on intersex infants and children before they reach an age at which they are able to provide their free, prior and informed consent.”253 It recommended New Zealand “adopt clear legislative provisions explicitly prohibiting the performance of unnecessary surgical or other medical treatment on intersex children before they reach the legal age of consent, provide the families of intersex children with adequate counselling and support and provide redress to intersex persons who have undergone such unnecessary surgical or medical treatment.”254 Also of note is that the Government accepted a recommendation from the 2019 Universal Periodic Review to consider putting an end to non-consensual medical procedures which affect intersex persons.255 In 2017, a national, multidisciplinary Clinical Reference Group was established by the Ministry of Health for a fixed term of two years.256 Under its terms of reference, the group’s membership brings together lived experience intersex expertise with clinical, psychosocial, and human rights perspectives.257 The group’s mandate is to improve health practices, systems, and approaches for intersex children and youth up to 18 years of age. The development of this group came as a result of two intersex roundtables co-hosted by the Commission, the Intersex Trust of Aotearoa New Zealand (ITANZ), and Tīwhanawhana Trust in 2016258 and 2017;259 and in response to the New Zealand government’s reporting to the Committee on the Rights of the Child in 2016.260 The group has a programme of work which includes undertaking a stocktake of current educational resources relevant for the health workforce, intersex children and young people, and their whānau; recommending tools to establish a national data set of clinical outcomes for intersex children and youth; developing a primary care referral pathway; and updating the Starship Hospital neonatal guideline about babies born with variations of sex characteristics; but has not addressed the practice of surgical normalisation in New Zealand. Informed consent Informed consent plays a fundamental role in respecting, protecting, and fulfilling the right to health. In the health setting, it means to grant permission in full knowledge of possible consequences, including the risks and benefits; and is the concept of being involved in decisions that affect a person’s life.261 In the case of people with diverse sex characteristics and gender identities, informed consent is relevant to rights regarding self-determination, bodily autonomy and integrity, and reproductive justice. Young people aged 16 or older are considered able to make decisions about their medical care.262 However, age is not a barrier to informed consent. Younger people are not prohibited from consenting to their own medical treatment if deemed competent to make an informed choice.263 Gender-affirming healthcare Throughout most of New Zealand, the provision of transgender healthcare is inconsistent. The government has admitted that delivery of health services for trans people has not kept up with the sharp increase in demand.264 National Committee on the Elimination of Discrimination against Women Concluding observations on the eighth periodic report of New Zealand UN Doc CEDAW/C/NZL/CO/8 (25 July 2018) at [23(c)]. 254 Committee on the Elimination of Discrimination against Women Concluding observations on the eighth periodic report of New Zealand UN Doc CEDAW/C/NZL/CO/8 (25 July 2018) at [24(c)]. 255 Working Group on the Universal Periodic Review New Zealand’s responses to recommendations (as of 13 September 2019) at 122.102. 256 New Zealand Human Rights Commission Intersex roundtable report 2017: Ending the practice of genital normalisation on intersex children in Aotearoa New Zealand (Wellington, 2018) at Appendix 4. 257 Ibid. 258 New Zealand Human Rights Commission Intersex roundtable report 2016: The practice of genital normalisation on intersex children in Aotearoa New Zealand (Wellington, 2016). 259 New Zealand Human Rights Commission Intersex roundtable report 2017: Ending the practice of genital normalisation on intersex children in Aotearoa New Zealand (Wellington, 2018). 260 Committee on the Rights of the Child Concluding observations on the fifth periodic report of New Zealand UN Doc CRC/C/NZL/CO/5 (21 October 2016) at [25(b)]-[25(e)]. 261 Health and Disability Commissioner (Code of Health and Disability Services Consumers’ Rights) Regulations 1996, Right 7. 262 Care of Children Act 2004, s 36. 263 Health and Disability Commissioner (Code of Health and Disability Services Consumers’ Rights) Regulations 1996, Right 7. 264 In October 2018, the Acting Health Minister stated, “Our health system has never met the needs of transgender New Zealanders, and that has to change.” See Thomas Coughlan “Gender affirmation surgery cap lifted” Newsroom (New Zealand, 23 October 2018). 253 43