The number of girls sold into forced marriages and the rate of so-called “honour crimes” spikes during the Christmas season, a UK based charity has claimed.
Karma Nirvana, a national charity that trains the police, NHS, and social services on the issue of honour-based abuse and forced marriage, said that the horrific crimes against girls and women spike during the holiday season in the UK.
The charity said that “honour crimes” including forced marriages, female genital mutilation and “honour killings” rose by 57 per cent during December of last year and January of this year, according to The Independent.
574 cases (33%) involved victims below 18 years of age; and a further: 542 cases (31%) involved victims aged 18-25.
165 cases (9%) involved victims aged 26-30.
146 cases (8%) involved victims aged 31-40.
45 cases (3%) involved victims aged 41 and over.
In 17% of cases the age of the victims was unknown.
In 2018, the majority of cases – 1,322 (75%) – involved women, with 297 cases (17%) involving men (gender in the remaining cases was unknown). These proportions are in line with previous years.
Forced marriage is illegal in England and Wales. This includes: taking someone overseas to force them to marry (whether or not the forced marriage takes place) marrying someone who lacks the mental capacity to consent to the marriage (whether they’re pressured to or not)
Forced marriage is not a problem specific to one country or culture. Since 2011, the FMU has handled cases relating to over 110 countries across Asia, the Middle East, Africa, Europe and North America.
Natasha Rattu, the director of Karma Nirvana, said that despite the spike in honour crimes, the charity receives 22 per cent fewer calls from the public and officials during December because authorities believe it to be a low-risk period.
“It is strange you do not get the same increase of calls before Christmas as you get before other holidays because we know that pupils go missing around Christmas. We tend to find it is the week before they break up because travel tends to be cheaper”, Rattu said.
“Those absences go unnoticed because it is Christmas – girls at risk are more invisible at that time of year. Everything before and over Christmas grinds down to a halt. There are often fears among victims about escalation over the festive period”, she added.
Despite banks’ recent efforts to promote gender equality, women are leaving the trading floor and make up as little as 11% of director and managing-director roles in finance, according to one study. What’s behind the gap? The daily grind may be preventing some women from climbing the ranks, according to a Bloomberg report, with female trading professionals telling the news outlet that constant interruptions when they speak at meetings, getting paid less than their male colleagues and working without female role models has been taking it’s toll.
By Crimson Tazvinzwa
Riva Gold, News Editor at LinkedIn
This has been an issue in finance for a long time — when I was covering markets, it was rare to find women in trading to talk to across regions and institutions, let alone one who was overseeing broader trading operations. Interviews featured in this Bloomberg article suggest that unfortunately, despite major efforts to improve gender balance at banks, not much has happened for women in trading, especially not in senior positions. Do you see the landscape starting to change?
Women Desert Trading Floors as Bias Blocks Path to Management
Rhona Gibson says it is a few steps forward, a few steps back on certain trading floors. “Banks are trying to hire and promote women, and several pointed to specific programs and goals. But upper levels of management don’t show it. None of the top 10 investment banks has a woman running global currencies trading, according to information provided by the banks. [Camilla] Sutton and Catherine Flax, the former Americas head of foreign exchange and commodities at BNP Paribas, were among women highlighted in a Bloomberg story three years ago on the rise of female currency traders. Both have since left the industry.”
It wasn’t until the 1980s, after a series of nervous breakdowns, that Bo Laurent—then in her 30s—set out to investigate the source of her deep distress.
The truth, when it finally came, was both liberating and traumatizing: Bo discovered she had been born with atypical genitalia, which surgeons had operated on to make her look—arbitrarily—more typically female, inflicting irreversible harm on her in the process, and telling her parents that they should never reveal to Bo the surgery she had undergone as an infant.
Intersex and the City|Huffpost||
Doctors had told Bo’s parents, and Bo herself once she found out, that her condition was so rare there was no one else like her. But after learning the truth from her medical records, and as she traveled the country telling her story, she found this was untrue. Her California mailbox began to fill with letters from people describing similar experiences.
In 1993, Bo, using the name Cheryl Chase, founded the Intersex Society of North America (ISNA) to meet and help people who, like her, were born with biological sex characteristics that fall outside typical definitions—that is, their chromosomes, gonads, or internal and external sex organs differ in some way from what science and society have long deemed to be “male” or “female.”
