76 of a measure that establishes a differentiated treatment and that involves one of these categories, it must examine this strictly, incorporating particularly demanding elements in its analysis; in other words, the different treatment must constitute a necessary measure to achieve an imperative purpose pursuant to the Convention. Thus, when analyzing the appropriateness of the differentiating measure, the objective pursued must be not only legitimate within the framework of the Convention, but also imperative. The measure chosen must not only be appropriate and effective, but also necessary; that is, it cannot be replaced by a less harmful alternative. Additionally, this includes the application of a consideration of proportionality stricto sensu, according to which the benefits of taking the measure in question must clearly outweigh the restrictions that it imposes on the treatybased principles that it infringes. 242. The Commission has asserted that, “this case provides an example of the multiples forms of discrimination that affect the enjoyment and exercise of human rights of some groups of women, such as I.V., based on the intersection of various factors such as their sex, immigrant status, and economic situation.” And, I.V.’s representative argued before this Court that, subjecting her to sterilization without her consent was discriminatory based on her condition as (i) a woman; (ii) poor; (iii) Peruvian, and (iv) a refugee. 243. The Court recognizes that, historically, a woman’s liberty and autonomy as regards her sexual and reproductive health, has been limited, restricted or annulled319 based on negative and prejudicial gender stereotypes, as described by the physician himself during the public hearing.320 This is because, socially and culturally, men have been assigned a preponderant role in decision-making with regard to a woman’s body, and women have been seen, above all, as a reproductive entity. In particular, the Court notes that non-consensual sterilization was influenced by the historically unequal relationship between women and men. Even though sterilization was a contraceptive method used by both women and men, non-consensual sterilization affected women disproportionately, because they were women, and because society assigned the reproductive function and family planning to women.321 Furthermore, the fact that women are the sex with the biological capacity to become pregnant and give birth means that, during a caesarean section, they were frequently subjected to non-consensual sterilization, because they were excluded from the process of taking informed decisions with regard to their body and reproductive health on the basis of the prejudicial stereotype that they were unable to take such decisions responsibly.322 Consequently, the Court considers that the strict protection provided by Article 1(1) of the Convention is applicable based on sex and gender323 because, traditionally, women have been marginalized and discriminated against in this regard. Therefore, the Court will examine this aspect of the case rigorously. 244. In this context, the Court emphasizes that “in the case of the prohibition of discrimination based on one of the protected categories contained in Article 1(1) of the Convention, the possible restriction of a right requires a weighty and rigorous justification, which means that the reasons used Cf. UN, Report of the Special Rapporteur on the right of everyone to the highest attainable standard of physical and mental health, Anand Grover, A/64/272, August 10, 2009, paras. 54 and 55. 319 During the hearing, Dr. Torrico Ameller gave a historical review of the evolution of the autonomy of women with regard to consent in relation to medical procedures during his career as a gynecologist. He divided this evolution into three stages: a first stage where the doctor was “omnipotent” and the issue of informed consent was not discussed in the medical schools; a second stage where greater decision-making powers were assigned to the patient’s doctor or husband, and a third stage, where women had greater autonomy over the decisions relating to their bodies. Cf. Statement made by Edgar Torrico Ameller before the Inter-American Court during the public hearing held on May 2, 2016. 320 321 3960). Cf. Expert opinion provided by Luisa Cabal by affidavit on April 28, 2016 (evidence file, volume XI, affidavits, folio Cf. UN, Report of the Special Rapporteur on the right of everyone to the highest attainable standard of physical and mental health, Anand Grover, A/64/272, August 10, 2009, para. 55. 322 323 Cf. Juridical Status and Rights of Undocumented Migrants, Advisory Opinion OC-18/03, supra, para. 101.