Human Rights Watch (HRW), an international human rights advocacy group, is calling on Japan to end its practice of forced sterilizations for transgender people.
HRW condemned the island nation's criteria for legally recognizing a transgender person's gender identity in a report issued as part of the "16 Days of Activism Against Gender-Based Violence" campaign.
"Forcing people to undergo unwanted surgeries to obtain documentation is contrary both to Japan's human rights obligations and its reputation as a champion of LGBT rights," the report stated. "The government should urgently revise Law 111 to end forced sterilization."
Under Japanese Law 111 of 2003, to legally change their gender, transgender individuals must "be single and without children under 20, undergo a psychiatric evaluation to receive a diagnosis of 'Gender Identity Disorder' (GID), and be sterilized," according to HRW's report.
The Japanese law defines sterilization as "to not have gonads or permanently lack functioning gonads," whether they be testis or ovaries.
The law also requires individuals applying for a gender change to undergo sex reassignment surgery, according to an HRW letter addressed to the United Nations.
Kyle Knight, a researcher for HRW's Lesbian, Gay Bisexual, and Transgender Rights Program and a co-author of the report, told NBC News his organization began focusing on this issue in 2016.
"In 2016 we did an investigation on bullying," Knight explained. "It came up so frequently from the gender-nonconforming and transgender kids we interviewed about how terrified they were of the requirements in this law. That knowing that when they became adults, this was their option and their only option for becoming legally recognized as who they are."
A GLOBAL ISSUE
Japan is far from the only developed country that continues to make sterilization a requirement in order to have one's preferred gender be recognized — despite the United Nations' recommendation against this requirement.
Europe, arguably the world's most transgender-inclusive continent, is home to more than 20 countries that still include compulsory sterilization as a criteria to legally changing one's gender, according LGBTQ-rights group ILGA-Europe. These countries include relatively progressive nations like Switzerland, Finland and Luxembourg.
Since 2012, European countries including Sweden, Norway and France have removed sterilization requirements for transgender people as part of the process for legal recognition.
Denmark, Ireland, Malta, Norway and France are currently the only European countries that do not require transgender people to receive a Gender Identity Disorder diagnosis, undergo medical or surgical intervention or be sterilized to legally change their gender on federal documents, according to ILGA-Europe.
ILGA-Europe's senior policy officer, Sophie Aujean, said all countries should work to rid their recognition processes of these requirements.
"Forced sterilisation is an appalling infringement of an individual's human rights," Aujean told NBC News via email. "To include it in legal or policy frameworks as a criteria that trans people must fulfill for gender recognition is abusive and intrusive. In 2017, trans people should be able to access a transparent, quick, accessible legal gender recognition procedure fully based on self-determination."
The European Court of Human Rights ruled in April that the sterilization requirement for transgender people is a violation of Article Eight of the European Convention on Human Rights (ECHR), which states "everyone has the right to respect for his private and family life."
Following the decision, Transgender Europe Executive Director Julia Ehrt issued a statement calling the ruling a "victory for trans people" and said the "decision ends the dark chapter of state-induced sterilisation in Europe." However, the ECHR does not have a strong enforcement mechanism that can force lawmakers to pass new legislation, so it remains to be seen what impact the ruling will have.
In the Western Hemisphere, Argentina is leading the way in providing legal protections and rights to trans people, according to Transgender Europe. In 2012, the Latin American country passed the Gender Identity Act, which allows trans individuals to change their name and sex on legal documents as long as they are 18 years old. There are no medical requirements.
Colombia followed Argentina's example in 2015 when the country's Minister of Justice decreed that medical or surgical interventions would no longer be included in the recognition process.
Uruguay also does not require surgical interventions like sterilization or gender reassignment surgery, according to Open Society Foundations.
In the United States, requirements for changing one's gender on official documents vary by state and depend on what types of documents one is trying to change. Neither the federal government nor any U.S. state, however, require sterilization in order to legally be recognized in one's preferred gender.
Knight said it "is entirely possible" for countries like Japan that still enforce compulsory sterilization to alter their transgender recognition policies to mimic countries like Argentina and Denmark.
"This is a very basic switch, and it's not asking a lot for the government to do this," Knight said. "The basic thing that it's arguing is that the government shouldn't decide for people who they are and shouldn't put people through arduous, harmful, expensive, irreversible procedures as a part of recognizing people for who they are."