Male Or Female? Intersex Newborns Put Parents In Dilemma

Amina’s first cry in early 2022 brought joy and happiness to her mother Aisha (both names changed to protect their identities).

However, within moments of Amina’s birth, there was a dilemma. Amina was born intersex.

Intersex people are born with sex traits or reproductive anatomy that does not fit binary medical definitions of male or female. Experts say that up to 1.7% of people born globally are intersex.

Apart from being intersex, Amina had spina bifida, a condition that affects the spinal cord. As a result, the doctor recommended euthanasia, which is illegal in Nigeria.

The doctor’s “mercy killing” recommendation left Aisha in shock. That’s not what she wanted for Amina, so she took her to a different hospital where doctors told her they needed to perform “correctional surgery” on her genitals. Aisha consented.

Myths Vs Science

Ahmad Gafar, a Sokoto-based laboratory scientist, said intersex is not related to a person’s gender (how they see themselves in relation to the society’s definition of “male” or “female”) but rather to the sexual characteristics a person is born with.

This may include their external genitals like a vagina or penis, internal reproductive organs like ovaries or testes, or sex chromosomes — the genetic material that determines a person’s biological sex.

“Not all intersex [conditions] are the same,” said Dr. Samuel Ogani, a Urologist at the University of Nigeria Nsukka. “It comes with variations. There may be a person who has XX chromosomes and ovaries typically regarded as female but external genitals typically regarded as male, or XY chromosomes but external genitalia that are typically regarded as female,” he added, citing two examples.

“Intersex is neither a type of sexual orientation nor a medical problem. It is a naturally occurring variation that may or may not be apparent and may or may not pose any health concerns,” Ogani added.

Lack of knowledge about intersex conditions coupled with cultural, religious, and social beliefs often results in prejudice, stigma, and discrimination against intersex people in Nigeria and much of the world.

“My relatives said my baby’s birth is the result of a generational curse. Other people make fun of my baby,” said a Sokoto-based mother of an intersex baby who asked not to be named for fear of negative reactions.

According to Eunice Joseph, who was born intersex, it is not easy to identify as intersex in Nigeria. “We are treated almost like strangers, and people see us as abnormal. The government has forsaken us. Nothing is done to [aid] our plights,” she said.

Surgery Without Consent

In Nigeria, fear of discrimination, misinformation, and parents’ desire for their children to be seen as “normal” in society compels many parents to choose “corrective” or cosmetic surgery on their intersex children.

Jonathan Abel, a Urologist from the University of Jos, Northcentral Nigeria said most surgeries performed on young intersex children are done at the request of their parents.

He notes that medical practitioners are not always the first contact for parents when children are born and that many are misinformed on the medical implications of being intersex or the legal implications of performing surgery on an intersex child.

“Nigeria has adopted the Child’s Right Act (2003) that provides for and guarantees the rights of all children in line with the United Nations,” Abel said. “Medical practitioners should seek either the parents’ or relatives’ consent before carrying out any surgery on a child.”

According to Human Rights Watch, intersex surgeries often come with serious lifelong emotional and physical consequences; high complication rates; and reduced sexual function. The United Nations considers these surgeries human rights violations when done without the individual’s informed consent.

Most intersex surgeries are done when a child is under two years old, when they are far too young to consent.

“In Nigeria, some medical practitioners still perform surgery on their patients without adequately seeking their consent. Intersex people are being denied choices and their own well-being,” said Segun Ogundipe, a public affairs analyst.

Musa Jamil, a Lagos-based medical practitioner, says most doctors believe parental consent is legally enough to change the appearance or function of an intersex infant’s genitalia, including cosmetic alterations to the clitoris.

“A doctor cannot operate on anybody without the consent of their relatives. Our duty is to undergo the relevant tests and advise them. In most cases they (the parents) request surgeries,” Musa said.

The Nigerian constitution provides, among other fundamental rights, the right to life and to private and family life for children under the custody of their parents or guardians.

Human Rights activists in Nigeria say intersex people should be able to self-determine their gender and sex when they are old enough to know and understand these things, either in puberty or adulthood.

Muhammad Salame, a human rights activist, believes the provision in the constitution that states that, “No citizen of Nigeria shall be subjected to any disability or deprivation merely by reason of the circumstances of his birth” includes intersex people.

Adam, an intersex person now in his 20s living in Sokoto, said he regrets that surgery was performed on him when he was two. “I would have appreciated my parents allowing me to be my natural way,” he said.