“Struggling for Ethnic Identity: Czechoslovakia’s Endangered Gypsies”
Human Rights Watch, August 1992
During the communist era, a significant number of Romany women were sterilized. Many Romany women reported to Helsinki Watch that they were sterilized without their informed consent during a caesarean section or an abortion. Others claim that they were pressured into agreeing to the operation by government social workers and health workers. Most reported that they were enticed with monetary incentives offered to them in bad times by social workers. These incentives were available to all citizens, but were more persistently offered to Romany women, who were almost entirely dependent on government welfare. Others may still not know they have been sterilized.
A Public Decree on Sterilization, issued by the Ministries of Health of the Czech and Slovak Socialist Republics in 1972, outlined specific requirements and indications which a sterilization applicant had to fulfill in order to be granted permission to undergo sterilization. A sterilization commission which included the chief doctor of the gynecological or urological department of the hospital, the director of the Regional Institute of National Health, and the director of the Hospital with Polyclinics was authorized to examine each request. In theory, the Decree was designed to safeguard against arbitrary or ill-informed sterilization of all Czechoslovak citizens. In practice, however, the government reportedly took specific steps to encourage the sterilization of Romany women in order to reduce the “high unhealthy” Romany population and, as a result, a disproportionately high number of Romany women were sterilized, often in violation of the existing safeguards and of their rights to non-discrimination on the basis of ethnicity or sex.1
Although the decree on sterilization never specifically refers to Romanies, other government documents reveal that the government sought to regulate and lower thebirth rate of Romanies. The communist government's concern over the high birth rate of the Romanies was repeatedly couched in terms like the “high unhealthy population” of the Romanies. Charter 77 asserted in 1979 that sterilization of Romany women was a “planned administrative policy” and that “at internal meetings the success of the workers is assessed according to the number of Romany women whom they have persuaded to be sterilized.”2 This is reinforced by a July 1977 document obtained by Helsinki Watch prepared by the Secretariat of the Government Commission for Questions of Gypsy Inhabitants of the Slovak Socialist Republic. The authors state, “Health indications which will enable the possibility of sterilization are not being taken into account.... In practice, the gypsy citizens have not been influenced enough until now to use the possibility of sterilization ... in cases when further pregnancy endangers the health of further descendants.”3 The authors report that previous efforts to control the “high unhealthy” Romany population through family planning and contraception had been unsuccessful and discuss the possibility of using sterilization to control the Romany population, exploring ways to obtain the “consent” of Romany women to undergo the sterilization:
This government document clearly links monetary incentives with obtaining the consent of Romany women to undergo sterilization. Further measures that influenced the fully informed and voluntary consent of Romany women to undergo sterilization were officially implemented in 1988. Apparently the need to up the sterilization ante was taken into consideration, and in September 1988 an official policy was initiated which allowed one-time financial grants for women who underwent an operation in "the interest of the health of the population."5 Again, this provision for financial grants did not directly state that it was to be used for sterilization or for Romany women. In practice, however, these paragraphs were used in both the Czech and Slovak republics to entice Romany women into undergoing sterilization. These grants varied from region to region, women in the Czech republic generally receiving a grant of up to 10,000 Crowns and in the Slovak republic of up to 25,000 Crowns.6 This grant came in the forms of money and coupons for such things as furniture.
Helsinki Watch interviewed several Romany women who underwent sterilization under circumstances which indicate that they did not give their full, informed, and voluntary consent. Many now regret having had the operation and want to have children again. From these interviews, it is possible to isolate three main variables which seem to have influenced the women's decisions: financial incentives that were broken up into cash payments and coupons for things like furniture; pressure from social workers, social curators,7 and local commissions for the “Gypsy question,” who repeatedly suggested and offered financial rewards to women to undergo sterilization; and the role of doctors, whose activities ranged from legally encouraging women to be sterilized to possibly violating the decree on sterilization by misinforming women in order to obtain consent before performing an operation or by not informing them at all.
Helsinki Watch heard several reports from Romany women who claim that they were sterilized after a caesarean section or an abortion without their consent. They claim that they were not fully informed about the operation and thus may have signed a request for the operation without realizing they were doing so. It was impossible to verify these reports, as we did not have access to their medical files.
