allegations of coercive sterilisations in the Czech Republic. We believe it is of the utmost importance that from the outset the commission include independent experts in human rights, medical ethics and in legal standards relating to informed consent, to ensure that the commission adequately addresses all issues of justice arising in relation to alleged practices of coercive sterilisation in the Czech Republic.

"Toward these ends, we respectfully request that Czech authorities seek the inclusion of the Council of Europe's Commissioner for Human Rights, as well as the Council of Europe's Steering Committee on Biomedical Ethics, august bodies with extensive expertise in matters related to the issue at hand. The organisations listed here note that, in addition to these important expert bodies, Czech authorities can benefit from the inclusion in the commission of other individuals and groups with expertise in the medical ethics, informed consent and other human rights issues with whom we are in contact. We are ready to assist with any and all contacts for relevant experts the Ministry, the Ombudsman, or other persons involved in the investigation may require or request to ensure that all relevant medical, legal and ethical issues are adequately evaluated. We thank you in advance for all efforts in this matter."

To date, these issues have not yet been acted upon, and it seems Czech authorities may try to keep the issue entirely domestic. This may raise serious questions about the independence of investigations.

A further development took place on October 15, when Czech media reported that the Minister of Health had announced a proposal for the creation of a "Hospital Ombudsman" to defend the rights of patients.

As of the date of this writing, there has as yet been no result of investigations into the complaints submitted to the Ombudsman in September. However, there have already been a number of positive results of the action. In the first place, the Czech public has finally opened serious debate on this issue – an issue which had remained unaddressed throughout post-Communism, despite being among the major legacies of Communism and post-Communism in the Czech Republic. More than one month after the issue was first taken up by Czech media, articles, news features and serious discussions have continued to appear in both print and electronic media. This alone is an issue of significance. Major media outlets in the Czech Republic including the Czech weekly Respekt, the Czech dailies Mlada Fronta Dnes and Pravo, and the Czech state television should be commended for high-quality journalism and the promotion of serious debate on this issue. The ERRC is reprinting herewith two of the best pieces appearing; an editorial by Petr Uhl appearing in the daily Pravo on September 22, and an article by Jan Kovalik appearing in Respekt on September 27.

Secondly – and perhaps far more importantly – a major watershed has been reached in terms of the confidence of victims to come forward. By contrast with events in Slovakia, in which in many cases victims were hounded into silence by police investigators and media, in the Czech Republic, more and more women have begun to come forward to press claims concerning coercive sterilisations they have undergone. According to information made public by the Czech Ombudsman on November 10, as of that date, more than fifty individuals had submitted complaints to the Ombudsman concerning coercive sterilisations. Two of the complaints reportedly concern non-Romani women and one was submitted by a man alleging coercive sterilisation.

Finally, on November 4, the partner organisations involved in action to challenge coercive sterilisation in the Czech Republic organised a meeting of victims to discuss the possibility of constituting a victim support group. The meeting was hosted by ERRC partner organisation Life Together in the eastern Czech city of Ostrava and was attended by all of the partner organisations, Deputy Ombudsperson Anna Šabatová and colleagues responsible for investigating the complaints, and fourteen women who have submitted complaints to the Ombudsman. At the meeting, the victims decided to constitute themselves into a formal group and to begin undertaking public action to inform other women of their rights related to this issue. The group resolved to meet monthly. Participants at the meeting spoke of their joy at finally being able to discuss in an open forum traumatic issues which they have endured in silence, in some cases for many years.

The ERRC will continue to follow up with partner organisations on this issue in the Czech Republic, both by continuing to facilitate complaints to Czech authorities concerning allegations of coercive sterilisations, as well as by organising support groups for victims. We will also continue to press for the establishment of an abuse-specific procedure such that victims of this practice may come forward in safety, comfort and privacy to press claims and receive due compensation. As in other countries to have addressed similar troubling chapters of their treatment of marginalised ethnic groups – such as Sweden and Switzerland – the matter will likely not rest in full until the government makes a full public accounting of the issue and undertakes significant proactive measures to try to make amends.

