Slowly more and more women are coming forward. They are stepping out of the shadows of silence and raising their voices. Despite the shame that has held them captive for so long they are now sharing their stories about what has been done to their bodies, without consent.
According to the HIV Stigma Index, 7% of HIV-positive women report being victims of forced sterilisation. As well as this, 43% of South Africans who are HIV positive suffer from ‘internalised stigma.’ Allegations of forced sterilisation have been made in South Africa, Namibia, Kenya and Swaziland – among female HIV-sufferers, disabled and underprivileged women.
For pregnant women, their stories start in the usual way. They arrive at the hospital, in labour and are advised that they need to have a caesarean section. This is common for women who are HIV positive, as it decreases the risk of the mother transferring the virus to her unborn child. Prior to the procedure it is protocol for women to sign consent forms, granting the surgeon permission.
However, when these women come out of surgery they learn to their horror that at the time of the c-section, they have been sterilised as well – taking away their right to have any more children.
‘They are robbed of their right to have children,’ says Jody-Lee Fredericks, a lawyer at the Women’s Legal Centre in Cape Town. The women have been duped. Not only are they exhausted new mothers, but they have been tricked by a medical professional – taking away their reproductive right.
The doctors say the women were informed of the procedure while the women say this was not the case and nothing regarding a sterilisation procedure was discussed with them. Many of them report that they did not even know the term sterilisation or what it meant. It turns into a ‘he said, she said situation,’ Fredericks laments.
There have also been reports of women who are disabled being forced into a sterilisation procedure. Their legal guardians are signing consent forms on their behalf thinking that sterilisation is in their best interest. However, disabled women have begun to speak out as well, saying that these procedures were done against their will. According to a briefing by the Human Rights Watch, ‘safeguards to prevent forced sterilisation should not infringe the rights of women with disabilities to choose sterilisation voluntarily and be provided with the necessary supports to ensure that they can make and communicate a choice based on free and informed consent.’
Regardless of the circumstances, all of these women feel that people who they should be able to trust have violated their bodies and reproductive rights.
It is a question with no clear answer. In Frederick’s opinion, the medical professionals are coercing women into sterilisation because they feel that they are preventing further issues down the line. This raises a big ethical dilemma because who is to say that the doctors preforming these procedures have the right to make decisions regarding another woman’s body.
Where does the law stand on this? According to South African law a woman must be thoroughly informed about the sterilisation procedure and fully understand the procedure before signing consent. They also have a right to withdraw consent at any time (prior to the operation). In all the cases Fredericks has seen, the women have signed the consent forms, however it was under duress since they were in labour and most likely not able to think straight. This is where the law falls short.
Melanie Pleaner, a technical specialist in sexual and reproductive health at the Wits Reproductive Health and HIV Institute (WITS RHI) explains that the current policies are clear under the Sterilisation Amendment Act and National Contraception Clinical Guidelines. ‘All sterilisations are to be preformed only with informed consent and the person needs to be in a physical and psychological state to understand the information and make a decision without feeling pressurised.’ Pleaner emphasises that ‘getting informed consent is a process;’ a process that should not be taken lightly.
Currently nationwide, according to Fredericks, lawyers are litigating the state to put in place stricter standards to protect these women from loopholes in current laws.
Pleaner narrows it down to the fact that people, particularly healthcare professionals, believe that they are actually doing the right thing. ‘I think the mind-set that if a woman has too many children and if she can’t afford the children, then she should be sterilised is a judgement of socioeconomic status, so wealthy women in a private hospital would not necessarily be subject to forced sterilisation despite the number of children she has.’ But these medical practitioners miss the vital point: It is that woman and her alone who has autonomy over the decisions relating to her body.
Socioeconomic status doesn’t appear to be the only driving force in the healthcare professional’s decision. In some cases, the women claim the doctor refused to help them until they had signed the form. Disabled women have also made claims that the doctors suggest sterilisation to their legal guardian because they believe it will make their and their caregivers lives easier in the future. The biggest question of all is why is this burden being placed on the woman? Why is it her responsibility alone to curb HIV rates and unplanned pregnancy? Where do you here of men being coerced into sterilisation or being blamed for the HIV epidemic that plagues Africa today. You don’t.
‘All health practitioners should be made aware of women’s rights and their rights to fertility choices, their rights to contraception and their rights to have or not have more children.’-Pleaner
In the midst of these huge human rights violations there is still hope that women’s sexual rights can be returned to them. The first step is breaking the silence and dissolving the stigma that has held so many women hostage. The more women who share their stories about forced sterilisation, the more ammunition there will be for lawyers to make strides in policy reformation and to further protect women in the future.
Pleaner emphasises that in the case of forced sterilisation ‘there is a gap between what our policy and laws say and the professionals and health practitioners’ awareness.’ She continues, ‘all health practitioners should be made aware of women’s rights and their rights to fertility choices, their rights to contraception and their rights to have or not have more children.’
It is this awareness that will help bridge the gap between the current state of women’s sexual rights and the standard that society to should be adhering to. Despite the South African Constitution outlining the right to healthcare, including reproductive healthcare, medical professionals violate this condition by forcing some women to undergo sterilisation. This is done without consent or without properly explaining the consent form. Women’s right to autonomy over their bodies must be addressed so that the healthcare practitioners – entrusted with a patient’s best interest – are made accountable. Only then will the right of control over their own bodies will be returned to women
Liv is a writer and blogger from New York City. She loves yoga, the beach and anything in nature. Her goal is to help make the world a better place through writing and responsible journalism.
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