Japan Forces Sterilization of Transgender People Seeking Legal Gender Change
“I don’t want to [have surgery], to be honest. However, I have to just because it is a requirement…I feel pressured to be operated on – so terrible.”
In Japan, any transgender individual appealing for the legal recognition of a gender change must undergo a psychiatric evaluation and forced sterilization. The discriminatory practices of Japan’s Gender Identity Disorder Special Cases (GID) Act is detailed in an 84-page report by Human Rights Watch (HRW) released on Tuesday.
The report titled, “‘A Really High Hurdle’: Japan’s Abusive Transgender Legal Recognition Process,” claims the procedures required to be undergone by any individual wishing to legally change their gender under the GID Act violates international human rights law and international medical best practices.
“Japan should uphold the rights of transgender people and stop forcing them to undergo surgery to be legally recognized,” said Kanae Doi, Japan director at Human Rights Watch. “The law is based on an outdated premise that treats gender identity as a so-called ‘mental illness’ and should be urgently revised.”
The HRW report is based on interviews with 48 transgender people, as well as with lawyers, health providers, and academics from 14 prefectures in Japan.
The GID act sets basic requirements under which an individual can seek to change their legal gender status. The requirements include an individual must not have kids under the age of 20, must undergo a psychiatric evaluation to receive a diagnosis of “gender identity disorder,” must be single and must be sterilized.
HRW’s report interviewed transgender individuals in Japan who spoke of their struggles to fit into schools, receive employment, establish a family and receive healthcare in a strict binary gender world. They also disclosed to HRW how the GID Act and its requirements hurt their self-respect and ability to be accepted by society.
“It is definitely a system that is wrecking people’s dignity as a human being,” one said to HRW. Another transgender man said he believed the law was designed to exclude trans people “in order not to admit the exceptions and so as to keep homogeneity.”
One transgender man told HRW: “I don’t want to [have surgery], to be honest. However, I have to just because it is a requirement…I feel pressured to be operated on – so terrible.”
“Of course I want to change the gender on my official family register, and have relationships with my significant other,” said a transgender woman in Tokyo. “But the walls that I have to overcome are just too big.”
What Does ‘Transgender’ Mean?
Transgender individuals are anyone who identifies with a gender and personal identity different than the sex they were assigned at birth. The physical characteristics and biological makeup of individuals who identify as transgender can vary.
According to the Intersex Society of North America, transgender is not the same as intersex:
“People who identify as transgender or transsexual are usually people who are born with typical male or female anatomies but feel as though they’ve been born into the “wrong body.” For example, a person who identifies as transgender or transsexual may have typical female anatomy but feel like a male and seek to become male by taking hormones or electing to have sex reassignment surgeries.
“People who have intersex conditions have anatomy that is not considered typically male or female. Most people with intersex conditions come to medical attention because doctors or parents notice something unusual about their bodies. In contrast, people who are transgendered have an internal experience of gender identity that is different from most people.
“Many people confuse transgender and transsexual people with people with intersex conditions because they see two groups of people who would like to choose their own gender identity and sometimes those choices require hormonal treatments and/or surgery. These are similarities. It’s also true, albeit rare, that some people who have intersex conditions also decide to change genders at some point in their life, so some people with intersex conditions might also identify themselves as transgender or transsexual.
“In spite of these similarities, these two groups should not be and cannot be thought of as one. The truth is that the vast majority of people with intersex conditions identify as male or female rather than transgender or transsexual. Thus, where all people who identify as transgender or transsexual experience problems with their gender identity, only a small portion of intersex people experience these problems.”
Understanding of Transgenderism Grows
The GID Act was drafted in 2003 and put into practice in 2004 and according to HRW was not unusual for its time.
“Other legal regimes around the world from that period contain similar discriminatory and abusive provisions. Legislatures, domestic courts, and regional human rights courts and bodies have in recent years found that such requirements violate human rights law,” says the report.
It was only in June of 2018 that the World Health Organization removed “transsexualism” from its list of mental health disorders and instead renamed it “gender incongruence” and listed in its chapter on “Conditions Related to Sexual Health.”
The change came as the WHO released its newest version of the International Classification of Diseases (ICD) manual, commonly referred to as ICD-11.
According to NBC News, ICD-11 also removes what “residual” diagnoses remained for same-sex attraction that were used to justify “reparative therapies” for gays, lesbians and bisexuals.
In 2012, the American Psychiatric Association (APA) made a similar move when it removed the term “Gender Identity Disorder” – a term that was often used by doctors and mental health professionals to diagnose transgender individuals. Instead, the APA adopted the term “gender dysphoria” which describes a person’s personal experience of emotional distress over how they gender identify conflicting with the gender assigned to them at birth.
WHO Calls on Japan For Reform
Japan’s Supreme Court ruled on a pivotal case in January 2019 of a 43-year-old transgender man who wanted to change genders but did not want to undergo sterilization.
According to the WHO’s report, the Supreme Court upheld a lower court ruling that the forced sterilization did not violate Japan’s constitution but the ruling noted that “it cannot be denied that there is an aspect in which freedom from invasion of the physical body is restricted.”
“The suffering that [transgender people] face in terms of gender is also of concern to society that is supposed to embrace diversity in gender identity,” two justices wrote in a concurring opinion. They concluded that for transgender people, being “able to receive rulings of changes in recognition of gender status…is an important, perhaps even urgent, legal benefit.”
In recent years Japan has taken positive steps towards recognizing gender discrimination and the rights of LGBT people, HRW says.
In 2016, Japan’s Education Ministry issued a “Guidebook for Teachers” in that outlines how to treat LGBT students in schools and one year later, the ministry revised its national bullying prevention policies to include LGBT individuals.
Tokyo also passed a law in 2018 which states “the [city government], citizens, and enterprises may not unduly discriminate on the basis of gender identity or sexual orientation.” HRW also reported that Japan has voted for two UN Human Rights Council resolutions to end violence and discrimination on the basis of sexual orientation and gender identity.
However, while progress has been made, HRW called on Japan’s government urgently “to address and fundamentally revise the legal recognition process that remains anchored to a diagnostic framework that fails to meet international standards and has been roundly criticized and discredited worldwide.
“Legal gender recognition is an essential element of other fundamental rights—including the right to privacy, the right to freedom of expression, rights related to employment, education, health, and the ability to move freely.”