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Inclusion, fairness and non-discrimination in sport: a wider lens
  1. Sheree Bekker1,
  2. Ryan Storr2,
  3. Anna Posbergh3
  1. 1 Centre for Health and Injury and Illness Prevention in Sport, Department for Health, University of Bath, Bath, UK
  2. 2 Sport Innovation Research Group, Swinburne University of Technology, Hawthorn, Victoria, Australia
  3. 3 Department of Kinesiology, University of Maryland at College Park, College Park, Maryland, USA
  1. Correspondence to Dr Sheree Bekker, Department for Health, University of Bath, Bath BA2 7AY, UK; s.bekker{at}

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Sport and Exercise Medicine (SEM) practitioners have, in recent years, taken a leading role in two immensely important areas of research and practice: safeguarding athletes1 and athlete mental health.2 We, as a field, recognise that these intertwined, pressing and growing concerns are becoming more visible thanks to the power of athlete voice.

The International Olympic Committee (IOC) has also taken a leadership role in these two areas . Driven by affected stakeholders (athletes) who have experienced harm, and resultant increased legal and social pressure, in March 2020 the IOC recognised harassment and abuse as a current human rights challenge.3 In doing so, the IOC drew on the 2016 IOC Consensus Statement on Harassment and Abuse1 and testimonies of affected athletes to recognise that LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer and other gender expansive people) athletes are at ‘particular risk of harm and structural discrimination’ in unique ways (eg, governance structures and policies that allow abuse to occur).3 As a result, the IOC took stock of how International Federations approached and applied eligibility regulations for women’s sport, particularly in light of scrutiny by United Nations (UN) bodies around the ‘severe harms’ that transgender women and women with sex variations were subjected to, including coerced surgeries3 4 (eg, medically unnecessary interventions performed to modify or remove atypical or ambiguous genitalia or internal sex organs or gender affirmative surgery done solely for the purposes of sports participation).

New IOC framework on fairness, inclusion and non-discrimination

It is this scrutiny and recognition of severe harm that led the IOC to publish their new Framework on Fairness, Inclusion and Non-Discrimination on the Basis of Gender Identity and Sex Variations5 in 2021. This new framework ‘provides guidance to sports bodies within the Olympic Movement on how to draft and implement eligibility criteria for men’s and women’s categories in competitive sport’ and was the result of an extensive research, design and stakeholder consultation process over the course of 3 years.6 Central to the new Framework are 10 principles (box 1).5

Box 1

IOC framework on fairness, inclusion and non-discrimination on the basis of gender identity and sex variations principles.5

  1. Inclusion.

  2. Prevention of harm.

  3. Non-discrimination.

  4. Fairness.

  5. No presumption of advantage.

  6. Evidence-based approach.

  7. Primacy of health and bodily autonomy.

  8. Stakeholder-centred approach.

  9. Right to privacy.

  10. Periodic reviews.

These principles safeguard ‘the rights of all athletes, in particular, the rights of transgender athletes and women athletes with sex variations who have historically faced hostile sporting environments, including discrimination and abuse, and in some cases have experienced irreversible impacts on their health, privacy, safety and livelihoods’.6

Athlete health protection as a human right

Understanding this context for the framework helps us to move beyond thin, extrapolatory scientism and towards a thicker and fuller comprehension of why this framework now exists, and why it matters. It helps us to understand athlete health protection as a human right, and that human rights and dignity are not simply a ‘nice to have’ or an optional extra. Rather, human rights are a set of international standards and obligations, which are further built into the laws of nation states. This is why, for example, the World Rugby Transgender Guideline7 (which excludes trans women from women’s rugby) may not be implemented in member nations such as Canada and South Africa where gender identity is enshrined in legislation and constitution, respectively.

Crucial to understanding the new IOC framework5 and the direction in which many sports are moving is that fairness, inclusion and non-discrimination extend beyond data, medical/scientific interpretations, understandings and applications.4 Rather, this is about (inter)national human rights standards and obligations, medical ethics8 and conducting relevant, comprehensive and ethical research and practice.4 The era of sports organisations circumventing these standards and obligations is swiftly coming to an end, and SEM must recognise and understand this wider lens in our own research, policy and practice.

A commitment to safeguard all athletes

In response to the IOC framework,5 the International Federation of Sports Medicine and European Federation of Sports Medicine Associations argued that ‘if an athlete is fully informed and consents, then it is their free choice to undergo carefully considered or necessary interventions for gender classification for sport to compete fairly and safely in their chosen gender’.9 We argue that for an athlete under duress with the threat of non-participation at hand, this is not ‘consent’ but rather ‘coercion’, and this approach opens a dangerous door towards invasive examinations and potential abuse, especially for athletes of younger age.10

More dialogue with diverse perspectives (including affected athletes themselves), more research across different sports and more experience are clearly needed to effectively apply and evaluate the IOC framework for fairness, inclusion and non-discrimination. However, if SEM clinicians and researchers are to stay committed to our duty of care, including to safeguarding and the mental health of athletes, then we must embrace these principles,5 this framework5 and perhaps most importantly the dignity of all athletes we serve.

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  • Twitter @shereebekker, @annaposbergh

  • Contributors SB drafted the first version of this editorial. RS and AP critically reviewed and added to subsequent drafts. All authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SB completed her PhD in 2018 at the Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), an International Olympic Committee Research Centre. RS is a Co-Founder of Proud2Play Inc. AP received funding in 2020 from the International Olympic Committee Solidarity as part of the PhD Students and Early Career Academics Grant Programme for a research project on 'Fairness and Contemporary Sex Reassignment Regulations: Contextualizing Scientific Understandings of "Fair Play"’.

  • Provenance and peer review Not commissioned; externally peer reviewed.