A.D., a Romany woman from Krompachy, claims she was sterilized after going in for an abortion:
Similarly, two Romany women who now live in Brno (in the Czech republic) told Helsinki Watch about their experiences in Gelnice, Eastern Slovakia. K.F. claims she was sterilized when she was eighteen years old with two children:
Pavel Horvath told Helsinki Watch about his daughter's sterilization in Slovakia:
Other women told Helsinki Watch that they themselves applied for the sterilization through the defined procedure. Most of these women were clearly motivated by the money they would receive and now say that they regret having had the operation. They say that the monetary offer came from social workers, who often refused to give them their welfare payments and claimed that the sterilization was the only way they could get some money from the state. Alzbeta Conkova, a Romany woman from Kosice who was twenty-six years old with four children when she was sterilized, told Helsinki Watch:
In Vysoke Myto, (in the Czech republic) I.G., a twenty-five-year- old Romany woman, told Helsinki watch about her sterilization in 1988:
Furthermore, some women did not have much time to think over the operation or to discuss it with their husbands. M.K., from Medzev, Eastern Slovakia, reported:
Gynecologists and social workers interviewed by Helsinki Watch admitted that many Romany women would not have requested the sterilization without the financial incentive. Dr. Okosova, presently working at the employment office in Rimavska Sobota, who worked at the local department for the care of families and children during communist times, reported:
Dr. Pavlini, the head gynecologist at the hospital in Krompachy, told Helsinki Watch:
That money was intentionally used to convince women to agree to be sterilized is further substantiated by a 1989 article by two Slovak gynecologists that approvingly describes an increase in the number of Romany women sterilized in the year 1987 due to monetary grants.9 The article states that monetary grants had begun to have an effect on the number of Romany women sterilized in 1987. The Public Notice that officially allowed a one-time monetary grant for an operation “in the interest of the health of the population,” however, was not effective until 1988. Thus, we can conclude that the practice of offering monetary grants in connection with a sterilization operation was conducted by government employees before they were officially authorized to do so. This reinforces the claims of Charter 77 that a “planned administrative policy” to sterilize Romany women existed.
In addition, the government's apparent belief that certain communities of Romanies were inbreeding to an unhealthy degree was expressed in a Helsinki Watch interview with Elena Jonasova, a social worker in Banska Bystrice:
The supposed genetic inferiority of certain groups of Romanies was debated by the medical community. One Prague gynecologist and professor, who chose not to be named in this report, gave Helsinki Watch the following information about sterilization in Slovakia:
In Most, a city in Northern Bohemia heavily populated by Romanies, Jiri Biolek, a pediatrician, told Helsinki Watch:
Helsinki Watch obtained some statistics regarding how many Romany women were sterilized in relation to how many women were sterilized overall. According to “The Problems of Planned Parenthood among Gypsy fellow-citizens in the Eastern Slovakian Region,” by Dr. Posluch and Dr. Posluchova, 25.8 percent of the women who underwent sterilization in 1983 were Romanies; by 1987, this figure had risen to 36.6 percent.10 In a response to a letter written to Ruben Pellar and Z. Andrs from Prague inquiring about the material grants received by Romany women for sterilization, the Ministry of Health and Social Affairs of the Czech Socialist Republic wrote that twenty-five percent of the grants in the Czech republic for sterilization were given to Romany women, although Romanies constitute two or three percent of the population in the Czech republic.11
Similarly, a social worker in Brno, Mrs. Skorupova, told Helsinki Watch:
Nearly fifty percent of the women sterilized in Brno in 1989 were Romanies, yet the social worker interpreted this as a low number; Romanies allegedly committed about twenty-five percent of all crimes in Brno, whereas the social worker considered this high.
The communist government of Czechoslovakia was accused several times of attempting to commit genocide on the Romany population by sterilizing Romany women and forcefully removing their children from their homes. The first such protest came from Charter 77 in 1979, in which the communist government was warned that it was in danger of breaking Law Number 259 of the penal code on genocide. This protest stated:
Protests came from several local and international human rights organizations.13 Although there has been no official condemnation of these practices, the protests against and investigations of the violations of human rights have had some positive results, as we shall describe below.
From the fall of the communist regime in 1989 until late 1990, monetary incentives continued to be offered to women for sterilization. The last case documented by Ruben Pellar at the Committee for Human Rights in Prague in which a Romany woman received money after a sterilization occurred in August 1990 in Poprad, Eastern Slovakia, for 25,000 Crowns. After persistent protests by both Czechoslovak citizens and international organizations such as the Lau Mazeril Foundation, the paragraph that allowed a financial grant to be given for such operations is now in the process of being eliminated; women are no longer tempted by money or furniture to undergo the operation. Furthermore, regulations enumerated in the decree on sterilization have been amended and applicants must now obtain permission from a commission on which a lawyer and two independent doctors must also sit. Helsinki Watch received no reports of sterilizations of Romany women performed after offers of monetary incentives or pressure from social workers in 1991 or 1992. As far as we could tell, Romany women are no longer being targeted by the Czechoslovak government for sterilization, but prejudice among some government and health officials remains.
