Legal Trends and Issues in Voluntary Sterilization

This review considers the current legal status of sterilization in the countries of the world (legal by special statute, legal by lack of prohibition, illegal, and legal status unclear) and the issues in voluntary sterilization -- approaches to law reform; personal choice; therapeutic considerations; spousal consent; age and parity restrictions; assuring availability; informed consent; waiting periods; consent by institutionalized, minor, and incompetent persons; incentives and disincentives; and rights and liabilities of providers.  In both developing and developed countries, new legislation, court decisions, government policy statements, and ministerial regulations increasingly leave the sterilization decision to the individuals involved rather than to medical experts or government officials.  These legal changes confirm that voluntary sterilization is an acceptable means of fertility regulation and a legitimate medical procedure.  In some countries barriers still exist making it difficult for poor and rural populations to obtain voluntary sterilization.  These obstacles arise when voluntary sterilization is excluded from national health and family planning programs and from private insurance plans.  Countries which explicitly declares that voluntary sterilization is legal include Singapore, Panama, Japan, the Scandinaivan countries, 2 republics of Yugoslavia, and some US states.  Countries where voluntary sterilization is legal because no law forbids it include, among others, China, South Korea, and most countries that derive their laws from English, or common law, including India, most other Commonwealth countries, and most US states.  Criminal statutes prohibiting sterilization continue in Burma, Somalia, Spain, and Turkey.  Saudi Arabia banned all contraception, including voluntary sterilization, in 1975.  Countries where the legal status of voluntary sterilization is unclear include France, Belgium, Eastern Europe, Francophone Africa, and some Latin American countries.  Because sterilization is elective and its effect on fertility is usually irreversible, new statutes and regulations often define conditions for the choice of voluntary sterilization.  These conditions vary from country to country, but virtually all these new laws accept voluntary sterilization as a legitimate family planning method, distinct from both involuntary sterilization and therapeutic sterilization.  Recent laws and regulations in the US and Europe try to assure that the choice of voluntary sterilization is made by the individual concerned and that it is made after receiving complete information about risks, benefits, and alternative contraceptive methods.  Overall, recent law reforms have dual considerations:  to remove the procedure from criminal code and to place it within the realm of family planning programs and health law, as 1 of several options available to regulate fertility; and to assure voluntary and informed personal consent to the procedure.

Johns Hopkins Bloomberg School of Public Health,Center for Communication Programs,Population Information Program