I 
117TH CONGRESS 
1ST SESSION H. R. 5730 
To amend part E of title IV of the Social Security Act to require States 
to prohibit genital surgery on foster children with variations in sex 
characteristics who are under six years of age as a condition of receiving 
grants under such part. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 26, 2021 
Ms. GARCIA of Texas (for herself, Mr. TAKANO, Mr. RASKIN, Ms. PRESSLEY, 
Mr. QUIGLEY, Ms. JACKSON LEE, and Mr. PAYNE) introduced the fol-
lowing bill; which was referred to the Committee on Ways and Means 
A BILL 
To amend part E of title IV of the Social Security Act 
to require States to prohibit genital surgery on foster 
children with variations in sex characteristics who are 
under six years of age as a condition of receiving grants 
under such part. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. PREAMBLE. 
(a) The Congress opposes all forms of prejudice, bias, 
and discrimination, and affirms its commitment to the 
dignity and autonomy of all people, including those born 
with variations in their physical sex characteristics. The 
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Congress especially notes the importance of protecting 
children within the guardianship of the foster care system. 
(b) ‘‘Variations in physical sex characteristics’’ is an 
umbrella term used to describe a wide range of natural 
bodily variations in traits including genitals, gonads, hor-
mone function, and chromosomal patterns. 
(c) People born with variations in their physical sex 
characteristics are a part of the fabric of the Nation’s di-
versity and are equally entitled to dignity and bodily au-
tonomy. 
(d) People born with variations in their physical sex 
characteristics are regularly subjected in infancy to sur-
geries to change the appearance or function of those vari-
ations, even though such surgeries may result in lasting 
harm. 
(e) The Congress recognizes that surgeries on infants 
with variations in their physical sex characteristics are 
often justified by generalized assumptions about people’s 
preferences about their bodies’ appearance and function. 
These assumptions perpetuate gender stereotypes and 
may not reflect an individual’s actual preferences when 
they are capable of articulating their wishes. 
(f) Not all persons with variations in their physical 
sex characteristics will need or desire the surgeries that 
may be recommended or performed on them in infancy. 
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People born with variations in their physical sex character-
istics should be free to choose whether to undergo sur-
geries that impact not only their bodily autonomy but also 
their reproductive and sexual futures. 
(g) The Congress recognizes that leading pediatric 
hospitals have begun to institute partial bans on these sur-
geries on patients who are too young to participate in a 
meaningful discussion of the implications of these sur-
geries. 
(h) Therefore, the Congress calls upon the States to 
hold health professionals responsible for safeguarding the 
bodily autonomy of people born with variations in their 
physical sex characteristics and ensuring patient-centered 
care that conforms with best practices in the medical pro-
fession by ending the practice of performing specified sur-
geries on such children when they are under the age of 
six and the surgery is not required to address an imme-
diate risk of physical harm, as provided. 
SEC. 2. FINDINGS. 
The Congress finds the following: 
(1) Individuals with variations in their physical 
sex characteristics may present with differences in 
genital anatomy, internal reproductive structures, 
chromosomes, or hormonal variations. ‘‘Intersex’’ re-
fers to the variety of different physical indicators 
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that create those differences. As many as 1.7 per-
cent of babies are born with physical sex characteris-
tics which do not conform to the expectations for a 
typical male or female. The vast majority of babies 
born with these variations do not require surgical 
intervention related to their physical sex characteris-
tics immediately, if at all. 
(2) Beginning in the 1950s physicians in the 
United States began performing irreversible sur-
geries (often referred to as genital-normalizing sur-
geries) on infants with variations in their physical 
sex characteristics without medical justification. 
(3) As many as two-thirds of these irreversible 
surgeries occur on infants under the age of two. A 
literature review of genital surgery conducted on 
children with variations in their physical sex charac-
teristics published in the Journal of Steroid Bio-
chemistry and Molecular Biology found that between 
2005 and 2012 the average age of patients was 11.2 
months old and the median age was 9.9 months at 
initial surgery. 
(4) These surgeries, which include unnecessary 
infant vaginoplasties, clitoral reductions and reces-
sions, and removal of gonadal tissues, are often per-
formed before a child can even speak or stand, 
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meaning the individual is excluded from the decision 
whether to undergo these irreversible procedures. 
(5) There is evidence that these surgeries cause 
severe psychological and physiological harm when 
performed without the informed consent of the indi-
vidual. These harms may include scarring, chronic 
pain, urinary incontinence, loss of sexual sensation 
and function, sterilization, depression, post-trau-
matic stress disorder, suicidality, and incorrect gen-
der assignment. 
(6) A number of domestic and international 
human rights organizations have conducted thorough 
inquiries into genital surgeries on infants with vari-
ations in their physical sex characteristics and have 
concluded that these procedures are cruel and cata-
strophic, as follows: 
(A) 
The 
United 
Nations 
Special 
Rapporteur on Torture and Other Cruel, Inhu-
man or Degrading Treatment or Punishment 
explained in 2013, ‘‘children who are born with 
atypical sex characteristics are often subject to 
irreversible sex assignment, involuntary steri-
lization, involuntary genital normalizing sur-
gery, performed without their informed consent, 
or that of their parents, ‘in an attempt to fix 
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