Although the practice of giving a financial grant to women for undergoing sterilization has ceased, many Romany women now feel that they were coerced or lured into undergoing the operation. Many claim that they did not fully understand the irreversible consequences of the operation. Others may have been sterilized and don't even know it. Furthermore, those doctors suspected of performing unlawful sterilizations on Romany women continue to practice in their professions. There is no guarantee that without a proper investigation and prosecution of past violations, doctors and government workers will not continue past practices which were sometimes based on “good intentions.”
The Committee for Human Rights in Prague has brought specific cases of sterilizations of Romany women to the attention of both Czech and Slovak prosecutors. Ninety cases of possibly illegal sterilization of Romany women were brought to the attention of the Czech Prosecutor in 1990. The Committee for Human Rights was promised an answer by September 1990, but still hasn't received any response. Slovak Prosecutors have investigated and dismissed several groups of cases, rejecting charges of genocide according to Law Number 259 of the penal code and claiming that other questionable sterilizations were not illegally performed. These decisions were often based on the assumption that the link between financial incentives and sterilization did not compromise women's full, informed and voluntary consent.
The District Examination Office of the Police Corps of the Slovak Republic in Presov, in response to the suggestion to investigate the cases of seventeen Romany women sterilized between 1985 and 1989, dismissed these cases on September 30, 1991, with the following reasoning:
The decisions of the prosecutors are based on the fact that the decree on sterilization does not target Romany women for sterilization, that the women signed consent forms for the operation, that in most cases the operation was approved by the sterilization commission and seemed to have been carried out in accordance with the decree on sterilization. However, they do not take into account the reasoning behind the monetary grants, aimed to control the growth of an “unhealthy population.” Furthermore, the reasoning of the Presov decision is not consistent with the then-existing decree on sterilization. There is no clause in the sterilization decree which allows sterilization of a woman younger than thirty-five with fewer than three children and in good health for “social reasons.” (See Appendix A for list of indications required for sterilization.) Furthermore, the prosecutor does not consider the possibility that the financial incentive offered by social workers may have had an influence on the “consent” of the women, many of whom were so poor that the instant gratification of getting a sum equivalent to half a year's salary may have played a decisive role in their decision. The Committee for Human Rights addressed these issues in a complaint written to the Presov Prosecutor on October 14, 1991. The prosecutor dismissed this complaint without ever addressing these issues.
The failure of the Czech Prosecutor to respond to the Committee's inquiries and the cursory investigations by the relevant Slovak district prosecutors' offices fail to answer several key questions which go to the heart of the nature of and accountability for past abuses of Romany women by the previous government. For example, what "social reasons" exist for legal sterilization according to the sterilization decree? What was the role of the monetary grant offered to the women by social workers? Did the financial incentive play a determining role in influencing the so-called consent of the women? Was an in-depth investigation conducted of the archives of both local and republic commissions for the “Gypsy Question” to ascertain whether there was a conscious attempt to lower the “unhealthy” population of Romanies? Are there any documents in government archives which indicate why the paragraph offering grants for women who undergo an operation in “the interest of a healthy population” was added in 1988?
Helsinki Watch found that many Romany families continue to suffer mental anguish because of the forced sterilization carried out in the communist era. Doctors and social workers who reportedly pressured Romany women into undergoing the sterilization and apparently violated then-existing laws continue to practice. The failure of government officials and judicial authorities to publicly condemn and fully investigate past policies and practices of sterilizing Romany women should be remedied. Public officials and doctors suspected of violating then-existing laws and decrees should be prosecuted. The cases of all women who claim to have been sterilized without their consent or under pressure should be reviewed; where violations are found, these women should be given monetary reparations. Only a thorough investigation of past practices can answer these questions, establish responsibility for past abuse and help put an end to on-going discrimination.
Helsinki Watch urges the Federal Government of Czechoslovakia, as well as the Czech and Slovak republic governments, to:
1972 Decree on Sterilization
Bulletin of the Ministry of Health of the Czech Socialist Republic*
Part 1-2 29 February 1972 Volume XX
Sterilization is considered to be a medical treatment that prevents fertility without removing or damaging sexual glands.
