AWARE Comments on the Proposed Changes to the Voluntary Sterilisation Act.

AWARE welcomes the Ministry of Health’s aim to better safeguard the sexual and reproductive autonomy of persons with intellectual or developmental disabilities, with its proposed amendments to the Voluntary Sterilisation Act.

Enacted in 1974, the Voluntary Sterilisation Act (VSA) legalised sexual sterilisation for non-medical reasons in Singapore as part of the nation’s family planning programme. It required consent from the person undergoing sterilisation before such treatment could take place, but allowed the parents or spouse of persons with hereditary illnesses, intellectual or developmental disabilities, or health conditions such as mental illnesses or epilepsy to consent to sterilisation on their behalf.

Last month, the Ministry of Health released its Draft Voluntary Sterilisation (Amendment) Bill, which aims to align the VSA with the Mental Capacity Act (2008) and the United Nations Convention on the Rights of Persons with Disabilities, which Singapore will be signing later this year. AWARE submitted its feedback on these proposed changes to MOH as part of the public consultation that ended on Monday.

According to the Mental Capacity Act, a person with a disability or heath condition should not be assumed to lack mental capacity, which is the ability to make a specific decision at a particular time. Rather, people are assumed to possess mental capacity until it has been established otherwise. In order to align the VSA to the Mental Capacity Act, the Ministry wants to change the law to say that all those who possess mental capacity need to personally consent to sterilisation before the procedure can be carried out on them. This is a step in the right direction, as it means that someone with a hereditary illness, for instance, will be able to make her own decision on undergoing sexual sterilisation. 

However, AWARE is concerned that the proposed amendments do not adequately protect people – especially women and girls – who lack mental capacity and are therefore considered unable to consent to sterilisation. For these members of society, the Amendment Bill does not offer adequate protection against treatment for sterilisation that may not truly benefit them. Besides requiring approval from a medical practitioner, decisions to sterilise these women and girls only require the consent of one parent. Where the woman or girl does not have any parents, it is the guardian who consents; where the woman is married, only the consent of the spouse need be obtained.

Sterilisation is a highly intrusive procedure that results in the irreversible termination of a person’s reproductive function. It often has profound physical and psychological effects on a person. Intellectually disabled women and girls face greater discrimination and violence than other women, and the United Nations has noted that non-consensual sterilisation is one of the ways in which the bodies of women and girls with intellectual disabilities are violated.

Sterilisation is usually rationalised to be in the “best interests” of women or girls with intellectual disabilities. However, the reasons given often simply have to do with “social convenience” such as menstrual management, hygiene or to prevent pregnancies. Historically, many women and girls with disabilities have also sterilised in the name of eugenics.

Given the seriousness of sexual sterilisation, AWARE is deeply disturbed to find that the Amendment Bill offers intellectually disabled people lower standards of protection when it comes to sterilisation than the Mental Capacity Act does for less weighty decisions, such as managing their finances. AWARE queries why the extensive safeguards provided under the Mental Capacity Act for persons who lack capacity were not fully adopted in the Amendment Bill, since the stated intent of the amendments is to align the VSA with the Mental Capacity Act.

AWARE is also concerned that the Amendment Bill provides insufficient protection to minors. The existing law, as well as the Amendment Bill, allow persons under 21 to consent to sterilisation for non-medical reasons, provided a parent, guardian or spouse also consents. However, it is doubtful to what extent minors, especially those who are younger, are able to understand the concept of sexual sterilisation. As it stands, a number of countries either have a minimum age where persons are considered capable of consenting to sterilisation, or require a court order before a minor can be sterilised.

In its submission, AWARE made a few key recommendations:

• Voluntary sterilisation decisions should be brought under the Mental Capacity Act.
• In relation to the sterilisation of minors, there should be a minimum age at which minors are deemed capable of giving consent for sexual sterilisation (together with her parents/guardian). A court order or independent committee decision should be required for minors below this age.
• We believe that the decision to sterilise a person who lacks capacity (because of age or mental condition), except in emergency situations where the life or health of the person is threatened, should be made by a court of law or an independent committee.
• Sterilisation should only be considered when less restrictive options are not available or have been exhausted. It should not be carried out for non-therapeutic reasons such as contraception.
• More social support, respite care and training should be provided to the caregivers of persons with intellectual disabilities, including the management of their sexual and reproductive functions (such as menstruation), so that sterilisation is not seen as a method of care management.

AWARE has requested a meeting with the Ministry of Health to discuss these issues.

To download AWARE’s submission on the Draft Voluntary Sterilisation (Amendment) Bill, please click here.