THE road to sex reassignment covers some very difficult terrain, ranging from hormone treatment and possibly surgery, to social stigma and discrimination. But in many European countries those wanting to have the reassignment legally recognised face extra challenges. Citizens of Malta, Ireland, Denmark and Norway can simply tell authorities their decision. Elsewhere the process requires judicial consent or even the diagnosis of a mental disorder. Switzerland, Greece and 18 other, mostly eastern European, countries have a final hurdle: sterilisation. Why is this the case?

The requirement for sterilisation has dark echoes of eugenics. In the early 1970s Sweden became the first country in the world to allow transgender people to reassign their sex legally. It enforced a strict sterilisation policy though, on the grounds that such people were mentally ill and unfit to care for a child. (Indeed the World Health Organisation still lists “transsexualism”, which it describes as “a desire to live and be accepted as a member of the opposite sex”, as a mental and behavioural disorder.) The nationwide eugenics programme ended in 1976 after 42 years, but sterilisation remained a condition for sex reassignment until 2013; it had already spread to other countries when they started tackling the same issue.

Amnesty International estimates that the European Union is home to around 1.5m transgender people (those whose gender identity differs from their biological sex). Though Europe is widely seen as progressive on LGBT rights, transgender rights specifically still lag. The processes involved in sex reassignment vary greatly between countries, most of which require a complex combination of medical interventions and legal paperwork. Compulsory sterilisation is perhaps the most controversial measure, provoking criticism from LGBT activists and the UN. States in which the idea of a man giving birth or a woman fathering a child is considered inconsistent with family values may cling to these clauses. In April, the European Court of Human Rights ruled in favour of three French complainants on the grounds that forced sterilisation violated their right to a private and family life—something guaranteed by the European Convention on Human Rights.

The court's ruling binds France. It suggests that the law in the 20 countries that retain a condition of sterility or infertility violates the convention on human rights. But it does not force these countries to reform. Activists say it is likely to require several similar court cases before the continent reaches any kind of legal consensus. Understanding about transgender people is spreading, though, including the knowledge that many of them do not seek surgery. In some countries, gender is becoming less important a characteristic for organising society: the Dutch parliament is considering whether official documents should record gender at all.