No official summary available for this bill.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10426 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 10426
To amend part E of title IV of the Social Security Act to require
States to prohibit genital surgery on foster children with variations
in sex characteristics who are under six years of age as a condition of
receiving grants under such part.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 16, 2024
Ms. Garcia of Texas (for herself, Mr. Pocan, Mr. Takano, Mr. Torres of
New York, Ms. Bonamici, Ms. Chu, Mr. Frost, Mr. Garcia of Illinois, Mr.
Green of Texas, Ms. Jacobs, Ms. Jayapal, Ms. Lee of California, Ms. Lee
of Pennsylvania, Mrs. Lee Carter, Ms. McClellan, Mr. McGovern, Mrs.
McIver, Ms. Pingree, Ms. Pressley, Mr. Quigley, Mrs. Ramirez, and Ms.
Tlaib) introduced the following bill; which was referred to the
Committee on Ways and Means
_______________________________________________________________________
A BILL
To amend part E of title IV of the Social Security Act to require
States to prohibit genital surgery on foster children with variations
in sex characteristics who are under six years of age as a condition of
receiving grants under such part.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Protect Intersex Children Act''.
SEC. 2. PREAMBLE.
(a) The Congress opposes all forms of prejudice, bias, and
discrimination, and affirms its commitment to the dignity and autonomy
of all people, including those born with variations in their physical
sex characteristics. The Congress especially notes the importance of
protecting children within the guardianship of the foster care system.
(b) ``Variations in physical sex characteristics'' is an umbrella
term used to describe a wide range of natural bodily variations in
traits including genitals, gonads, hormone function, and chromosomal
patterns, and may be referred to as ``difference of sex development''
or ``intersex''.
(c) People born with variations in their physical sex
characteristics are a part of the fabric of the Nation's diversity and
are equally entitled to dignity and bodily autonomy.
(d) People born with variations in their physical sex
characteristics are regularly subjected in infancy, without their
consent, to surgeries to change the appearance or function of those
variations, even though performing such surgeries may result in lasting
harm and therefore does not serve the child's best interests.
(e) Not all persons with variations in their physical sex
characteristics will need or desire the surgeries that may be
recommended or performed on them in infancy. People born with
variations in their physical sex characteristics should be free to
choose whether to undergo surgeries that impact not only their bodily
autonomy but also their reproductive and sexual health.
(f) The Congress recognizes that leading pediatric hospitals have
begun to institute partial bans on these surgeries on patients with
variations in their physical sex characteristics who are too young to
participate in a meaningful discussion of the implications of these
surgeries, and therefore cannot meaningfully assent or consent to them,
but the prohibition on non-consensual surgical procedures on pediatric
patients with differences in sex characteristics should not be
construed to apply to, regulate, or prohibit surgical procedures
provided to transgender patients, with the consent of the patients, by
skilled and knowledgeable surgeons.
(g) Therefore, the Congress calls upon the States to hold health
professionals responsible for safeguarding the bodily autonomy of
people born with variations in their physical sex characteristics and
ensuring patient-centered care that conforms with best practices in the
medical profession by ending the practice of performing specified
surgeries on such children when they are under the age of six and the
surgery is not required to address an immediate risk to life, as
provided.
SEC. 3. FINDINGS.
The Congress finds the following:
(1) Individuals with variations in their physical sex
characteristics may present with differences in genital
anatomy, internal reproductive structures, chromosomes, or
hormonal variations. An estimated 1.7 percent of babies are
born with genetic, physiological, or anatomical variations that
can cause their physical sex characteristics to not conform to
the expectations for a typical male or female baby. The vast
majority of babies born with these variations do not require
surgical intervention related to their physical sex
characteristics immediately, if at all.
(2) Beginning in the 1950s physicians in the United States
began performing irreversible and involuntary surgeries (often
referred to as genital-normalizing surgeries) on infants with
variations in their physical sex characteristics without
medical justification.
(3) According to available public records, at least about
80 percent of these irreversible surgeries occur on infants
under the age of 2, with even higher figures reported in
published medical studies. A literature review of genital
surgery conducted on children with variations in their physical
sex characteristics published in the Journal of Steroid
Biochemistry and Molecular Biology found that between 2005 and
2012 the average age of patients was 11.2 months old and the
median age was 9.9 months at initial surgery.
(4) These surgeries, which include unnecessary infant
vaginoplasties, clitoral reductions and recessions, and removal
of gonadal tissues, are often performed before a child can even
speak or stand, meaning the individual is excluded from the
decision whether to undergo these irreversible procedures.
(5) There is evidence that these surgeries cause severe
psychological and physiological harm when performed without the
informed consent of the individual. These harms may include
scarring, chronic pain, urinary incontinence, loss of sexual
sensation and function, sterilization, depression, post-
traumatic stress disorder, suicidality, and surgical
enforcement of incorrect gender assignment.
