Forced or coerced sterilisation is based on exclusion and aims to eliminate those who are regarded as socially unacceptable. Thus historically it has been forced on the marginalised and unwanted, usually the poor, mentally ill, disabled and unwanted minorities.
At the core, it is a negation of a person’s right to decide whether, and when, they want to reproduce. Fortunately our Constitution expressly protects this right. Section 12 guarantees the right to bodily integrity, which includes the right to make decisions about reproduction and the right not to be subjected to medical treatment without giving informed consent.
Moreover, South Africa is a signatory to several codes such as the Convention on the Elimination of All Forms of Discrimination against Women and the African Protocol on the Rights of Women, which guarantee women’s reproductive rights.
Despite these guarantees, the shocking reality is that in at least four provinces in South Africa forced sterilisation is being done by the public health service, especially in poor informal settlements and rural areas.
According to reports, HIV-positive mothers, when accessing reproductive health services, and particularly abortion and prevention of HIV mother-to-child transmission, are being compelled to consent to sterilisation before receiving treatment. This is unconstitutional and a denial of one of the most elementary rights of society. But to understand the extent of these violations, it is necessary to contextualise them.
Primarily owing to misinformation and a lack of education, HIV and Aids carry an unwarranted negative social stigma in rural and poor areas. As a result, HIV-positive women are usually abandoned by their families and their community because of their status.
In addition, these already vulnerable women are largely uneducated and thus ill equipped to understand fully the consequences of such coerced consent. In poor societies, characterised by male domination, female sexual submission is the norm and reproductive abilities are critical to survival.
The net result of sterilisation is a deepening of the systemic disadvantages experienced by this marginalised group. Why then has this alarming practice emerged? And why is it going unheeded?
One of the most prevalent ways that HIV is transmitted from mother to child is around and at the time of birth. The argument for sterilisation is based on a sense of responsibility — that it will reduce the risk of motherto- child transmission of HIV and thus contribute to the fight against the Aids pandemic.
Accordingly, the violation on the mother’s reproductive rights is thought justified. However, it is equally common cause that the provision of ante-retrovirals will substantially reduce that risk.
The true reason for sterilisation is rather a consequence of the ideology that informed the HIV/Aids policies. Initially, the government’s reaction was one of denialism.
As the reality of the extent of the disease dawned, the response shifted to a reactionary one, focused entirely on curbing what had become a pandemic. No consideration was given to the bodily integrity of this unwanted group and even less to the reasons why an HIV-positive woman would want to have children.
The reasons why such women would want to have children are not that different from those of other women. They are varied and include a personal desire to have a family, as well as meeting familial and social expectations and pressures.
Within the Aids context, they are also often as a result of a hope that children will provide labour to sustain the household, security in old age and wanting to replace children already lost to HIV/Aids.
The question arises as to why such gross violations of women’s rights have gone unchallenged for almost 15 years in South Africa. This is partly because our public health programmes ignore women’s reproductive rights. But another reason is that the women themselves are not sufficiently informed or mobilised to put a stop to this unlawful practice.
Given their marginalised status, the responsibility to educate and organise this group clearly falls on society at large. To do so requires that we create and support an environment in which HIV-positive women are able to organise themselves as a political force to be reckoned with.
Furthermore, there is a need for the government to respect, protect and fulfil its domestic, regional and international human rights obligations towards HIV-positive women, immediately end coerced or forced sterilisation and ensure that the sexual and reproductive rights of HIV-positive women are fully protected.
Noluthando Ntlokwana is assistant director of the Centre for Constitutional Rights