ERRC/NEKI: International Legal Action on Hungarian Sterilization

12 February 2004

Young Hungarian Romani woman sterilised without any prior explanation from doctors: ERRC and NEKI initiate international legal action.

On 2 January 2001, a Hungarian Romani woman was sterilised by doctors at Fehergyarmat hospital. While on the operating table she was asked to sign forms giving her consent to this and other operations, without a full explanation about sterilisation. No information was provided to her as to the nature of the intervention, or what the consequences of being sterilised would be. Nor did doctors tell her what the risks involved in the operation were. The right to be fully informed before an operation is a cornerstone of modern medical practice and is anchored at the core of international human rights law. Nevertheless, despite suing the hospital in Hungarian Courts, she has yet to obtain justice.

After the operation, when she learnt that she had been sterilised, the victim (Ms.S.) said "We wanted a big family. I wanted to give birth again. But I simply cannot."

ERRC and NEKI are therefore helping the victim, Ms. S., take her case to the United Nations Committee on the Elimination of Discrimination against Women.

ERRC Legal Director, Branimir Plese, said "This is a sadly typical example of women's and patients' rights violations in the health care systems in Central and Eastern Europe. Many men and women are treated as passive objects by an authoritarian caste of professionals uninterested in facilitating the individual's right to decide in matters related to her own medical care. Due to high levels of anti-Romani sentiment in the region, Romani women are particularly exposed. We hope that by bringing this case to the United Nations, we can change the practices of some doctors, and that Governments will take note and tighten relevant laws and regulations, so that cases of this kind may not happen again. Most importantly of course, we seek, finally, justice for the victim, after her long ordeal."

Note to editors

On 12 February 2004, the European Roma Rights Center (ERRC) and the Legal Defence Bureau for National and Ethnic Minorities (NEKI) jointly filed a complaint against Hungary with the United Nations Committee on the Elimination of Discrimination against Women (CEDAW) relating to an illegal sterilisation of a young Hungarian woman of Romani origin (Ms. S.). The complaint asserts that Hungary, as a State Party to the Convention on the Elimination of All Forms of Discrimination against Women, is in violation of Article 10.h. (no adequate information on contraceptive measures and family planning), Article 12 (the lack of informed consent on the part of the victim as a violation of her right to appropriate health care services), and Article 16.1.e. (the states interference with the victims ability have children in the future).

The facts of the case

On 2 January 2001, Ms. S' birth pains started. She was taken by ambulance to the public hospital in Fehergyarmat, in pain, having lost her amniotic fluid and bleeding heavily. During an examination the attending physician informed Ms. S. that her unborn baby had died in her womb and that a caesarean section needed to be immediately performed to remove the dead embryo. While on the operating table the doctor asked her to sign a statement of consent to the caesarean section. At the bottom of this form the doctor had added in a hand-written, barely readable script -- a consent to sterilisation. He wrote the Latin equivalent of the Hungarian word for sterilisation on the consent form, a word unknown to Ms. S. She signed the consent forms. The hospital records show that only 17 minutes passed from the ambulance arriving at the hospital until the completion of both operations. Before leaving the hospital, Ms. S. sought out the doctor to ask him for information on her state of health and when she could try to have another child. It was only then that she learnt the meaning of the word sterilisation and that she could not become pregnant again. This information had a profound effect on Ms. S. as she has strict religious beliefs that prohibit any form of contraception, including sterilisation.

At no point prior to the operation did Ms. S. receive full information about the nature of sterilisation, its risks and consequences, or about other forms of contraception. This lack of informed consent before a medical intervention, and the resulting inability to reproduce, amounts to a clear and compelling violation of numerous international legal standards.

Relevant international law provisions

The United Nations Committee on the Elimination of Discrimination against Women, in its General Recommendation 24, explained that "Women have the right to be fully informed, by properly trained personnel, of their options in agreeing to treatment or research, including likely benefits and potential adverse effects of proposed procedures and available information." The Recommendation further states that "Acceptable [health care] services are those that are delivered in a way that ensures that a woman gives her fully informed consent, respects her dignity, guarantees her needs and perspectives. States parties should not permit forms of coercion, such as non-consensual sterilisation."

The European Convention on Human Rights and Biomedicine states that "An intervention in the health field may only be carried out after the person has given free and informed consent to it. This person shall beforehand be given appropriate information as to the purpose and nature of the intervention as well as on its consequences and risks." The World Health Organisation's Declaration on Patients Rights states that "patients have the right to be fully informed about their health status, including the medical facts about their condition; about the proposed medical procedures, together with the potential risks and benefits of each procedure; about alternatives to the proposed procedures, including the effect of non-treatment, and about the diagnosis, prognosis and progress of treatment." It further states that "Information must be communicated to the patient in a way appropriate to the latter's capacity for understanding, minimising the use of unfamiliar technical terminology. If the patient does not speak the common language, some form of interpreting should be available."

The UN Convention on the Elimination of Discrimination against Women states that "[women] have the right to decide freely and responsibly on the number and spacing of their children." The Committee that oversees the Convention emphasised, in their General Recommendation 21, that "Decisions to have children or not ... must not be limited by Government. The means to reproduction were taken away from Ms.S. by Hungarian State actors, the doctors at the hospital, in violation of the Convention.

Legal action in Hungary

On 15 October 2001, Ms. S and her attorney filed a civil claim for damages against the hospital. They requested that the Town Court of Fehergyarmat find the hospital in violation of the plaintiff's civil rights and that it had acted negligently in its professional duty of care with regard to the sterilisation of Ms. S in the absence of her full and informed consent. The Town Court turned down the claim in its decision of 22 November 2002. On appeal, the Szabolcs-Szatmar-Bereg County Court held that the hospital doctors had indeed acted negligently in failing to provide Ms. S with the relevant information about the sterilisation and stressed that "the information given to the plaintiff concerning her sterilisation was not detailed ... [and that she] ... was not informed of the exact method of the operation, of the risks of its performance, and of the possible alternative procedures and methods". Nevertheless, and contrary to international jurisprudence as well as medical practice, the same Court then went on to conclude that sterilisations as such are fully reversible operations and that as Ms. S. had provided no proof that she had suffered a lasting detriment, she was not entitled to compensation.

Having obtained no redress in Hungary, with the assistance of the ERRC and NEKI, Ms. S. has now decided to turn to the United Nations Committee on the Elimination of Discrimination against Women and request that international justice be served.

For further details on this case, please contact Mr Alan Anstead at ERRC (Alan.Anstead@errc.org) or Dr Bea Bodrogi at NEKI (bbodrogi@yahoo.com).

Further information on the human rights situation of Roma in Hungary is available on the ERRC website (http://www.errc.org) and the NEKI website (http://www.neki.hu/).