Hilma Nendongo went to a hospital outside the Namibian capital Windhoek to deliver her baby by caesarean section. The procedure went well and Hilma gave birth to a healthy baby boy. Months later, Hilma discovered that while she was at the hospital, the doctor had sterilized her without her knowledge. The reason? Hilma is HIV-positive, and the hospital staff decided she should not have any more children.
As part of an ongoing campaign against the forced and coerced sterilization of HIV-positive women, the Open Society Initiative for Southern Africa has partnered with renowned filmmaker Gideon Mendel to produce a series of short videos featuring stories of HIV-positive women who were forcibly sterilized in government-funded hospitals in Namibia and South Africa. In the above video, Hilma takes us back to the heartbreaking day she learned she was sterilized.
The incidence of forced sterilization of HIV-positive women worldwide is unknown, but community-led documentation efforts in Chile, the Dominican Republic, Mexico, Namibia, South Africa, and Venezuela—as well as anecdotal reports from countries in Eastern Africa, Central America, and Southeast Asia—indicate that forced sterilization of HIV-positive women is an increasingly global abuse.
Hilma was sterilized without her consent because she has HIV, but forced sterilization is never a legitimate method to prevent mother-to-child transmission of HIV or to regulate fertility. Women living with HIV can live long and productive lives and care for children. According to the World Health Organization, with proper medication and treatment, the chance that a mother will transmit HIV to a fetus is virtually nonexistent. Hilma herself proved how effective evidence-based mother-to-child transmission prevention programs can be when she gave birth to an HIV-negative son.
Despite advances in effective and affordable treatment, health care workers regularly coerce HIV-positive women to become sterilized. It is not uncommon for medical workers to misinform women about the likelihood that they will transmit HIV to their fetus if they continue a pregnancy. In some cases, women are denied access to essential medicines or medical services unless they consent to sterilization. Most commonly, women report being pushed to sign unexplained consent forms during childbirth, often as they were wheeled to the operating theater for cesarean sections and are already experiencing labor pains.
Forced and coerced sterilization of HIV-positive women is widespread and a systemic issue. A 2008 investigation by the International Community of Women Living with HIV shed light on the systemic nature of the abuse in Namibia when it found that 40 of 230 HIV-positive women from multiple regions of the country had been forced or coerced into sterilization.
However, sterilization is highly stigmatized, making it risky for affected women to come forward for fear of ridicule and abandonment. Survivors have described the physical and emotional pain as unbearable. As an HIV activist from South Africa recently told me, “If you have HIV you are still at least a woman. If you have HIV and you are sterilized you are no longer a woman.” This abuse has been characterized by United Nations officials as a form of violence against women.
In October 2009, 16 HIV-positive women who were sterilized without their consent sued the Namibian government for N$1.2m (approx. USD $167,000). With support from the Legal Assistance Centre and the Southern African Litigation Centre, the women claim that this procedure violated their rights to life, privacy, and freedom from cruel, inhuman, and degrading treatment. The hearings began in June 2010, sparking mass mobilizations and public demonstrations by HIV and human rights activists in support of the women. Under pressure from the unexpected international media spotlight on these cases and having underestimated the time necessary for the hearings, the cases were continued to September 2010 for two weeks, and have been postponed again until January 2011. You can get case updates and follow upcoming community actions on the End Forced Sterilization campaign blog.
As a result of media attention on the lawsuits, women are now finding out about their own sterilizations. We met one group of women outside the court in September. They brought their Namibian health passports with them: each had been stamped with the letters “TBL.” For months, and sometimes years, the women remained curious about the letters but never knew what they meant. Now they know TBL stands for “tubal ligation”—a permanent form of female sterilization.
The Namibian government maintains that there was no force or coercion in these cases because the women signed consent forms for the procedure. But as we see in Hilma’s video, a signature on a piece of paper means nothing if a woman is tricked into signing it. Informed consent is a process of communication between a medical provider and a patient. Sterilization is never a medical emergency. Medical workers have ample time to explain the consequences of an irreversible procedure before a patient enters the operating room.
Regardless of what happens with the legal cases, the Namibian government needs to acknowledge its role in perpetrating this abuse—a grave violation of international human rights standards. It must put measures in place to ensure that all women fully and freely consent before being sterilized. Women who have been sterilized should be compensated for this violation of their rights. This will send a clear message to medical workers that they cannot continue to violate the rights of their patients or treat women living with HIV as less than human.
Until then, we will continue to hear more stories like Hilma’s. We will see more women decoding the mysteries of their health passports. And women will continue to fight back against these acts of abuse.