Sterilization is admissible if it is done in a medical institution on the request or with the consent of the person on which the sterilization has to be done,
a) on morbid sexual organs of the man or the woman for a therapeutic purpose according to the rules of medical science,
b) on healthy sexual organs of the woman, if the pregnancy or childbirth would severely endanger the life of the woman or cause her severe and permanent life damage,
c) on the healthy sexual organs of the woman, if the woman suffers from a disease that would endanger the physical or mental health of her children,
d) on the healthy sexual organs of the man, if the man suffers from a permanent disease that could endanger the physical or mental health of his children,
e) on the healthy sexual organs of the man, if his wife suffers from a disease that can be a reason for the execution of sterilization according to letters b and c, but in respect to her health status the sterilization could be dangerous for her or because of other reasons for which the woman doesn't want to undergo the sterilization operation,
f) on the healthy sexual organs of the woman if her husband suffers from a disease that can be a reason for the execution of sterilization according to letter d and the husband doesn't want to undergo the operation,
g) on the healthy sexual organs of the woman if the woman permanently fulfills the conditions of artificial pregnancy termination for health reasons.
The list of indications which can be a reason for sterilization according to Par. 2, letters bBf, is in the appendix to these regulations; the indications for the execution of sterilization according to Par. 2, letter g, are identical with the indications for artificial pregnancy termination, if these indications have a permanent character.
The sterilization cannot be allowed if there are medical reasons against it (contraindications). Contraindications are all morbid states which don't allow surgical treatment. This is why a complete internal examination of the patient has to be done before the operation.
(1) To ascertain the fact that the sterilization is indicated is decided by:
(2) For the evaluation of sterilization for genetic reasons (Par. 2, letters c and d) the sterilization committee is obligated to ask for the opinion of the Genetic Counseling Committee which is set up by the Ministry of Health of the Czech Socialist Republics on the request of the Genetic Committee and the Endocrinology Section of the Czech Medical Society of J.E. Purkyne/Czech Medical Society).
Sterilization for the reasons mentioned in Par. 2, letters b-g, can be requested in written form by the person on whom the sterilization is to be done, or by the doctor, the chairman of the appropriate sterilization commission (according to the place of permanent residence, ultimately the residence of the working place or school which the person attends), with the consent of the person.
. . . .
If the request is approved, the chairman sends the request to the applicant with a recommendation to the Women's (urology or surgical) Department, whose chief is a member of the commission. At the same time, he sends a copy of the report, which becomes a part of the clinical picture. Before the treatment, the person on which the sterilization is to be done must eventually sign [a release form] stating that she or he consents to the execution of the sterilization and that she or he takes heed of the written information regarding to what extent the sterilization is reversible.
If the request is rejected, the Chairman informs the applicant and eventually his/her legal attorney (Curator) of the result and reasons, and informs her or him of the possibility of reexamination of the decision according to the regulations of Par. 77 of the law number 20/1966.
The sterilization can be allowed in citizens of foreign states who have been living in the CSSR for a long time.
The regulations of the Ministry of Health number 22/1968 published in Vestnik MZ number 29/1966, are abolished, regarding the execution of sterilization.
These regulations become effective on January 1, 1972.
List of indications which can be a reason for the execution of sterilization:
I. Diseases of the Heart and Cardiovascular System
II. Lung Diseases (in women)
III. Kidney and Urinary Tract diseases (in women)
IV. Diseases of the Digestive System (in women)
V. Metabolism Diseases (in women)
VI. Blood Diseases (in women)
VII. Diseases of Glands of Inner Secretion (in women)
VIII. Diseases of the Nervous System
IX. Mental Diseases (in women and men)
X. Skin diseases (1 and 2 in women and men, 3-5 in women)
XI. Diseases of the bones, joints and muscles (in women)
XII. Ocular Diseases (1-5 in women, 6 in women and men)
XIII. Hearing Diseases (in women and men)
XIV. Obstetrical and Gynecological indications
XV. Genetic Indications (in women and men)
For genetic indications the opinion of the relevant genetic council committee is necessary.
Financial Grants for Sterilizations
Public Notice 151/152 of the Ministry of Health and Social Affairs of the Czech Socialist Republic from 8 September 1988.*
Sbirka zakon number 151,152/1988, 33, September 29, 1988, Czechoslovak Socialist Republic, page 965, from the Bulletin of Health and Social Affairs of the Czech Socialist Republic, September 8, 1988.
Financial and Material grants
Financial and material grants to parents with children with no subsistence and to pregnant women:
(1) Financial and material grants are given by National Committees to socially weak parents taking care of children who still have to be taken care of, especially to families with a large number of children, single parents and single pregnant women. The financial grant can be given to a child who needs care only when it is not possible to satisfy the child's needs with the grant for alimentation.
