Part I Experiences of being lesbian, gay, bisexual, transgender and intersex in the Asia Pacific … ensure that no-one is subjected to unnecessary medical or surgical treatment during infancy or childhood, guarantee bodily integrity, autonomy and self-determination to children concerned, and provide families with intersex children with adequate counselling and support.280 In October 2015, the Committee on the Rights of the Child criticised medically unnecessary, nonconsensual, irreversible surgeries and other medical treatment on intersex children in Chile. This was followed by recommendations to Ireland and France in January and February 2016 respectively,281 in which the Committee cited its 2014 General Comment on harmful practices, issued jointly with the Committee on the Elimination of Discrimination against Women.282 In December 2015, the Chilean Ministry of Health published a circular instructing its national health service to stop performing “unnecessary ‘normalisation’ treatment of intersex children, including irreversible genital surgeries, until they are old enough to decide about their bodies”. The Ministry also announced that a protocol would be developed to regulate health care for intersex children.283 The Gender Identity, Gender Expression and Sex Characteristics Act passed in Malta on 1 April 2015 introduced a right to bodily integrity and physical autonomy for all Maltese citizens and residents. The Act makes it unlawful to “conduct any sex assignment treatment and/or surgical intervention on the sex characteristics of a minor” that can be deferred until the person being treated is able to give informed consent. The law places additional limitations on the exceptional circumstances where interventions will be permitted when a child is not yet able to give informed consent. These include expressly excluding “medical interventions … driven by social factors”.284 In this region, the Australian Senate Community Affairs References Committee’s conclusions reiterated these concerns: There is frequent reference to ‘psychosocial’ reasons to conduct normalising surgery. To the extent that this refers to facilitating parental acceptance and bonding, the child’s avoidance of harassment or teasing, and the child’s body self-image, there is great danger of this being a circular argument that avoids the central issues. Those issues include reducing parental anxiety, and ensuring social awareness and acceptance of diversity such as intersex. Surgery is unlikely to be an appropriate response to these kinds of issues.285 The Committee’s recommendations included developing human rights-based guidelines that ‘favour deferral of normalising treatment until the person can give fully informed consent, and seek to minimise surgical intervention on infants undertaken for primarily psychosocial reasons’.286 Fear of discriminatory attitudes can never justify human rights abuses, including forced medical treatment and violations of an intersex person’s right to physical integrity. States have a duty to combat harmful stereotypes and discrimination, rather than reinforcing them.287 280 Committee on the Rights of the Child, Concluding Observations: Switzerland, 2015, CRC/C/CHE/CO/2-4. 281 Committee on the Rights of the Child, Concluding Observations: Chile, 2015, CRC/C/CHL/CO/4-5; Committee on the Rights of the Child, Concluding Observations: Ireland, 2016, CRC/C/IRL/CO/3-4, para. 40; Committee on the Rights of the Child, Concluding Observations: France, 2016, para 48. The Committee’s comprehensive recommendations are included in the summary of treaty body recommendations that close this section of this chapter. 282 Committee on the Elimination of Discrimination against Women and Committee on the Rights of the Child, Joint General Recommendation No. 31 of the Committee on the Elimination of Discrimination against Women / General Comment No. 18 of the Committee on the Rights of the Child on harmful practices, 2014, CEDAW/C/GC/31-CRC/C/GC/18. 283 M. Carpenter, ‘Chilean Ministry of Health issues instructions stopping ‘normalising’ interventions on intersex children’, 11 January 2016; at https://oii.org.au/30250/chilean-ministry-stops-normalising/. 284 There is a provision in article 14(2) of the Gender Identity, Gender Expression and Sex Characteristics Act for treatment to be agreed in exceptional circumstances. However, ‘medical intervention which is driven by social factors without the consent of the individual concerned will be in violation of this Act’. 285 Australian Senate, Community Affairs References Committee, Involuntary or Coerced Sterilisation of Intersex People in Australia, October 2013, p. 74. 286 Ibid, p 75. 287 OHCHR, Fact Sheet: Intersex, 2015. Chapter 4: Being intersex in Asia and the Pacific | 73