6 May 2019

South Africa: Semenya's IAAF Loss and the Ethical Implications

Photo: Sport Now/YouTube
South Africa's two-time Olympic 800m champion Caster Semenya arrives at the Court of Arbitration for Sport on February 18, 2019.
analysis

The world is reacting to the International Association of Athletics Federation's controversial rule regulating testosterone levels in female athletes, which will come into effect on 8 May. This comes after the Court of Arbitration for Sport ruled in the federation's favour in a landmark case filed by Caster Semenya, the South African 800m Olympic champion.

For many years South African Olympian Caster Semenya has had to endure in-depth and dehumanising scrutiny. As if being subjected to sex testing on a global stage was not harrowing enough, the athlete has faced seemingly targeted discrimination since. This is because of the International Association of Athletics Federation's (IAAF) desire to determine whether she has a "rare medical condition" giving her an "unfair advantage".

This desire culminated in an announcement in April 2018 by the IAAF that new rules would require hyper-androgynous athletes to lower their testosterone levels through medication.

Reports indicate that due to the narrow scope of the rule changes, which apply only to athletes competing in the 400m, 800m and 1 500m, many thought the change was designed specifically to target Semenya. However, this may also extended to other athletes with differences in sexual development (DSDs) such as Francine Niyonsaba of Burundi and Kenya's Margaret Wambui. Both have also faced questions on their testosterone levels in the past.

On 19 June 2018, Semenya announced that she would legally challenge the "unfair" IAAF rules, and her legal hearing began on 18 February 2019. Sadly, in a 2-to-1 decision, the Court of Arbitration for Sport ruled that restrictions on permitted levels of naturally occurring testosterone were discriminatory but that such discrimination was a "necessary, reasonable and proportionate means" of achieving track and field's goal of preserving the integrity of female competition.

The rule change will target athletes with one of the seven "differences of sexual development" (DSD) listed by the IAAF (intersex athletes are not concerned, only those with the X or Y chromosome). It will govern female athletes with levels of testosterone of five nanomoles per litre (nmol/L) of blood or higher, with the IAAF saying these individuals benefit from increased bone and muscle strength similar to men who have gone through puberty.

In reaction to the loss of the landmark case, Semenya is quoted by The New York Times as saying, "I know that the IAAF's regulations have always targeted me specifically. For a decade the IAAF has tried to slow me down, but this has actually made me stronger. The decision of the court will not hold me back. I will once again rise above it and continue to inspire young women and athletes in South Africa and around the world."

The World Medical Association weighs In

The implications of the rule are that should Semenya want to continue in the 800m race at international competitions, she would have to take hormone-suppressing drugs and reduce her testosterone levels to below five nanomoles per litre for six months before competing. She must also maintain those lowered levels.

The chairman of the World Medical Association, Frank Ulrich Montgomery, raised red flags in an interview with the Australian Broadcasting Corporation, saying, "We do think it is extremely serious if international sports regulations demand physicians to prescribe medication - hormonally active medication - for athletes in order to reduce normal conditions in their body."

Montgomery said that for women with DSD "it is just normal to be androgenic and there is nothing pathological about the situation of this athlete.

"No physician can be forced to administer these drugs, and we definitely urge our colleagues to refrain from giving hormonally active medication to athletes simply because some regulations demand it," he added. "If physicians do apply these drugs, they will be breaking ethical codes.

"The basic ethical code of all medical practice is to never do harm, and it is doing harm to a perfectly normal body with just a rather high level of testosterone if you administer drugs in order to make them eligible for women's sport under these regulations."

Montgomery said the argument that Semenya had an unfair advantage presented a potentially moving goal post. "So where is the limit to this? And therefore we say medicine shouldn't interfere with non-pathological situations simply to enhance sports activities."

Nike honours Semenya

Meanwhile, sports apparel brand Nike has released an incredibly emotional advert honouring the gold medallist and her struggle. In one instalment of Nike's new "short film series", Semenya narrates her frustrations, saying, "Will it be easier for you if I wasn't so fast? Will it be simpler if I stop winning? Would you be more comfortable if I was less proud?"

Although the athlete must now make serious decisions regarding her future career in athletics, we all hope to see her back on the track - even if this means stepping up to the 5 000 metres, where the IAAF's new rules do not apply.

More on This

Caster Semenya's Impossible Situation - Testosterone Gets Special Scrutiny but Doesn't Necessarily Make Her Faster

Sports are segregated by sex. But what happens when athletes don't fit neatly into sport's definition of gender? Read more »

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