,i #aag? ,,congress #a/ ,session ,h4 ,r4 #egcj ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,octob] #bf1 #bjba,ms4 ,g>cia ( ,texas 7= h]self1 ,mr4 ,takano1 ,mr4 ,rask91 ,ms4 ,pressley1 ,mr4 ,quigley1 ,ms4 ,jackson ,lee1 & ,mr4 ,payne7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,ways & ,means ,a ,,bill ,to am5d "p ,e ( title ,,iv ( ! ,social ,security ,act to require ,/ates to prohibit g5ital surg]y on fo/] *ildr5 ) v>iations 9 sex *>act]i/ics :o are "u six ye>s ( age z a condition ( receiv+ grants "u su* "p4 #a4 ,preamble 7a7 ,! ,congress opposes all =ms ( prejudice1 bias1 & discrim9ation1 & affirms its commitm5t to ! dignity & autonomy ( all p1 includ+ ^? born ) v>iations 9 _! physical sex *>act]i/ics4 ,! ,congress especially notes ! importance ( protect+ *ildr5 )9 ! gu>dian%ip ( ! fo/] c>e sy/em4 7b7 ,v>iations 9 physical sex *>act]i/ics is an umbrella t]m us$ to describe a wide range ( natural bodily v>iations 9 traits includ+ g5itals1 gonads1 hormone function1 & *romosomal patt]ns4 7c7 ,p born ) v>iations 9 _! physical sex *>act]i/ics are a "p ( ! fabric ( ! ,nation's div]sity & are equally entitl$ to dignity & bodily autonomy4 7d7 ,p born ) v>iations 9 _! physical sex *>act]i/ics are regul>ly subject$ 9 infancy to surg]ies to *ange ! appe>ance or function ( ^? v>iations1 ev5 ?\gh su* surg]ies may result 9 la/+ h>m4 7e7 ,! ,congress recognizes t surg]ies on infants ) v>iations 9 _! physical sex *>act]i/ics are (t5 ju/ifi$ by g5]aliz$ assumptions ab\t p's pref]5ces ab\t _! bodies' appe>ance & function4 ,^! assumptions p]petuate g5d] /]eotypes & may n reflect an individual's actual pref]5ces :5 !y are capable ( articulat+ _! wi%es4 7f7 ,n all p]sons ) v>iations 9 _! physical sex *>act]i/ics w ne$ or desire ! surg]ies t may be recomm5d$ or p]=m$ on !m 9 infancy4 ,p born ) v>iations 9 _! physical sex *>act]i/ics %\ld be free to *oose :e!r to und]go surg]ies t impact n only _! bodily autonomy b also _! reproductive & sexual futures4 7g7 ,! ,congress recognizes t lead+ p$iatric hospitals h begun to in/itute p>tial bans on ^! surg]ies on pati5ts :o are too "y to p>ticipate 9 a mean+ful discussion ( ! implications ( ^! surg]ies4 7h7 ,!re=e1 ! ,congress calls ^u ! ,/ates to hold heal? pr(essionals responsible = safegu>d+ ! bodily autonomy ( p born ) v>iations 9 _! physical sex *>act]i/ics & ensur+ pati5t-c5t]$ c>e t con=ms ) be/ practices 9 ! m$ical pr(ession by end+ ! practice ( p]=m+ specifi$ surg]ies on su* *ildr5 :5 !y are "u ! age ( six & ! surg]y is n requir$ to address an imm$iate risk ( physical h>m1 z provid$4 #b4 ,f9d+s ,! ,congress f9ds ! foll[+3 7#a7 ,individuals ) v>iations 9 _! physical sex *>act]i/ics may pres5t ) diff]5ces 9 g5ital anatomy1 int]nal reproductive /ructures1 *romosomes1 or hormonal v>iations4 ,int]sex ref]s to ! v>iety ( diff]5t physical indicators t create ^? diff]5ces4 ,z _m z #a4g p]c5t ( babies are born ) physical sex *>act]i/ics :i* d n con=m to ! expectations = a typical male or female4 ,! va/ majority ( babies born ) ^! v>iations d n require surgical int]v5tion relat$ to _! physical sex *>act]i/ics imm$iately1 if at all4 7#b7 ,beg9n+ 9 ! #aiejs physicians 9 ! ,unit$ ,/ates began p]=m+ irrev]sible surg]ies 7(t5 ref]r$ to z g5ital-normaliz+ surg]ies7 on infants ) v>iations 9 _! physical sex *>act]i/ics )\t m$ical ju/ification4 7#c7 ,z _m z two-?irds ( ^! irrev]sible surg]ies occur on infants "u ! age ( two4 ,a lit]ature review ( g5ital surg]y conduct$ on *ildr5 ) v>iations 9 _! physical sex *>act]i/ics publi%$ 9 ! ,j\rnal ( ,/]oid ,bio*emi/ry & ,molecul> ,biology f\nd t betwe5 #bjje & #bjab ! av]age age ( pati5ts 0 #aa4b mon?s old & ! m$ian age 0 #i4i mon?s at initial surg]y4 7#d7 ,^! surg]ies1 :i* include unnecess>y infant vag9opla/ies1 clitoral r$uctions & recessions1 & removal ( gonadal tissues1 are (t5 p]=m$ be=e a *ild c ev5 speak or /&1 mean+ ! individual is exclud$ f ! decision :e!r to und]go ^! irrev]sible proc$ures4 7#e7 ,!re is evid5ce t ^! surg]ies cause sev]e psy*ological & physiological h>m :5 p]=m$ )\t ! in=m$ cons5t ( ! individual4 ,^! h>ms may include sc>r+1 *ronic pa91 ur9>y incont95ce1 loss ( sexual s5sation & function1 /]ilization1 depression1 po/-traumatic /ress disord]1 suicidality1 & incorrect g5d] assignm5t4 7#f7 ,a numb] ( dome/ic & int]national human rights organizations h conduct$ ?or\gh inquiries into g5ital surg]ies on infants ) v>iations 9 _! physical sex *>act]i/ics & h conclud$ t ^! proc$ures are cruel & cata/rophic1 z foll[s3 7,a7 ,! ,unit$ ,nations ,special ,rapporteur on ,torture & ,o!r ,cruel1 ,inhuman or ,degrad+ ,treatm5t or ,puni%m5t expla9$ 9 #bjac1 *ildr5 :o are born ) atypical sex *>act]i/ics are (t5 subject to irrev]sible sex assignm5t1 involunt>y /]ilization1 involunt>y g5ital normaliz+ surg]y1 p]=m$ )\t _! in=m$ cons5t1 or t ( _! p>5ts1 9 an attempt to fix _! sex1 leav+ !m ) p]man5t1 irrev]sible inf]tility & caus+ sev]e m5tal suff]+44 7,b7 ,! ,unit$ ,nations ,high ,commission] = ,human ,rights expla9$ 9 #bjae1 m$ically unnecess>y surg]ies & o!r invasive treatm5t ( int]sex babies & *ildr5 ''' are r>ely discuss$ & ev5 m r>ely inve/igat$ or prosecut$4 ''' ,! result is impunity = ! p]petrators2 lack ( rem$y = victims2 & a gap betwe5 legislation & ! liv$ realities ( int]sex p44 7,c7 ,! ,_w ,heal? ,organization expla9$ 9 #bjae1 t *ildr5 ) v>iations 9 _! physical sex *>act]i/ics h be5 subject$ to m$ically unnecess>y1 (t5 irrev]sible1 int]v5tions t may h lifelong consequ5ces = _! physical & m5tal heal?1 includ+ irrev]sible t]m9ation ( all or "s ( _! reproductive & sexual capacity4 ''' ,human rights bodies & e?ical & heal? pr(essional organizations h recomm5d$ t free & in=m$ cons5t %\ld be ensur$ 9 m$ical int]v5tions = p ) int]sex conditions1 includ+ full in=mation1 orally & 9 writ+1 on ! sugge/$ treatm5t1 its ju/ification & alt]natives44 7,d7 ,physicians = ,human ,rights has called = an end to all m$ically unnecess>y surgical proc$ures on int]sex *ildr5 be=e !y are able to give mean+ful cons5t to su* surg]ies44 7,e7 ,human ,rights ,wat* conclud$ t ^! surg]ies are (t5 cata/rophic1 ! suppos$ b5efits are l>gely unprov51 & !re are g5]ally no urg5t heal? consid]ations at /ake4 ,proc$ures t c\ld be delay$ until int]sex *ildr5 are old en\gh to decide :e!r !y want !m are in/ead p]=m$ on infants :o !n h to live ) ! consequ5ces = a lifetime44 7#g7 ,int]sex advocacy gr\ps l$ by individuals ) v>iations 9 _! physical sex *>act]i/ics !mselves advocate = ! po/pon+ or bann+ ( ^! surg]ies1 z foll[s3 7,a7 ,^? subject$ to surg]y to alt] _! v>iations 9 sex *>act]i/ics at a "y age express despair ov] ! fact t !y 