Commentary by Petr Uhl1 Forced sterilization of Roma women? When the government’s Special Rapporteur for Human Rights, Jan Jařab, was in Geneva in May at a meeting of the Committee for the Prevention of Racial Discrimination (a UN authority overseeing an international treaty binding on the Czech Republic!), the US member of the Committee asked him: “Mr Jařab, how can you be continuing the sterilization of Roma women, weren’t they all sterilized in the past?” The rest of the Committee did not agree with the opinions of this member, a famous feminist fighting against male domination in “postcommunist” countries, but it did recommend the Czech government investigate the suspicion that Roma women are being pressured into sterilization in the Czech Republic. Committee recommendations are binding for the Czech Republic. The European Roma Rights Center in Budapest has been dealing with these suspicions for several years. Serious Czech civic associations - the League of Human Rights, IQ Roma Servis and Kumar Vishwanathan’s Living Together – have filed a complaint along with them. The Ombudsman, a state authority which is independent of the government, has taken up the matter on the basis of the complaints of 10 Roma women, and this is good, since his impartiality cannot be doubted. The Special Rapporteur also has a reputation as a man who is not willing to cover up government iniquities. It seems that even today, the first-ever sources of the suspicion of forced sterilization of Roma women are the following sentences of a Charter 77 document from December 1978 entitled The Position of the Gypsies/Roma: “The question of sterilization is especially serious.... The consent of Roma women to sterilization is gained under pressure and there is no guarantee of their receiving objective medical advice. In some districts sterilization of Roma women is performed as a planned administrative practice and the success of staff is evaluated at internal meetings according to the number of Roma women they have convinced to consent to sterilization. Under such conditions any objectivity is automatically ruled out. Many times the consent to sterilization is obtained by exploiting the demagogic tactic of monetary reward. Sterilization is thus becoming one of the approaches of the majority population against the minority aimed at preventing the birth of minority children.” This Charter document is very detailed, compiled as it was in cooperation with experts in the field (several were fired from their jobs as social workers with the Roma after signing Charter 77). And that last sentence is written so as to include the definition of genocide. Despite this, back then we decided not to charge the regime with practicing genocide against the Roma, since we knew that the sterilization of Roma women was not centrally administered, but a question of local health authorities and the approaches of individual doctors to their patients. However, a quarter of a century after the Charter document, and 15 years after the introduction of a democratic order accompanied by public control of all areas of life in this society, the ERRC in Budapest is warning of possible cases of not completely voluntary sterilization. Sometimes the consent was allegedly obtained while the woman was giving birth, during labor pains. Sometimes it was given due to an incorrect understanding of the terminology, or after receiving manipulative information. Sometimes no explanation was given of the results and possible psychological effects of sterilization, or no information on alternative methods of birth control was given. The civic associations are also demanding investigation into whether social workers are pressuring Roma women to submit to sterilization by offering them financial rewards or threatening to stop their social support. Finally, what is truly unknown is any possible racist motivation of the doctor who obtains the woman’s consent. Czech government representatives are supposed to have admitted to the ERRC that the culture of the Czech medical profession in some instances has not advanced as far as patients’ rights are concerned. Special Rapporteur Jařab is said to have admitted that informed consent to sterilization is a problem, but to have downplayed the opinion that it is being performed out of racist motivation. Social Affairs Minister Zdenek Skromach has said the ERRC complaint “concerns only one place, Ostrava, which is a specific case in and of itself” and rejected their concerns as based on “stereotypical, unsubstantiated formulations and information.” The ERRC denies both claims. It seems the Ombudsman can only address one part of this matter. It is of such importance that the Czech government and the health minister should initiate an investigation to either confirm or deny the dubious practices mentioned. The charges are far too serious. This editorial appeared in the Czech daily Pravo on September 22, 2004. Translation provided voluntarily by Gwendolyn Albert.

 
Endnotes:

1. ^{Programmes Director; ccahn@errc.org.}
2. ^{The League of Human Rights is a non-governmental organisation providing free legal and psychological assistance to victims of gross human rights violations, in particular to members of the Roma minority, victims of domestic violence and children. Its mission is to create a future in which the Czech state actively protects the human rights of its citizenry and respects both the spirit and the letter of the international human rights conventions to which it is signatory (further information about the League of Human Rights is available at: www.llp.cz).}
3. ^{Life Together is a Czech Romani organisation fighting social exclusion and marginalisation in the Ostrava region of the Czech Republic, as well as strengthening Czech-Roma mutual confidence and co-operation. Further information about Life Together is available by contacting: vzajemne.souziti@tiscali.cz.}
4. ^{IQ Roma Service, based in Brno, Czech Republic, is a non-profit, non-governmental organisation active in socially excluded Roma communities. IQ Roma service provides community and social field work, free counseling and law services together with employment support for Roma clients. It also initiates social inclusion strategies for Roma and minority communities on a local level. Further information about IQ Roma Service is available by contacting: iqrs@iqrs.cz.}