CEDAW/C/89/D/170/2021 disabilities for involuntary sterilization […] is an increasingly global problem”. 36 The Special Rapporteur has also asserted that “forced abortions or sterilizations carried out by State officials in accordance with coercive family planning laws or policies may amount to torture”. 37 In the same vein, the Special Rapporteur on violence against women and girls, its causes and consequences has asserted that “forced sterilization and forced abortion are crimes and forms of gender-based violence against women”, 38 and that “forced sterilization is an example of intersectional discrimination often targeting women belonging to minorities and Indigenous women”. 39 The Committee is aware that many women (including women who are of African descent, HIV-positive, living in poverty, incarcerated, or lesbian, bisexual, transgender or intersex) may be affected by intersectional forms of discrimination. Indigenous women with disabilities, for example, commonly experience the denial of legal capacity, which leads to further human rights violations, including in the areas of access to justice, institutionalized violence and forced sterilization. 40 8.4 The Committee takes note of the State party’s argument that measures exist to ensure the free, prior, full and informed consent of women in sexual and reproductive health procedures and that, on the basis of the information provided by the authors, it cannot be verified that they in fact underwent procedures as part of the Programme on Reproductive Health and Family Planning or that they did not give their consent. In the coherent and consistent narrative presented by the authors, they were co-opted by means of coercion, pressure or deception, as part of campaigns, in clinics without specialized infrastructure or personnel; they underwent procedures without their informed consent; some of them did not know how to read and/or did not speak Spanish and lived in remote areas; and, in some cases, they did not understand the significance of the procedure or the fact that it was permanent. The Committee also notes that the authors have been included in the Registry of Victims of Forced Sterilization since 2017 and that, in order to be included, they submitted documents attesting to the fact that they had been sterilized under the Programme on Reproductive Health and Family Planning. The Committee recalls that, in accordance with its general recommendation No. 24 (1999), quality healthcare services are those that are delivered in a way that ensures that a woman gives her fully informed consent, respects her dignity, guarantees her confidentiality and is sensitive to her needs and perspectives. 41 However, since 2002, the Committee has noted with concern numerous cases of women being sterilized without their prior informed consent, through the use of psychological violence or the promise of financial incentives, thereby affecting those women’s right to decide on the number and spacing of their children. 42 The Inter-American Court of Human Rights has underscored that sterilization without consent is a phenomenon that, in various contexts and parts of the world, has had a greater impact on women belonging to groups that are more likely to suffer that human rights violation, as a result of their socioeconomic position, race, disability or HIV status. 43 Although sterilization is used as a form of contraception for both women and men, forced sterilization disproportionately affects women, because of their gender, on the basis of perceptions about their primarily reproductive role and their inability to make responsible reproductive health and family __________________ 36 37 38 39 40 41 42 43 16/19 Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment (A/HRC/22/53), para. 48. Ibid. Report of the Special Rapporteur on violence against women, its causes and consequences (A/74/137), para. 21. Ibid., para. 44. General recommendation No. 39 (2022), para. 21. See N.A.E. v. Spain (CEDAW/C/82/D/149/2019), para. 15.7. Concluding observations on the fifth periodic report of Peru, 23 August 2002 (A/57/38 (Supp)), para. 484. Inter-American Court of Human Rights, I.V. v. Bolivia, Judgment, 30 November 2016, para. 247. 24-19966