Sterilisation: the fight for bodily integrity

Accessing justice has been a long process for the sterilized HIV positive women whose cases are being heard before a judge in Namibia - and longer still for the women who may never have their day in court

After another week of testimony, the cases of forced and coerced sterilization of HIV positive women being heard in the Namibian courts have once again been postponed – this time until January of 2011.  Accessing justice has been a long process for the sterilized HIV positive women whose cases are being heard before a judge - and longer still for the women who may never have their day in court.

The movement for acknowledging the egregious violations of positive women’s rights in Namibia began in 2007 when the International Community of Women Living with HIV/AIDS and the Namibia Women’s Health Network  published a report documenting cases of forced and coerced sterilization.  Since this initial report documenting 40 cases of sterilization, formal fact-finding missions by the Namibia Women’s Health Network have resulted in the documentation of more cases of sterilization. In other instances HIV positive women have come forward with their own experiences of sterilization after hearing reports in the news.  Such was true even in the most recent week of trial as more women reported their sterilizations as word of the cases spread through Namibia.

Those who argue in support of every woman's right to have children are often met with a common refrain: “but why must a woman who has seven (insert any number here, really) children have the right to have more?  Especially an HIV positive woman!”  Life is not that straightforward when it comes to reproduction, not for an HIV positive women, and not for many other women.  Women frequently face a lack of access to contraceptives, inability to access safe abortion services, lack of education and information about preventing pregnancy.  Further, social factors including sexual violence, pressure to bear children, and a woman’s fears around child survival can influence when and how a woman becomes pregnant.

Sexual and reproductive health services must meet the needs of women as identified by women in order to respect women’s sexual and reproductive rights as well as build trust in the health care system.  A woman facing sexual violence at home needs to be able to disclose that information and seek assistance for herself and her family.  If she seeks contraceptives she should be given full access to reproductive health services with information about the effects and consequences of these options.   These types of services respect bodily integrity and enhance trust in health care providers.  This is drastically different from the outcomes of forced and coerced sterilization that, aside from the traumatic physical and emotional consequences, lead to mistrust in and fear of the health care system. This lack of trust leads to even further negative health outcomes -- as women who fear sterilization might avoid hospitals during childbirth or choose not to approach the health care system for necessary care and treatment around HIV.

One major success of the campaign to end forced sterilizations of HIV positive women thus far has been the outpouring of support for the reproductive rights of HIV positive women in Namibia.  Over sixteen hundred people from around the world signed a petition demanding that the rights of HIV positive women be respected – the petition was hand delivered to Ministry of Health officials.  Alongside the local and international activism came hundreds of articles and blogs highlighting the inequalities faced by HIV positive women.  The cases have helped also to shed light and attention on the potentially widespread nature of forced sterilization for HIV positive women outside of Namibia, as well forced sterilization of other communities of marginalized women.  Recent cases of forced sterilization against HIV positive women have been documented in Chile and South Africa.  In the case of South Africa, the sterilizations represent a failure on the part of the government to achieve the human rights principles enshrined in the country’s constitution.  With regard to other marginalized groups of women, forced sterilizations have been documented in numerous regions including in Hungary against Roma women and performed on indigenous women in Peru

International activist support and media attention has bolstered the creation of a strong and sustained movement for the rights positive women and others who are victims of forced or coerced sterilization. The alienation of HIV positive women in the context of antenatal care undermines the potential of effective prevention of mother to child transmission of HIV programs. In Namibia, the increased attention to the issue has contributed not only to support HIV positive women, but has helped raise awareness of the fact that despite gains in ensuring that human rights are respected in the response to HIV, positive women continue to suffer at the hands of the very health care system that should be providing treatment and support 

Keeping sustained focus on the issue of sterilization has made a difference in the ability of a larger movement to take shape both inside Namibia and out.  Despite the slow moving response of the courts and the states involved, it's essential that we keep the attention on the issue of forced sterilization in order to finally end this egregious violation of women’s bodies and lives.

While the cases will hopefully result in some justice for the women, there are several other steps the Namibian government should take in moving forward to rectify the current situation in hospitals that allow for forced and coerced sterilization to occur.  The government can draft a law that explicitly protects women from forced and coerced sterilization.  Currently, no such law in Namibia exists.  This should go hand in hand with a law clearly articulating the rights of women to choose when and how many children they have regardless of HIV or other marginalized status. Informed consent policies must be strengthened to ensure that women and girls receive full information about procedures, their risks, outcomes, and consequences.  Women and girls should always be offered the full range of available options for family planning and HIV positive women should be a part of this implementation process to ensure transparency. National HIV and AIDS policies should ensure that the sexual and reproductive health and rights of HIV positive women are clearly articulated.  This list is not comprehensive, but provides some insight into the many actions that could take place to help move Namibia towards a greater respect for the rights of HIV positive women.

While the court cases are going on there will be no apologies, but when the court makes its ruling the government should issue an official apology to the many Namibian women who have been forcibly sterilized, but who may never have their day in court. 

While some in the media imply or argue that there may be reasons why sterilization is warranted, we should continue to be clear that forced and coerced sterilization is never justified: the HIV epidemic cannot continue to be an excuse for violating women’s bodies.  

 

About the authors

Jennifer Gatsi Mallet is the ICW Project Officer for Parliamentarian's for Women's Health in Namibia.

Aziza Ahmed is Assistant Professor of Law at Northeastern University School of Law. She has worked as Project Manager/Research Associate at the Program on International Health and Human Rights, Harvard University.  Ms. Ahmed was a Women’s Law and Public Policy Fellow with the International Community of Women Living with HIV/AIDS where she helped to launch a project on the forced and coerced sterilization of HIV positive women in Namibia.