Sterilised without consent

Women’s rights activists have claimed that South African and Namibian public health doctors are making HIV-infected women infertile against their will.

South Africa’s Woman’s Legal Centre (WLC) has documented 12 cases of South African women, most of them HIV-infected, who claim to have undergone what the health world calls “coerced sterilisation”.

Promise Mthembu, a Wits University researcher based in Durban, who is helping compile the cases, said coerced sterilisations were happening “in very large areas” of South Africa.

Mthembu said many of the patients were told that to gain access to medical services they had to undergo the procedure. She told of a 14-year-old Orange Farm resident who “went to get an abortion earlier this year, and they said they would only operate if she was sterilised”.

Another documented case was that of a 19-year-old patient at Prince Mshiyeni Hospital, outside Durban. In 2007 she was allegedly pulled out of the delivery ward while in labour and told by the doctor that “you have to be sterilised”.

“It comes down to the issue of informed consent,” said Aziza Ahmed of the Washington DC office of the International Coalition of Women Living with HIV (ICW).

“If you don’t understand what sterilisation means, or if the physician doesn’t speak your language, that’s not informed consent.

“You also can’t really consent when you’re in labour. If someone says to you ‘sign these forms to have assistance with delivery’, you’re going to sign whatever’s put in front of you.”

South African health department spokesperson Fidel Hadibe said he could not comment on the claims.

In Namibia, the ICW is planning legal action against the government over alleged sterilisations. The group claims to have 40 confirmed cases, seven of which will be aired in court by the end of the year.

Ahmed argued that if pregnant women had improved access to programmes and drugs aimed at the prevention of mother-to-child transmission of HIV, such reproductive control would diminish. “The way new medicines work, there’s a less than 2% chance of giving HIV to your child. Obviously we need to stop the spread of HIV to children, but [sterilisation] is not the correct way of looking at the issue.” Prevention of mother to child transmission programmes in the region are underfunded, leaving millions of women without services.

Jennifer Gatsi-Mallet, the ICW’s Namibian coordinator, said many of the women interviewed by the organisation “didn’t know what sterilisation was. It was never explained to them; they thought it was part of a programme for women living with HIV.”

Even after the procedure, most women did not fully understand what had happened. “One woman didn’t even realise that she was sterilised until she went back to the doctor to get birth control,” Mallet said.

The Namibian health ministry has not explicitly called for sterilisations, but the ICW claims that according to local doctors the issue was referred to in guidelines issued to all public health sites in the early 1990s, when HIV was beginning to hit the country.

The ICW said that despite repeated requests the ministry has refused to hand over old and current guidelines.

Priti Patel, a project lawyer with the HIV/Aids programme at the South African Litigation Centre, said the planned court action against the Namibian government was based on the country’s Constitution.

“Sterilising a woman without her consent goes against fundamental concepts of people having the right over their own bodies,” Patel said. “Part of being a human, and especially a woman, is the right to reproduce.”

Mara Kardas-Nelson

Mara Kardas-Nelson

Mara Kardas-Nelson is a journalist with the Mail & Guardian's Centre for Health Journalism, where she focuses on access to medicine, health policy, financing, and planning. She has been contributing to the Mail & Guardian since 2009, writing on a wide variety of topics ranging from the environment to development to local culture. In 2010 she shared a Mondi Shanduka Newspaper award with photographer Sam Reinders for their work on acid mine drainage in Gauteng and Mpumalanga. Her work has appeared in publications across Africa, North America, and Europe.  Read more from Mara Kardas-Nelson

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