American Academy of Pediatrics statement on Intersex Awareness Day

American Academy of Pediatrics logo
The American Academy of Pediatrics has issued a statement recognising Intersex Awareness Day, 21 years after the demonstration outside an Academy conference that is marked by Intersex Awareness Day:

On Oct. 26, Intersex Awareness Day, the American Academy of Pediatrics joins in supporting families of children born with differences of sex development. The AAP and its 66,000 member pediatricians, pediatric medical subspecialists, and pediatric surgical specialists are committed to the health and dignity of all children, including children who do not easily fit into binary gender categories.

“We all share the same goal of healthy, happy children,” said American Academy of Pediatrics President Fernando Stein, MD, FAAP. “When a child is born with any type of congenital difference, parents will have many questions for the medical team, including what caused it and what will happen to their child. Pediatricians have the responsibility to offer useful and reliable information, to help the parents access specialists, and to coordinate the child’s care. Above all, it’s important to support the child and family.”

The care of children with differences of sex development is an evolving field, and the AAP looks forward to additional research regarding treatment outcomes. Meanwhile, the AAP is committed to continued dialogue regarding the best ways to support these children and their families.

Current surgical practices on infants and children with intersex variations lack an evidence base. Human rights violations occur routinely in US hospitals, and elsewhere in the world. In July 2017, Human Rights Watch published a major report on human rights violations in US hospitals, calling on the Academy to:

Retract the support of the AAP for the 2006 Consensus Statement as an official position statement of the AAP, and replace it with a statement that is consistent with international human rights standards and with the AAP statements on Assent, Informed Permission and Consent, and on FGM. The new statement should also:

  • advocate to end to surgical procedures on children with atypical sex characteristics too young to participate in the decision, when those procedures both carry a meaningful risk of harm and can be safely deferred.;
  • advise that parents be given complete information about their intersex child’s condition and the risks, benefits, and alternatives of any recommended procedures;
  • advise that children and youth with atypical sex characteristics be given complete information about their conditions in an age-appropriate way;
    recommend that doctors routinely give parents of children with atypical sex characteristics information about available peer support groups; and
  • recommend that parents routinely have access to mental health support and information from mental health experts about their child’s condition before making irreversible decisions about their child’s health.

As we understand it, these recommendations have not been actioned.

Early in 2017, the Board of Trustees of the American Medical Association made the following recommendation:

That our American Medical Association support optimal management of DSD through individualized, multidisciplinary care that: (1) seeks to foster the well-being of the child and the adult he or she will become; (2) respects the rights of the patient to participate in decisions and, except when life-threatening circumstances require emergency intervention, defers medical or surgical intervention until the child is able to participate in decision making; and (3) provides psychosocial support to promote patient and family well-being. (New HOD Policy)

The American Academy of Pediatrics statement falls far short of these recommendations.

Read the Human Rights Watch/interACT report
Read the resolution of the Board of Trustees of the American Medical Association
Morgan Holmes writes about her experience demonstrating outside an AAP conference in 1996
Read the AAP Position on Intersexuality issued in response to the 1996 demonstration
Read the 2017 statement on the AAP website