(6) Three former United States Surgeons General who served
in both Republican and Democratic Administrations, Dr. Joycelyn
Elders, Dr. David Satcher, and Dr. Richard Carmona, issued a
statement calling for a moratorium on medically unnecessary
surgeries on intersex children too young to participate in the
decision, noting that, ``Cosmetic genitoplasty should be
deferred until children are old enough to voice their own view
about whether to undergo the surgery. Those whose oath or
conscience says `do no harm' should heed the simple fact that,
to date, research does not support the practice of cosmetic
infant genitoplasty.''.
(7) A number of domestic and international human rights
organizations have conducted thorough inquiries into genital
surgeries on infants with variations in their physical sex
characteristics and have concluded that performing these
procedures, inextricably without the consent of the infants, is
cruel and catastrophic, as follows:
(A) The United Nations Special Rapporteur on
Torture and Other Cruel, Inhuman or Degrading Treatment
or Punishment explained in 2013, ``children who are
born with atypical sex characteristics are often
subject to irreversible sex assignment, involuntary
sterilization, involuntary genital normalizing surgery,
[or] performed without their informed consent . . . `in
an attempt to fix their sex,' leaving them with
permanent, irreversible infertility and causing severe
mental suffering.''.
(B) The United Nations High Commissioner for Human
Rights explained in 2015 that non-consensual
``medically unnecessary surgeries and other invasive
treatment of intersex babies and children . . . are
rarely discussed and even more rarely investigated or
prosecuted. . . . The result is impunity for the
perpetrators; lack of remedy for victims; and a gap
between legislation and the lived realities of intersex
people.''.
(C) The World Health Organization explained in
2015, that children with variations in their physical
sex characteristics have been ``subjected to medically
unnecessary, often irreversible, interventions that may
have lifelong consequences for their physical and
mental health, including irreversible termination of
all or some of their reproductive and sexual capacity.
. . . Human rights bodies and ethical and health
professional organizations have recommended that free
and informed consent should be ensured in medical
interventions for people with intersex conditions,
including full information, orally and in writing, on
the suggested treatment, its justification and
alternatives.''.
(D) Physicians for Human Rights has ``call[ed] for
an end to all medically unnecessary surgical procedures
on intersex children before they are able to give
meaningful consent to such surgeries.''.
(E) Human Rights Watch concluded that these
surgeries, when performed without consent, are ``often
catastrophic, the supposed benefits are largely
unproven, and there are generally no urgent health
considerations at stake. Procedures that could be
delayed until intersex children are old enough to
decide whether they want them are instead performed on
infants who then have to live with the consequences for
a lifetime.''.
(8) In 2005, the San Francisco Human Rights Commission
performed an investigation into this topic and issued an in-
depth report, recommending that ```normalizing' interventions
should not occur in infancy or childhood. Any procedures that
are not medically necessary should not be performed unless the
patient gives their legal consent.''.
(9) Intersex advocacy groups led by individuals with
variations in their physical sex characteristics themselves
advocate for the postponing or banning of these surgeries.
Those subjected to surgery to alter their variations in sex
characteristics at a young age express despair over the fact
that they were unable to make these decisions for themselves,
publishing about their experiences in major news outlets: ``I
know firsthand the devastating impact [these non-consensual
surgeries] can have, not just on our bodies but on our souls.
We are erased before we can even tell our doctors who we are.
Every human rights organization that has considered the
practice has condemned it, some even to the point of
recognizing it as akin to torture.''.
(10) The United States Department of State has acknowledged
Intersex Awareness Day under the Obama, Trump, and Biden
Administrations by recognizing the harm of these surgeries. In
2017, the Department released a statement recognizing that ``at
a young age, intersex persons routinely face forced medical
surgeries without free or informed consent. These interventions
jeopardize their physical integrity and ability to live
freely.''.
(11) Physicians who have participated in these surgeries
have also expressed remorse that their training did not
properly prepare them to respect the bodily autonomy of people
born with variations in their physical sex characteristics. As
a Stanford-educated urologist explains: ``I know intersex women
who have never experienced orgasm because clitoral surgery
destroyed their sensation; men who underwent a dozen penile
surgeries before they even hit puberty; people who had . . .
vaginas created that scarred and led to a lifetime of pain
during intercourse . . . the psychological damage caused by
[non-consensual] intervention is just as staggering, as
evidenced by generations of intersex adults dealing with post-
traumatic stress disorder, problems with intimacy and severe
depression. Some were even surgically assigned a gender at
birth, only to grow up identifying with [a different]
gender.''.