ISNA became an eddy of activists, a support group for traumatized people who had more questions than answers, and the birthplace of momentous historical agitations such as “Hermaphrodites with Attitude.” Their mission was to convince the medical establishment to respect intersex people’s rights to health and bodily autonomy by stopping “normalizing” surgeries on children before they were old enough to understand the procedures and consent to them.
Speaking Truth to Power
ISNA’s message was not anti-doctor, or even anti-surgery, but pro-informed consent. Operations to alter the size or appearance of children’s genitals risk incontinence, scarring, lack of sensation, and psychological trauma. Surgery to remove gonads can amount to sterilization without patients’ consent, and then require lifelong hormone replacement therapy. The procedures are irreversible, severed nerves cannot regrow, and scar tissue can limit options for future surgery.
Bo and the other early ISNA participants believed the truth would soon set them—and future generations of intersex people—free. Their thinking, as Bo told me when we first met in the fall of 2016 near her home in Sonoma county, California, was: “As soon as we get our stories out there, this will all stop. Once doctors realize the harm they’ve done, they’ll change their minds and methods.”
But it wasn’t that simple.
Convincing the medical establishment proved to be significantly more complicated than anyone expected.
A change in medical paradigms requires a shift in understanding what the medical evidence shows—in this case, an acknowledgment that, although empirical data remains incomplete, there is now substantial evidence that medically unnecessary surgery on infants and young children with intersex traits often causes significant harm. Conversely, there is little evidence of its putative benefits, and certainly no empirical basis on which to conclude that the supposed benefits are real, let alone that they outweigh its harms.
But it’s not easy to suggest that doctors are engaging in practices that violate their patients’ basic rights—the white coat signals a lot. As an endocrinologist in Boston told me: “Aside from clergy, who else in our society but doctors do people listen to about the heaviest life and death, sickness and health questions?”
The Default-To-Surgery Paradigm
The medical paradigm that ISNA was up against had calcified in the US in the 1960s when John Money, a psychologist at Johns Hopkins University, theorized that gender in infants was malleable and surgical interventions could unproblematically determine lifelong gender identity. Operations on intersex bodies had been conducted sporadically around the world in prior decades, but it was Money’s infamous 1967 case of recommending female sex assignment surgery on a male baby following a botched circumcision that cemented the theory as the default medical practice.
There were no clinical trials, no consideration of the potential risks, just a hypothesis from an elite practitioner based on his marquis case—which became known as “John/Joan”—driving the theory’s momentum. The outcome was, in fact, disastrous. In 1997, the patient’s psychiatrist and a sexology professor in Hawaii exposed the trauma the boy had suffered, and how Money had knowingly distorted the truth in his publications. The child had, in fact, not grown up to identify as a woman, but a man—and transitioned in his 20s.
In 2004, the patient, David Reimer, committed suicide.
The default-to-surgery paradigm, however, had already become entrenched and, in fact, was already being exported around the world.
Despite the horrors of Reimer’s story, Bo and ISNA continued to believe there was no reason to demonize doctors. The goal was to tell the stories of people who had undergone medically unnecessary surgery at an early age, explain to the medical community the destruction these surgeries had done to intersex people, and detail how surgery had failed to deliver the supposed benefits of “normalcy” and happiness.
This was their tactic to move the needle and start advocating to help intersex adolescents and adults seek the care they actually wanted. And then, the thinking went, the non-consensual surgeries would stop, social awareness would garner acceptance, and the intersex community could flourish.
Although Bo herself was invited as a keynote speaker at an AAP conference as early as 2000, even having a seat at the table did not have linear impact.
“Doctors [would tell] me that the parents of intersex kids they’d operated on were happier than the parents of kids whose lives they’d saved,” Bo said, adding that most doctors could not say how the patients themselves felt about it once they reached adulthood because the doctors simply didn’t know—they had lost touch with them.
Bo and other advocates made compromises along the way, some of which led to rifts in the community. During my research on intersex issues around the US, I heard a range of opinions, for example, on what happened in 2006 when Bo agreed to work with a group of physicians on the “Disorders of Sex Development Consensus Statement”—a collaborative paper produced at a conference in Chicago.
An intersex activist in her 60s told me she left the movement when ISNA “allowed the high priests of medicine to call us, ‘disordered.’” Another said he understood the compromise to get a seat at the table, but was disappointed it never produced results: “We’re still seen as freaks that need to be fixed 20 years later.”