7 unable to make ^! decisions = !mselves1 publi%+ ab\t _! exp]i5ces 9 major news outlets3 ,i "k fir/h& ! deva/at+ impact ^! surg]ies c h1 n j on our bodies b on our s\ls4 ,we are eras$ be=e we c ev5 tell our doctors :o we are4 ,e human rights organization t has consid]$ ! practice has condemn$ x1 "s ev5 to ! po9t ( recogniz+ x z ak9 to torture44 7,b7 ,"y p born ) v>iations 9 _! physical sex *>act]i/ics :o h be5 able to p>ticipate 9 ^! life-alt]+ decisions are ?riv+1 su* z a "y ,cali=nia resid5t ) v>iation ( sex *>act]i/ics :o 0 n =c$ to und]go surg]y 9 infancy & in/ead p>ticipat$ 9 ! decision at ! age ( #af4 ,!y told report]s t = !m1 surg]y 0 ! "r *oice1 b t's v mu* an anomaly = int]sex p4 ''' ,! important ?+ 0 t ,i 0 old en\gh to make t decision = myself44 7#h7 ,! ,unit$ ,/ates ,dep>tm5t ( ,/ate has ackn[l$g$ ,int]sex ,aw>5ess ,day 9 bo? #bjaf & #bjag by recogniz+ ! h>m ( ^! surg]ies4 ,9 bo? ye>s ! ,dep>tm5t releas$ /atem5ts recogniz+ t at a "y age1 int]sex p]sons r\t9ely face =c$ m$ical surg]ies )\t free or in=m$ cons5t4 ,^! int]v5tions jeop>dize _! physical integrity & ability to live freely44 7#i7 ,9 light ( ongo+ advocacy by ! int]sex community1 9 #bjje ! ,san ,francisco ,human ,rights ,commission p]=m$ an inve/igation into ?is topic & issu$ an 9-dep? report1 recomm5d+ t normaliz+ int]v5tions %\ld n occur 9 infancy or *ildhood4 ,any proc$ures t are n m$ically necess>y %\ld n be p]=m$ unless ! pati5t gives _! legal cons5t44 7#aj7 ,physicians :o h p>ticipat$ 9 ^! surg]ies h also express$ remorse t _! tra9+ did n prop]ly prep>e !m to respect ! bodily autonomy ( p born ) v>iations 9 _! physical sex *>act]i/ics4 ,z a ,/an=d-educat$ urologi/ expla9s3 ,i "k int]sex wom5 :o h nev] exp]i5c$ orgasm because clitoral surg]y de/roy$ _! s5sation2 m5 :o und]w5t a doz5 p5ile surg]ies be=e !y ev5 hit pub]ty2 p :o _h false vag9as creat$ t sc>r$ & l$ to a lifetime ( pa9 dur+ int]c\rse ''' ! psy*ological damage caus$ by int]v5tion is j z /agg]+1 z evid5c$ by g5]ations ( int]sex adults deal+ ) po/-traumatic /ress disord]1 problems ) intimacy & sev]e depression4 ,"s 7 ev5 surgically assign$ a g5d] at bir?1 only to gr[ up id5tify+ ) ! opposite g5d]44 7#aa7 ,:5 ! physical heal? ( an infant born ) v>iations 9 _! physical sex *>act]i/ics is ?reat5$ & m$ical att5tion _c be safely def]r$1 all !rapeutic treatm5t options %\ld rema9 available to *ildr51 families1 & m$ical pr(essionals to ensure t ! imm95t physical dang] is address$4 7#ab7 ,! ,unit$ ,/ates %\ld s]ve z a model ( compet5t & e?ical m$ical c>e & has a compell+ int]e/ 9 protect+ ! physical & psy*ological well-be+ ( *ildr51 includ+ ^? born ) v>iations 9 _! physical sex *>act]i/ics4 #c4 ,/ates requir$ to prohibit specifi$ surg]ies on fo/] *ildr5 ) v>iations 9 sex *>act]i/ics :o are "u #f ye>s ( age1 z a condition ( p>ticipation 9 ! ,f$]al fo/] c>e & adoption assi/ance program 7a7 ,/ate plan requirem5t ,section #dga ( ! ,social ,security ,act 7#db ,u4,s4,c4 #fga7 is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 by /rik+ & at ! end ( p>agraph 7#cf72 7,b7 by /rik+ ! p]iod at ! end ( p>agraph 7#cg7 & ins]t+ 2 &2 & 7,c7 by add+ at ! end1 ! foll[+3 7#ch7 provides t ! ,/ate %all h 9 effect ! laws & proc$ures describ$ 9 subsection 7f71 :i* %all specify appropriate p5alties & en=cem5t me*anisms describ$ 9 