(12) When the life of an infant born with variations in
their physical sex characteristics is threatened and medical
attention cannot be safely deferred, therapeutic treatment
options should remain available to children, families, and
medical professionals to ensure that the imminent risk to life
is addressed. In such cases, where surgical intervention cannot
be deferred and the infant lacks agency to advance the infant's
own interests, clinical ethicists may be consulted or included
in decision-making to serve as a proxy for the interests of the
infant and to ensure that the infant's long-term well-being is
a primary consideration in decision-making.
(13) The United States should serve as a model of competent
and ethical medical care and has a compelling interest in
protecting the physical and psychological well-being of
children, including those born with variations in their
physical sex characteristics.
SEC. 4. STATES REQUIRED TO PROHIBIT SPECIFIED SURGERIES ON FOSTER
CHILDREN WITH VARIATIONS IN SEX CHARACTERISTICS WHO ARE
UNDER 6 YEARS OF AGE, AS A CONDITION OF PARTICIPATION IN
THE FEDERAL FOSTER CARE AND ADOPTION ASSISTANCE PROGRAM.
(a) State Plan Requirement.--Section 471 of the Social Security Act
(42 U.S.C. 671) is amended--
(1) in subsection (a)--
(A) by striking ``and'' at the end of paragraph
(36);
(B) by striking the period at the end of paragraph
(37) and inserting ``; and''; and
(C) by adding at the end, the following:
``(38) provides that the State shall have in effect the
laws and procedures described in subsection (f), which shall
specify appropriate penalties and enforcement mechanisms
described in subsection (f)(3) to ensure compliance with the
laws and procedures.''; and
(2) by adding at the end the following:
``(f) State Laws and Procedures To Prohibit Genital Surgery on
Foster Children Born With Variations in Their Physical Sex
Characteristics Who Are Under 6 Years of Age.--
``(1) In general.--The laws and procedures described in
this subsection are laws and procedures which prohibit a
physician who is licensed to provide medical care under State
law from performing any of the following surgical procedures on
a foster child who has not attained 6 years of age and who is
an individual born with variations in their physical sex
characteristics, unless the surgical procedure is to address an
immediate risk to life:
``(A) Clitoroplasty, clitoral reduction, or
clitoral recession, including corporal-sparing
procedures.
``(B) Gonadectomy.
``(C) Vaginoplasty, urogenital sinus mobilization,
or vaginal exteriorization.
``(D) Phallectomy, penectomy, or phalloplasty.
``(2) Definitions.--In paragraph (1):
``(A) Individual born with variations in their
physical sex characteristics.--The term `individual
born with variations in their physical sex
characteristics' means an individual born with physical
traits, including genitals, gonads, hormone function,
or chromosomal patterns, that vary from stereotypical
notions regarding the development, appearance, or
function of sex characteristics.
``(B) Surgical procedure to address an immediate
risk to life.--The term `surgical procedure to address
an immediate risk to life' means a surgical procedure--
``(i) to remove tissue that is malignant;
``(ii) to create an opening to allow urine
or feces to exit the body where an opening is
underdeveloped or not present;
``(iii) to reposition internal organs that
formed outside of the body;
``(iv) that is required to treat
complications of a previous surgery and cannot
be delayed without increasing physical health
risks to the patient; or
``(v) that is necessary to preserve life in
the event of a medical emergency.
``(3) Enforcement.--
``(A) In general.--The relevant licensing entity of
the State shall consider a violation of a State law or
procedure described in paragraph (1) to be
unprofessional conduct, and shall discipline any
violator of such a law or procedure accordingly.
``(B) Concurrent authority.--The relevant
department of health or regulatory body of a State
shall have concurrent authority to initiate proceedings
to address violations of a State law or procedure
described in paragraph (1).
``(4) Rule of interpretation.--This subsection shall not be
interpreted to require a State to impose liability on a
hospital at which a violation of a State law or procedure
described in paragraph (1) occurs.''.
(b) Effective Date.--
(1) In general.--The amendments made by subsection (a)
shall take effect on the 1st day of the 1st calendar quarter
that begins 1 year or more after the date of the enactment of
this Act, and shall apply to payments under part E of title IV
of the Social Security Act for calendar quarters beginning on
or after such date.
(2) Delay permitted if state legislation required.--If the
Secretary of Health and Human Services determines that State
legislation (other than legislation appropriating funds) is
required in order for a State plan developed pursuant to part E
of title IV of the Social Security Act to meet the additional
requirements imposed by the amendments made by subsection (a),
the plan shall not be regarded as failing to meet any of the
additional requirements before the 1st day of the 1st calendar
quarter beginning after the 1st regular session of the State
legislature that begins 1 year or more after the date of the
enactment of this Act. For purposes of the preceding sentence,
if the State has a 2-year legislative session, each year of the
session is deemed to be a separate regular session of the State
legislature.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Ways and Means.
Referred to the Subcommittee on Work and Welfare.
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