In the past decade, activists have worked to claim the space that the “DSD” consensus statement staked out. They quickly replaced “disorders” with “differences”—and today human rights bodies and even a handful of clinics use that language as well. But the default-to-surgery paradigm persists.
A father of a two-year-old child with intersex traits who is a clinical psychologist told me: “If you want to fuck somebody up psychologically, start calling a part of their body deformed and then see how that works out. The whole idea of disease and even the message the surgery sent is that there was something wrong that we had to fix.”
New Words, Same Ways
Despite shifts in terminology, and despite increasing controversy even within the medical community, the cohort of doctors who specialize in intersex treatment has largely clung to the default-to-surgery paradigm. The tone has changed: at least in their writing, doctors now mostly avoid construing surgery as a “quick fix” but rather a “legitimate option.” Teams of specialists— “DSD teams”—that sometimes include mental health providers typically meet with parents as part of the decision-making process.
But despite these advances, the surgical status quo remains largely intact. And medical justifications for cosmetic surgeries ring increasingly hollow.
For example, a 2015 article co-authored by 30 DSD healthcare providers reflecting on genital surgeries stated: “There is general acknowledgement among experts that timing, the choice of the individual and irreversibility of surgical procedures are sources of concerns.” It continued: “There is, however, little evidence provided regarding the impact of non-treated DSD during childhood for the individual development, the parents, society….”
Too often, as in the article by the 30 DSD doctors, the absence of evidence becomes part of the justification for continuing early surgery. The social hypothetical—fears of stigma for the child and chaos for family and society if surgery is delayed—continues to trump the actual harm that people who have undergone surgery suffer.
The foundational medical principle—“do no harm”—seems to dictate exactly the opposite: a moratorium on medically unnecessary cosmetic surgery on intersex children too young to consent unless and until there is evidence that the benefits outweigh the harms.
Real Risks Versus Hypothetical Happiness
There is now a growing body of outcomes data showing that early surgery can lead to physical and psychological harm, if not catastrophe, for intersex people. One of the many risks of “normalizing” surgery is assigning the wrong sex. Add to that the risk of needing additional surgeries to repair mistakes (I interviewed one person who had undergone 39 surgeries to keep his body functioning after a cosmetic operation in adolescence damaged him).
Then there’s scarring, incontinence, loss of sexual sensation and function, psychological trauma including depression and post-traumatic stress disorder, the risk of anesthetic neurotoxicity in young children, and the need for lifelong hormonal therapy.
In 2017, Dr. M. Joycelyn Elders, Dr. David Satcher, and Dr. Richard Carmona, all former US surgeons-general, wrote that they believed “there is insufficient evidence that growing up with atypical genitalia leads to psychosocial distress,” and “while there is little evidence that cosmetic infant genitoplasty is necessary to reduce psychological damage, evidence does show that the surgery itself can cause severe and irreversible physical harm and emotional distress.” They said: “These surgeries violate an individual’s right to personal autonomy over their own future.”
Despite the data, many physicians who perform the surgery continue to be unmoved. A New York urologist unabashedly published a paper in 2007 documenting how his clitoral surgeries were proven effective and “nerve sparing.” The evidence he offered was produced by inserting vibratory devices in post-operative patients—in some cases, seven-year-old girls—and asking them how strongly they felt it.
More recently, in July 2017 when a hospital in South Carolina settled a medical malpractice suit for its surgery on an intersex infant for nearly $500,000, a psychologist with more than 20 years of experience with intersex patients dug in his heels and defended the status quo. “I never question people’s experiences,” he said. “What I do question is whether their experiences are generalizable to others.”
Bioethicists have documented physicians’ reluctance to change the status quo for decades. Katrina Karkazis, an ethicist at Stanford, wrote in her 2008 book on the topic a number of “folk myths” that doctors perpetuate: “[A]s increasing numbers of studies have begun to demonstrate poor surgical outcomes, some surgeons and other clinical specialists discount even these findings,” she wrote, explaining that doctors believed their surgical techniques were always improving so data from past patients was irrelevant.
Karkazis wrote: “By charging that adequate studies are impossible because they will always assess old techniques, surgeons and others deflect current as well as future scientific and anecdotal evidence of poor surgical outcomes.”
In 2015, when patient advocates and ethicists publicly resigned from the largest research initiative on intersex healthcare to date—a multi-site university hospital project funded by the National Institutes of Health—citing frustration with the continuation of medically unnecessary surgeries on intersex children, one bioethicist wrote in her resignation letter that she was finished with “being asked to be a sort of absolving priest of the medical establishment in intersex care.”