(2) For the securement of alimentation or for the payment costs of other life needs which regularly repeat themselves, and eventually for the payment of higher costs connected to the cost of alimentation, repeated financial grants are given. Repeated financial grants serve to complement the parental income of the pregnant woman (regularly, up to the amount needed to secure the common costs of the household). It is possible to give a repeated financial grant of a higher amount when higher living needs are demonstrated, connected with for example housing, and running the household with limited capacities). Financial grants will be given in a lesser amount or will not be given if the parents don't take proper care of the children, don't care about the fulfillment of their compulsory school attendance, or because of their lifestyle, don't guarantee the proper education of their children.
(3) For the payment of non-recurring extraordinary expenditures, non-recurring financial and material grants are given. As material grants, particularly things needed for the satisfaction of basic life needs, clothing and outfitting of households, are given. Non-recurring financial and material grants are also given for the payment of increased costs for the needs of the children, especially connected with their hobbies—outfitting for summer camps, spa treatment. Non-recurring financial grants can also be given when the family is going to use another source of energy besides oil.
(4) Non-recurring financial grants are given to the height of 10,000 Crowns. Material grants are given up to 5,000 Crowns, in extraordinary cases up to 10,000 Crowns.
(5) The giving of separate grants according to articles 1 and 2 is excluded.
Extraordinary financial grant and material grant. Citizens who underwent medical treatment according to extra regulations in the interest of the health of the population and for the reason of overcoming unfavorable life circumstances of the family can be given a non-recurring financial grant of one material grant according to Paragraph 31, Article 4, of this decree by the Regional National Committee, up till one year after the medical treatment.
Bulletin of the Ministry of Health of the Czechoslovak Socialist Republic, Part 1-2, 29th.
This information was obtained from a report written by Ruben Pellar from October, 1991 called “‘Sterilization with Grant’ of Gypsies in Czechoslovakia.”
1See Appendix A for text of Decree on Sterilization. Ruben Pellar and Zbynek Andrs, two Czechoslovak citizens, have collected reports from hundreds of women whose sterilizations do not seem to follow the regulations enumerated in the Sterilization Decree. Many of these cases indicate that both members of the medical community and sterilization commissions may have blatantly violated this decree.
3“Material Designated for the Deliberation of the Governmental Commission of the Slovak Socialist Republic for Questions of Gypsy inhabitants” (“Material urceny na rokovanie Komisie Vlady SSR pre otazky ciganskych obyvatelov,”) number SKC-6406/77.
6Interview with Ruben Pellar at the Committee for Human Rights in Prague, who has conducted research on the sterilization of Romany women. Ruben Pellar's research indicates that women who were younger and had fewer children sometimes received a larger monetary grant than women who were older, had more children, and were in much greater need of financial assistance. The results of this research were published by the Lau Mazeril Foundation in Amsterdam in June, 1990, “Het Afkopen van Vruchtbaarheid: Een onderzoek naar sterilisatiepraktijec ten aanzien van Romavrouwen in Tsejchoslowakije, uitgevoerd door Paul Ofner en Bert de Rooij in opdracht van de Verenging Lau Mazeril en de Stichting Informatie over Charta 77,” in a section by Ruben Pellar and Zbynek Andrs entitled “Statistical Evaluation of Romany women in East Slovakia- Appendix to the "Report on the Examination in the Problematic of Sexual Sterilization of Romanies in Czechoslovakia.”
7Social curators were social workers who were assigned field work in specific Romany communities during the communist era. In some localities, they still function. In some communities, Romanies were very antagonistic to these curators, but in others they were appreciative for valuable services performed by the curators, e.g. legal advice, writing complaints for them.
9Dr. Posluch and Dr. Posluchova, “Problemy planovaneho rodicovstva u ciganskych spoluobcanov vo Vychodoslovenskom kraji,” (“The Problems of Planned Parenthood Among Romany Fellow-Citizens in the Eastern Slovak Region”), Zdravotnicka Pracovnice, (zP. Volume 39, Issue Number 4, 1989), pp. 220-223.
11This information was published in “Survey on the Sterilization of Roma-women in Czechoslovakia: Summary,” written by Paul Ofner and Bert de Rooij from the Lau Mazeril Foundation (Vereniging Lau Mazeril), published in June 1990. See also: Paul Ofner, “Sterilisation Practice in Czechoslovakia,” O Drom (Dutch magazine about Romanies, published by Lau Mazeril), April 1990, pp. 33-39.
13These protests came from Charter 77 in 1979, the American Journal Romaniya in 1988, Donald Kenrick from England, several Czechoslovak citizens in 1989, Charter 77 in 1990, the “Society for Endangered Nations” in 1990, the Lau Mazeril Foundation in the Netherlands in 1990, and the Committee for Human Rights in Prague. The Committee for Human Rights in Prague brought several cases of sterilization to the attention of both Czech and Slovak Prosecutors.