Forced and coerced sterilisation: violating the rights of women living with HIV.

A recent study by the Namibian Chapter of the International Community of Women Living with HIV and Aids (ICW) revealed that forced and coerced sterilisation is taking place in our country and that it is part of a broader range of discriminations faced by HIV positive women in sexual and reproductive health services. The study, The Forced and Coerced Sterilisation of HIV Positive Women in Namibia (March 2009) was conducted by staff and volunteers from ICW-Namibia and the Legal Assistance Centre. Findings reveal flagrant violations of rights guaranteed under the Namibian Constitution, as well as several other regional and international instruments of which Namibia is a signatory.

The study

From January through April 2008, more than two hundred women living with HIV participated in focus groups and interviews about their experiences of discrimination and sterilisation. The participants were found through community HIV support groups and came from the Khomas, Otjozondjupa and Oshana Regions. The women who participated in these focus groups and interviews were also trained on their legal rights. Of the 230 participants, 40 stated that they had been coerced or forced into sterilisation. During their research, ICW-Namibia also spoke with available hospital doctors and administrators to explore their knowledge and involvement in forced and coerced sterilisation.

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Misinformation, manipulation and coercion

The rights of the women in this study were violated in a number of ways. In some of the reported cases, medical personnel failed to provide women with a full description of the nature of the procedure, its effects, consequences and the risks associated with sterilisation. By withholding this information or by manipulating the facts, these hospital workers denied the women their right to informed consent. Women have been told that they are putting the health and lives of their future children at risk, some women being told that future children will die during birth due to HIV.

Other women were led to believe it was necessary to be sterilised because they were HIV positive or that HIV positive women are unable to have healthy children. The study asserts that such misinformation evokes guilt and mental anguish, often causing women to consent to being sterilised when they normally would not.

In some cases, tubal ligation was performed without the knowledge of the woman, leaving her to find out only after she had been sterilised. A tubal ligation is a surgical procedure which closes the fallopian tubes, and stops the egg from travelling to the uterus from the ovary. It also prevents sperm from reaching the fallopian tube to fertilise an egg. One woman consented to a tubal ligation without knowing that afterwards she would not be able to have children. In other cases, women were coerced into having the procedure as medical personnel demanded consent to sterilisation as a condition to performing other necessary services including delivery and abortion. An HIV-positive woman age thirty-one reported being sterilised at Katutura State Hospital after being told that if she wanted help delivering her baby, she would need to give consent to be sterilised. She was also told that "help was necessary because the baby was larger than normal size."

Violating patients' rights

The study reveals that HIV positive women frequently face other violations of their rights when it comes to the medical care that they receive. "Medical passports often did not reflect the health care concerns of the women interviewed," says the report. In addition, doctors in Oshikoto Region revealed that HIV positive women were only provided access to their medical records under the doctor's supervision and only if the patient explained what the information was needed for. Another major problem faced by HIV positive women is a violation of confidentiality. This is sometimes the result of a need for translation, but at other times women living with HIV had to identify themselves and be placed in separate waiting rooms.

Stigma and discrimination

The study suggests that stigma and discrimination are at the heart of most of the forced sterilisations and other violations. According to the report, many service providers believe that HIV positive women should not have children. "One doctor remarked that he is protecting the needs of the 'community' when he makes decisions to sterilise on behalf of positive women. Doctors also expressed the belief that women did not know how to best care for their own bodies or did not understand the information that was given to them," says the report. "One doctor at Katutura State Hospital justified her ill-treatment of HIV positive patients by claiming that patients' health passports are 'dirty' and that patients themselves 'do not wash'."

Participants in the study reported being told to "stand at the back of the line" when they lacked money for needed health services and being told that "they should not be pregnant because they are HIV positive." Some health facilities keep separate waiting areas for HIV positive and negative patients. The study goes on to say that one woman was unknowingly given medication to induce an abortion by a nurse who felt that she should not be pregnant.

Defending dignity and human rights

The Legal Assistance Centre (LAC) is currently following up on fifteen of the reported cases of forced or coerced sterilisation. According to William Magenya who is assisting Linda Dumba-Chicalu, the lawyer who will represent the women, four out of the fifteen cases happened over three years ago, putting them beyond the statute of limitations. The LAC has not dismissed those cases outright, but is instead focusing on the eleven cases that fall within the statute of limitations. Seven of these cases are in court and may come up for trial sometime this year. The remaining four are still under investigation, as the legal team gathers the necessary facts and information. If the evidence proves sufficient to bring forth a case, the LAC will do so.

In addition to the cases being handled by the LAC, the report spells out several recommendations to Parliament, the Ministry of Health and the Ministry of Justice designed to seek redress for the women whose rights have been violated and to ensure that the rights of women living with HIV are protected in the future.

The information documented in this study reveals that women living with HIV are experiencing violations of many of their rights including the Right to Information and Informed Consent, the Right to Equality and Non Discrimination, and the Right to Bodily Integrity. According to Jennifer Gatsi Mallet, ICW-Namibia Project Officer, "for HIV positive women who need to access health services for their survival, a hospital should be a place of safety, a place where one recuperates, and where one can fully understand and address the health issues that affect them. As documented by our organisation, health care facilities as sanctuaries of health and human rights for HIV-positive women in Namibia remain far from reality."