Overview of ICW’s Work to End the Forced and Coerced
The Namibia forced sterilization project was initiated when 3 of the 30 participants of an the International Community of Women Living with HIV/AIDS (ICW) advocacy training project with young HIV positive women, stated that they had been sterilized with out their informed consent. This alarming fact initiated a series of focus groups and interviews that did in fact suggest that HIV positive women were being coerced or forced into sterilization by hospital staff in Namibia. ICW realized that the forced sterilization was part of a broader range of discriminations faced by HIV positive women in reproductive health services and particularly against positive women who are pregnant or desire children.*
Of the research and education programs regarding sterilization that ICW has engaged in thus far 40 out of the 230 HIV positive women participating have indicated they were subjected to forced or coerced sterilisation. Thirteen of the 40 cases have been taken up for possible litigation by the Legal Aid Centre (LAC) in Namibia and all 40 cases have been presented to the Deputy Minister of Health and Social Services, Petrina Haingura, by the ICW, LAC and the Southern Africa Litigation Centre (SALC).
The documented forced and coerced sterilisations occurred at KatuturaState Hospital, Central State Hospital, and Oshakati State Hospital.
At least two of the women subjected to coerced or forced sterilisation have filed cases before the High Court alleging violations of their right to life, human dignity, equality and the right to be free from cruel, inhuman and degrading treatment. They are represented by the LAC.
In all thirteen of the cases documented, informed consent was not adequately obtained due to one or more of the following factors: consent was obtained under duress, consent was invalid as the women were not informed of the contents of the documents they signed, medical personnel failed to provide full and accurate information regarding sterilisation procedure. In at least six of the cases, consent was obtained by medical personnel in situations of duress. In a number of cases, women were asked to sign consent forms while they were in labor or on their way to the operating theatre. In other cases, women were told or given the impression that they had to consent to sterilisation in order to obtain another medical procedure such as an abortion or caesarian section or even medical help to give birth. In at least six of the cases, the women were asked to sign a consent form for sterilisation without being informed of the contents of the form. In all of the cases, the medical personnel failed to provide the women with a full description of the nature of the procedure, its effects, consequences, and risks. No medical personnel informed the women of the irreversible nature of the procedure or provided them information on alternative forms of birth control and family planning. In addition, no information was provided on the potential side effects of sterilisation.
In many cases, the women’s continuing trauma of being subjected to coerced or forced sterilisations is compounded by the discriminatory treatment they experienced. In one of the cases documented, nurses refused to touch the patient and made disparaging remarks about her. Moreover being sterilised has caused considerable distress for the women in their relationships with family.
The submission to the Deputy Minister highlights that forced or coerced sterilisation violate numerous rights guaranteed under the Namibian Constitution, Namibia’s obligations under International law, Namibia’s human rights obligations under the African Charter on Human and People’s Rights and the Protocol on the Rights of Women in Africa. Rights violated under these agreements include the right to be free from cruel, inhuman and degrading treatment; the right to liberty and security of person; the right to health and family planning; the right to privacy; the right to bodily integrity; the right to equality and to be free from discrimination; and the right to life.
ICW continues to engage in research and advocacy with partner organizations in order to end the forced and coerced sterilization of women living with HIV.
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One woman’s story….
Joanne was diagnosed with HIV right before she was sterilised. She was admitted for a pregnancy and the doctor told her she was HIV positive. She tried to ask for advice after finding out she was HIV positive and also pregnant but they ignored her. In fact one nurse said ‘you are pregnant and HIV positive probably your baby is already dead’. At no point was she given counselling about being HIV positive or given advice about treatment. She was upset and confused so she took an overdose – a mixture of washing power mixed with different medications including malaria medication from the hospital.
Joanne believes that the doctors recommended an abortion because of the possible damage caused to the baby by the overdose. The health worker sent her to the gynaecologist who told her that the abortion was dependant on her agreeing to the tubal ligation. She felt stuck and so agreed to sign the form. She was in pain and very sick at the time. The doctors did not give Joanne any information about the procedure, although they did tell her that they were going to remove the whole womb. She only found out they had closed the tubes and not removed the whole womb when her menstruation returned. She found out that the doctors had sterilised her because of her HIV status when she looked in her health passport.
One doctor found out Joanne was sterilised, possibly from checking her medical file, on the day that she was discharged. He asked a junior doctor on the day Joanne “why did you do the BLT – what if medicines came tomorrow?” That is when they started to go in “different directions”. Three nurses and a doctor were involved and never got permission from their superior. “This brings emotional pain to me because it was due to the fact doctors or nurses don’t have information or because of stigma.”
“I only agreed because I had no choice but I thinking what if they find a medication one day – the possibility of having a child one day – this was going on in my mind. From that time I went through a lot of emotional confusion. Now I am on treatment for a psychiatric problem. I get treatment every month. When I stop I start a headache and I can not sleep. The route cause was when I was told to go through all this, the abortion. From this year I started to think about having a baby – and how can I do it if this has been done. It has caused me a problem. When I have a boyfriend who marries me – when I am stopped to have birth how can he accept this issue? When you get married then you can’t give birth the people are shouting at you and that is the problem”. Joanne does not have any other children.
A family member was with Joanne when she was sterilised and they told the rest of the family that she had an abortion and that made her feel very bad. No other family member visited her while she was in hospital after that. “The time I was in hospital I did not want to go home because if I go home everyone will know that I had TOP and am HIV positive. Why can’t the car overturn and I will die?”
“I informed my parents and it created anger in them because my namesake was crying because what happened but I did not tell them I was HIV positive only that I was sterilised. It has caused me to start to concern and I was crying every day – when I get information about HIV I cry and cry - why do they do abortion? Maybe my child grow this high.”
Joanne’s name has been changed.
“Coerced sterilisation” is generally defined as the use of coercion in obtaining the necessary informed consent for the sterilisation procedure. “Forced sterilisation” refers to instances where the woman is unaware that she would be undergoing a sterilisation procedure at the time of the surgery and only learned of the sterilisation after the fact. Female sterilisation can occur either via a hysterectomy (the removal of the uterus) or through a tubal ligation (restricting the Fallopian tubes such that a woman’s egg does not reach her uterus). Both are serious surgical procedures and are considered permanent.