subsection 7f77#c7 to ensure compliance ) ! laws & proc$ures4 2 & 7#b7 by add+ at ! end ! foll[+3 7f7 ,/ate laws & proc$ures ,to prohibit g5ital surg]y on fo/] *ildr5 born ) v>iations 9 _! physical sex *>act]i/ics :o are "u #f ye>s ( age 7#a7 ,9 g5]al ,! laws & proc$ures describ$ 9 ?is subsection are laws & proc$ures :i* prohibit a physician :o is lic5s$ to provide m$ical c>e "u ,/ate law f p]=m+ any ( ! foll[+ surg]ies on a fo/] *ild :o has n atta9$ #f ye>s ( age & :o is an individual born ) v>iations 9 _! physical sex *>act]i/ics3 7,a7 ,clitoropla/y1 clitoral r$uction1 or clitoral recession1 includ+ corporal-sp>+ proc$ures4 7,b7 ,gonadectomy4 7,c7 ,vag9opla/y1 urog5ital s9us mobilization1 or vag9al ext]iorization4 7#b7 ,def9itions ,9 p>agraph 7#a73 7,a7 ,individual born ) v>iations 9 _! physical sex *>act]i/ics ,! t]m individual born ) v>iations 9 _! physical sex *>act]i/ics means an individual born ) physical traits1 includ+ g5itals1 gonads1 hormone function1 or *romosomal patt]ns1 t v>y f /]eotypical notions reg>d+ ! developm5t1 appe>ance1 or function ( sex *>act]i/ics4 7,b7 ,surg]y requir$ to address an imm$iate risk ( physical h>m ,! t]m surg]y requir$ to address an imm$iate risk ( physical h>m means-- 7i7 surg]y to remove tissue t is malignant2 7ii7 surg]y to create an op5+ to all[ ur9e or feces to exit ! body :]e an op5+ is und]develop$ or n pres5t2 7iii7 surg]y to reposition int]nal organs t =m$ outside ( ! body2 7iv7 surg]y t is requir$ to treat complications ( a previ\s surg]y & _c be delay$ )\t increas+ physical heal? risks to ! pati5t2 & 7v7 any o!r surg]y necess>y to pres]ve life 9 ! ev5t ( a m$ical em]g5cy4 7#c7 ,en=cem5t 7,a7 ,9 g5]al ,! relevant lic5s+ entity ( ! ,/ate %all consid] a violation ( a ,/ate law or proc$ure describ$ 9 p>agraph 7#a7 to be unpr(essional conduct1 & %all discipl9e any violator ( su* a law or proc$ure accord+ly4 7,b7 ,concurr5t au?ority ,! relevant dep>tm5t ( heal? or regulatory body ( a ,/ate %all h concurr5t au?ority to initiate proce$+s to address violations ( a ,/ate law or proc$ure describ$ 9 p>agraph 7#a74 7#d7 ,rule ( int]pretation ,?is subsection %all n be int]pret$ to require a ,/ate to impose liability on a hospital at :i* a violation ( a ,/ate law or proc$ure describ$ 9 p>agraph 7#a7 occurs4 4 7b7 ,effective date 7#a7 ,9 g5]al ,! am5dm5ts made by subsection 7a7 %all take effect on ! #a/ day ( ! #a/ cal5d> qu>t] t beg9s #a ye> or m aft] ! date ( ! enactm5t ( ?is ,act1 & %all apply to paym5ts "u "p ,e ( title ,,iv ( ! ,social ,security ,act = cal5d> qu>t]s beg9n+ on or aft] su* date4 7#b7 ,delay p]mitt$ if ,/ate legislation requir$ ,if ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es t ,/ate legislation 7o!r ?an legislation appropriat+ funds7 is requir$ 9 ord] = a ,/ate plan develop$ pursuant to "p ,e ( title ,,iv ( ! ,social ,security ,act to meet ! additional requirem5ts impos$ by ! am5dm5ts made by subsection 7a71 ! plan %all n be reg>d$ z fail+ to meet any ( ! additional requirem5ts be=e ! #a/ day ( ! #a/ cal5d> qu>t] beg9n+ aft] ! #a/ regul> session ( ! ,/ate legislature t beg9s #a ye> or m aft] ! date ( ! enactm5t ( ?is ,act4 ,= purposes ( ! prec$+ s5t5ce1 if ! ,/ate has a #b-ye> legislative session1 ea* ye> ( ! session is deem$ to be a sep>ate regul> session ( ! ,/ate legislature4