This week three cases of forced and coerced sterilization of HIV positive women will be heard before the High Court in Namibia to seek compensatory damages for harm done to the individual women. The women are each suing the Ministry of Health and Social Transformation and are amongst the first cases in Africa in which women are seeking compensation. As a demonstration of support protestors will convene at Namibian embassies and High Commissions in Zambia, Swaziland, South Africa and the United States, to demand justice.
Forced and coerced sterilization came to the forefront of positive women’s activism in Namibia when in 2008 the International Community of Women Living with HIV/AIDS (ICW) and the Namibia Women’s Health Network (NWHN) began documenting cases of forced and coerced sterilization of HIV positive women. The news of the sterilizations emerged slowly, first amongst the circles of support developed to address the needs of positive women. In 2008, a team from ICW and NWHN led by Jennifer Gaits-Mallet traveled to support groups around Namibia where women told us of their experiences of unwanted sterilization. Realizing the systematic nature of the sterilization of HIV positive women was startling as woman after woman raised her hand in group discussions to tell a story of a sterilization procedure that she had never consented to.
“Before I found out I was HIV positive and I was having a child I was okay. But after I tested positive they treated me badly. They said, "why do you want to have a baby if you are HIV positive?”. The sterilizations occurred primarily when women were in labour and during caesarean sections – or while seeking related sexual and reproductive health services. In several instances women were given incomplete or incorrect information about the realities of having a child while HIV positive. “I did not get information that a person living positive can have babies. They just told me I must go for sterilization, so I went for it. It was not my idea. They said, ‘if you go for sterilization, it’s for your health and so you don’t spread the disease".
The women’s experiences took place in an environment of stigma and discrimination practised by hospital staff who felt that HIV positive women should not be having children. In our interviews, doctors also expressed the belief that women did not know how best to care for their own bodies. To these physicians, this rationale justified making decisions on behalf of HIV positive women. " The hospital staff said to us you are not supposed to have more kids because there is no-one supporting you. You cannot support yourself or your kid so it is best if you are sterilized.”
Many more women continue to come forward to talk about having been forcibly sterilized. Several of these recently reported cases were documented by a fact-finding mission undertaken by the Human Rights Program at the Harvard Law School under the guidance of the Namibia Women’s Health Network in April of this year where again, in site after site, women came forward to report their experience with health care providers who encouraged sterilization, and in many cases, carried out sterilization without informed consent. These additional cases further demonstrate that the practice of sterilizing women without their full and informed consent is spread throughout the country.
The potential ramifications of mistreatment, stigma, and discrimination of HIV positive women are serious in all countries, and particularly so in Namibia where approximately 17.8% percent of women accessing pregnancy services test HIV positive. Currently access to anti-retroviral therapy can mean that an HIV positive woman has less than a 2% chance of having a child born with HIV. However, the systematic abuse of HIV positive women in hospital settings could deter women from trusting service providers and drive them away from hospital settings - making it increasingly difficult to reach HIV positive women, or indeed any pregnant women who fear they might have HIV - and provide them with the care that they need.
The reports of cases of forced and coerced sterilization of HIV positive women are not exclusive to Namibia. After the initial report was released by ICW and NWHN, the organizations were contacted by other groups based throughout sub-Saharan Africa with concerns that HIV positive women were also being coercively sterilized in their own countries. Organizations are also beginning to address this issue in other regions of the world. The Center for Reproductive Rights and Vivo Positive have recently supported an HIV positive Chilean woman to file a complaint against the Chilean government in the Inter American Court of Human Rights, stating that she was sterilized against her will due to her HIV status.
The cases of forced and coerced sterilization in Namibia and elsewhere is indicative of an attitude held by many that HIV positive women and men should not be allowed to have children. Positive women will challenge this attitude in court this week with representation from the Litigation Assistance Center and with support from several other organizations including NWHN, ICW, AIDS and Rights Alliance for Southern Africa, and the Southern African Litigation Center. We will await the decision of the High Court in Namibia in the hope that it will not only recognize these grave wrong doings and the deep stigma that exists against HIV positive people desiring children, but that the decision of the court will be a tangible move towards ensuring that discrimination against positive individuals will no longer be tolerated.