Ending Unnecessary Surgeries
The experience of those who have undergone early surgery and the principles of medical ethics suggest that doctors should weigh evident harm over hypothetical benefits. The real question doctors should be asking is how many more of their patients need to suffer before medically unnecessary surgeries end.
Medical and policy leaders have noted the need for a fundamental change in approach. United Nations human rights experts; the World Health Organization; Amnesty International; Physicians for Human Rights; every major lesbian, gay, bisexual, and transgender legal organization in the US; the American Medical Association Board of Trustees in 2016; three former US surgeons general in 2017, two US pediatrics associations later that year; and intersex-led organizations around the world have called for an end to medically unnecessary non-consensual surgeries on intersex kids.
Many providers who care for intersex children have become increasingly uncomfortable with the current paradigm, but there remains a lack of clear, centralized standards of care for intersex patients.
And so the inertia persists. ISNA has dissolved and Bo has retired from activism, but a new generation of intersex people, whose bodies were operated on decades after Bo’s, have taken up the fight. For Intersex Awareness Day 2017, activist Pidgeon Pagonis staged a protest outside the Chicago hospital where, as a child, Pidgeon’s clitoris, vagina, and gonads were all surgically altered without Pidgeon’s consent.
The hospital issued a public statement saying it was “committed to open communication with the Intersex community and fully respect the diversity of opinions that exist in affected individuals.” But a leaked internal communication struck a rather different tone, perhaps revealing why doctors continue to perform these surgeries decades after they became controversial even within the medical community. In it, the hospital called the protesters’ demands “extreme,” and said the group was targeting hospitals across the country.
Bo told me: “No one has proven that the interventions are necessary to do on an infant…. Even if you find some people who had early surgery who are happy, that doesn’t mean it’s safe or necessary…. There are probably happy people. But there are a lot of very unhappy people—ruined people.”
Women and girls are at the heart of CARE’s community-based efforts to confront hunger, ensure nutrition and food security for all, improve education and health, create economic opportunity and respond to emergencies.
Women and girls are at the heart of CARE’s community-based efforts to confront hunger, ensure nutrition and food security for all//Crimson Tazvinzwa
Today, nearly 821 million people around the world are chronically hungry and over 149 million children under five are stunted. In Mozambique, 70 percent of the population lives on less than $2 a day and 80 percent of the population cannot afford an adequate diet. The country also struggles with chronic food insecurity, and the life expectancy is alarmingly low at 58 years – one of the lowest in the world. Women and girls bear the strongest brunt of food insecurity and hunger.
Furthermore, the country is highly vulnerable to the impacts of climate shocks and extreme weather events such as drought, floods and cyclones. In March and April 2019, Cyclones Idai and Kenneth both hit Mozambique less than six weeks apart. The cyclones were the equivalent of category 2 and 4 hurricanes, respectively, and devastated local and regional infrastructure and destroyed more than 1.1 million acres of crops and productive land in the region. Cyclone Idai resulted in three million people, including 1.6 million children, in urgent need of humanitarian assistance.
On this five-day trip, the delegation witnessed how simple solutions – such as agricultural research and development, nutrition education and creating opportunities to connect small-scale farmers to markets – can empower communities to escape poverty and reach their full potential.
During the trip, the delegation met with partner organizations, such as the Food and Agriculture Organization (FAO), the International Potato Center, TechnoServe and the International Institute for Tropical Agriculture (IITA), to discuss the current challenges and opportunities in addressing hunger and malnutrition in the region. They also had the opportunity to meet with representatives from USAID and the State Department. Lastly, the delegation sat down with communities to learn about the successes and obstacles they face when it comes to food security, nutrition, education and gender equality.
Sexual behaviour in Britain: partnerships, practices and HIV risk behaviours’
Working for a human rights charity, my team and I spend a significant amount of time talking about sex. The right to have relationships with people – from friendships to sex – is part of each person’s fundamental human rights, guaranteed in law both internationally and here at home. But that isn’t the same as some rather unfortunate (and perhaps revealing) language reportedly used by a judge in a case currently at the Court of Protection, language which has hit the headlines this week.* He is quoted as saying “I cannot think of any more obviously fundamental human right than the right of a man to have sex with his wife – and the right of the State to monitor that.”
