A/HRC/31/57 Human Rights found that the sterilization of a Roma woman who consented to the procedure only during delivery by caesarean section violated the prohibition of torture and ill-treatment.25 Documented practices that may violate the prohibition of torture and illtreatment include Government-sponsored family planning initiatives targeting economically disadvantaged and uneducated women that shortcut the process of obtaining consent, sterilization certificates required by employers and coerced sterilization of HIV-positive women in some States. Despite the fundamental rights enshrined in the Convention on the Rights of Persons with Disabilities, women and girls with disabilities are also particularly vulnerable to forced sterilization and other procedures such as imposed forms of contraception and abortion, especially when they are labelled “incompetent” and placed under guardianship (A/67/227). Other abusive practices in health-care and educational settings 46. Women and girls seeking reproductive health care in professional settings are often exposed to severe pain and suffering and coerced into or subjected to unwanted, degrading and humiliating procedures and examinations. In some States, such practices include requiring sex workers to undergo weekly gynaecological examinations and blood tests, and forced or coerced pregnancy testing by means of physical examination or urine testing as a precondition for attending schools and public examinations. Virginity testing and the expulsion of pregnant girls from schools, which often result in long-term harmful consequences, constitute forms of discrimination and ill-treatment. 47. In many States women seeking maternal health care face a high risk of ill-treatment, particularly immediately before and after childbirth. Abuses range from extended delays in the provision of medical care, such as stitching after delivery to the absence of anaesthesia. Such mistreatment is often motivated by stereotypes regarding women’s childbearing roles and inflicts physical and psychological suffering that can amount to ill-treatment. The detention of post-partum women in health-care facilities for failure to pay medical bills amounts to ill-treatment by separating new mothers from their children and exposing them to significant health risks.26 Lesbian, gay, bisexual, transgender and intersex persons in health-care settings 48. Lesbian, gay, bisexual, transgender and intersex persons are frequently denied medical treatment and subjected to verbal abuse and public humiliation, psychiatric evaluations, forced procedures such as sterilization, “conversion” therapy, hormone therapy and genital-normalizing surgeries under the guise of “reparative therapies”. These procedures are rarely, if ever, medically necessary, lead to severe and life-long physical and mental pain and suffering and can amount to torture and ill-treatment (A/HRC/22/53). The criminalization of same-sex relationships and pervasive discrimination against lesbian, gay, bisexual, transgender and intersex persons lead to the denial of health care, information and related services, including the denial of HIV care, in clear violation of international human rights standards such as the Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity. 49. Transgender persons often face difficulties in accessing appropriate health care, including discrimination on the part of health-care workers and a lack of knowledge about or sensitivity to their needs. In most States they are refused legal recognition of their preferred gender, which leads to grave consequences for the enjoyment of their human 25 26 Application No. 18968/07, V.C. v. Slovakia, judgement of 8 November 2011. High Court of Kenya, Awuor and Oliele v. Attorney General of Kenya et al., judgement of 17 September 2015. 13