First announced in late August, Germany’s new law that allows parents to withhold designating a gender for their newborn has now taken effect in the country. The third gender is effectively an empty slot on the child’s birth certificate, and it’s intended to immediately shift the parents’ ownership of the newborn’s body to the newborn itself.

Implemented on Nov. 1, the new law allows intersex babies — those born with both sets of genitalia or some mix of the two, formally known as hermaphroditism — to delay sex reassignment decisions until an age when they can make more personal, informed choices. But advocates of intersex rights argue the third gender law doesn’t adequately protect children from their parents electing to have the surgery anyway.

"It's a first, important step in the right direction," Lucie Veith, an intersex person from Hamburg, Germany and a chair of the German Association of Intersex People, told Agence France-Presse. Veith argues the addition of a third gender option was never the point of the Intersex People’s fight – rather, "that we forbid cosmetic genital surgeries for newborns,” she said. “That is our first demand.”

Veith argues the new law violates her country’s constitution, which endows its citizens with a “right to bodily integrity,” and posits that such surgeries aren’t merely one-time decisions that get forgotten about with time. Vaginoplasties — the process of surgically constructing a vagina — for instance, require that dilators be frequently employed to prevent the vaginal wall from closing. "I've heard from many who experienced that as a kind of routine sexual invasion," Veith told Der Spiegel.

Additional hardships include emotional hurdles, such as parent resentment and troubling battles with one’s gender identity.

Up to one in 1,500 to one in 2,000 births occurs as an intersex birth, according to the Intersex Society of North America. The full list of disorders spans 15 different conditions, which range in frequency from one in 1,666 births (not XX and not XY) to one in 150,000 births (complete gonadal dysgenesis). Such complications make parents’ decisions difficult, particularly when the child isn’t old enough to understand what condition it has, let alone offer an opinion about it.

“We want people to be left alone, especially when they can’t even express themselves because they are so young,” Andrea Budzinski, president of the German Transgender and Intersex Society, told the Telegraph. “We have to ensure that no more babies and young children are subject to sex changes.”

Germany is the first country to allow the third gender option. Many advocates applaud the country’s efforts, but going forward, they say there is still much to be done.

One of the thornier questions revolves around the appropriate age to allow sex reassignment surgeries. Pre-pubescent children often understand little about what is happening to their bodies, just that something is changing. This has led Hamburg-Eppendorf University Medical Center sexual scientist, Hertha Richter-Appelt, to push for legal bans on any medically unnecessary interventions until the child is 16 years old.

It has also led to her pushing for a more open, honest discussion about the issue of gender when raising a child.

"Efforts to produce an unambiguous body impose circumstances upon the child that it may not want,” she told Der Spiegel. "When the issue is definitively deciding what is truly better for the children, we have to be honest and say that we often don't know.”