Let’s be clear, no man has the right to have sex with his wife (or anyone else). What he, and she, and everyone else, does have, is the right to have relationships and for the state to not interfere with this unless it is lawful to do so, for a legitimate (usually protective) aim, and it is proportionate to restrict that right. Clearly protecting people who do not, or cannot, consent from another person’s sexual advances meets this test. In fact, the right that protects our ability to form relationships, applies equally to all people involved, in this case the husband and the wife. As well as forming relationships, the right to respect for private life** also means that the other person does not have to have a relationship with you, ensuring that their informed consent, choice, control and well-being is secured. Indeed, human rights were an important part of dismantling English legal provisions which allowed martial rape until the early 1990s. Our criminal law, at least on paper, has caught up and it is clear that consent is required for sexual relationships; where there is no consent (which requires freedom and capacity to make that choice) the situation becomes one of rape and/or other offences under the Sexual Offences Act. And where sexual offences occur, it has been established that under the Human Rights Act there is an operarional duty on criminal justice services to investigate and protect people’s right to not be subjected to inhuman or degrading treatment.
“We’re working more, we’re working harder, and the reserve of energy we need to deal with life stress is not there anymore,” says Dr. Salcedo.
Reports of the case hitting the headlines suggest the woman has a learning disability(s) and that social services are concerned that she has diminishing capacity. Talking about capacity in this generalised way often sets off alarm bells for us. The law recognises that as people we don’t lose capacity wholesale, simply because we have a learning disability (or dementia, or a brain injury, etc.). Rather, it must be shown that we lack capacity to make a specific decision. So in this case the issue is whether the woman does indeed lack capacity to make an informed choice to consent to having sex with her husband. The woman, her rights, including her capacity, should be the central focus of the court’s undertaking. A detailed examination of the evidence, hearing arguments from those representing the woman, her husband and social services is what the judge has said needs to happen now.
The right to have relationships, and restricting this when a person’s capacity to consent may be impaired by learning disabilities or other issues, is something the courts have had to deal with before, and will continue to do so. In one case involving LC, a woman with Autistic Spectrum Disorder and a learning disability, the court found that by looking at capacity in an issue-specific context (as the law requires), it is possible to “possess the decision-making facility to embark on sexual relations whilst, at the same time, not being able to judge with whom it is safe to have those relations.”*** Another case involved CH, a man with Downs Syndrome who, after several years of living with his wife, sought fertility treatment, which triggered a capacity assessment. This found that CH could not consent until he had been provided with a sex education, which the consultant psychologist determined would enable CH to achieve capacity. The local authority wrote to his wife, WH stating that she must abstain from sexual intercourse with her husband as that would, given his incapacity to consent, be a serious sexual offence under the Sexual Offences Act. If this happened either CH or WH would be removed from the home. The course wasn’t provided to CH for 18 months, despite repeated requests on CH’s behalf. A court case was taken, which found that whilst some incursion on the sexual relations of CH and WH would have been a justifiable restriction of their rights, such a long time delay in enabling CH to achieve capacity to consent was not.****
Too often at BIHR, we see services that sweep in and assume that a person cannot consent because they are disabled or unwell and therefore staff can simply put a stop to relationships. At a recent BIHR session with care staff we were discussing a situation where a nurse had “caught” two residents who both live with dementia having sex in one of their bedrooms, and telephoned their families to relay this information. Whilst there were assumptions about what is appropriate for people with dementia, there was in fact no concern that either person did not consent. The next week we had a similar conversation with safeguarding staff where a woman with learning disabilities had been assessed as not having capacity to consent to sex, but was using social media to meet up with men to have sex. In both cases human rights law is there to protect the rights of people who do consent to sex to be able to exercise their rights to choice without public officials arbitrarily interfering and to ensure officials take positive action to step in an protect people who cannot consent, to ensure their rights to safety and well-being are protected.
There is no doubt much complexity to the case before the Court of Protection, and details in reports are patchy – but the question remains is it about misogyny? The comments of the judge certainly point to, at best an unfortunate use of language, but perhaps more worryingly deeper rooted issues about the perception of gender and women within our legal system. But we have to remember that what the headlines are leading with is the language of the person, not of human rights. Whilst the husband in this case has rights, so too does his wife, and it is in fact her human rights around capacity, choice, and well-being which will need to be paramount to the Court’s inquiry.