The ability to bear children continues to decide many women’s social standing and inheritance.
Children are the hallmark of many marriages. Across the African continent, they are a source of pride and – sometimes – a determinant of the wealth and inheritance a widow is entitled to after the death of her spouse.
Without a child, a family is often seen as incomplete. In many communities, women who do not have children don’t have a say in how decisions are made—they are literally the last person to speak at communal gatherings.
For all these reasons, the forced or coerced sterilisation of women living with HIV – a troubling trend that has been recorded in Kenya, Uganda, Namibia, Botswana, and South Africa – is an injustice that for most victims is harder to accept than their HIV status.
That sterilisation is held up as a means of reducing the risk and prevalence of HIV infection compounds this injustice, since there is no scientific basis for that claim. Thanks to modern and scientifically-evolving obstetric and infant feeding practices, HIV-positive women can give birth to healthy, HIV-negative babies. Additionally, reducing the risk of HIV transmission is best accomplished through the use of antiretroviral drugs; consistent condom use; and partner counselling, testing, and treatment, among other methods.
Sterilisation occurs via a surgical procedure known as tubal ligation during which a woman’s fallopian tubes are severed or blocked to permanently prevent pregnancy.
When a patient voluntarily requests the procedure, it is an acceptable form of long-term contraception.
When conducted without the full, free, and informed consent of the patient, however, sterilisation violates a woman’s human rights.
Considerable suffering has been associated with involuntary childlessness. Sterilised women generally face extreme stigma; they are also susceptible to greater rates of gender-based violence, and abuse from their partners and communities.
In 2014, the World Health Organisation and various United Nations bodies issued a joint statement on eliminating forced, coercive, and otherwise involuntary sterilisations. They explicitly condemned the practice, noting that states’ obligation to protect people from such treatment extends into the private sphere, including where such practices are committed by health-care professionals. This has largely been echoed by the African Commission on Human and Peoples’ Rights.
But the practice persists.
In Kenya, a report from the African Gender and Media Initiative documented the experiences of 40 women living with HIV who were forced or coerced into undergoing permanent sterilisation. For some, the procedure was done without their knowledge during emergency caesarean sections; others signed consent forms during active labour or after being coerced into believing that sterilisation was necessary before they received food or medical care for their children.
The organisation where I work represents five of these women who have sued various health-care institutions after being forcibly sterilised or coerced into agreeing to the procedure.
Not long ago, I asked a doctor in Nairobi if she performed forced sterilisations. “We don’t do it anymore,” she said.
“Did you ever do it?” I asked.
“Of course,” she said. “Most of us did it, thinking we were saving the lives of these women.”
Unfortunately, sterilisations continue, especially in Kenya’s rural areas. The country’s government – while publicly condemning the practice – has never made any effort to prevent doctors from committing this blatant infringement on women’s autonomy.
Meanwhile, about 1.5-million people in Kenya – mostly women and children – are living with HIV, according to UNAids. These numbers tell us what science has made clear long ago: forced sterilisation does not decrease new HIV infections.
In other words, we can’t even say that the suffering of women who have been forcibly sterilised was for a good cause.
One of the reasons forced sterilisation has been so hard to eradicate is that women in many countries have been reluctant to speak up about it.
In Kenya, we have broken the silence. The petitioners, in our case, accompanied by other women who were also sterilised, attend every single court proceeding and, in some cases, travel overnight to do so. Their bravery has inspired others.
In Uganda, the International Community of Women Living with HIV Eastern Africa recently completed a comprehensive study on involuntary tubal ligation. Earlier this year women in South Africa, led by the Women’s Legal Centre, filed a case challenging the practice.
We can never give back what was taken. But we can do our best to ensure that other women are not robbed of their future children, too.
Tabitha Griffith Saoyo is the programme manager for sexual reproductive health and rights at the Kenya Legal & Ethical Issues Network on HIV and Aids.