6 June 2016

East Africa: Forced Sterilisation of Women Living With HIV Must Stop

opinion

Forced sterilisation of women living with HIV is an injustice that many medical practitioners regard as a myth. But that is before they have listened to stories of women who have experienced this violation.

Take an example of Sandra Kalema (not real name) who narrates:

"My husband passed away just before I gave birth to our first child. As I went to the labour ward, I knew that after mourning, I would find another man to get involved with. Unknown to me then, that was the last time I would go to the labour ward as a mother to be. After giving birth, the doctor took it upon herself to sterilise me. I discovered this a while later and confirmed it when I got into a relationship and tried to get pregnant but failed. Years later, it still hurts like I just found out. I do not know what I would do to the doctor who did this to me if I laid my eyes and hands on her."

Kalema's is not an isolated case. A study conducted in Uganda and released by The International Community of Women Living with HIV Eastern Africa (ICWEA) about violations of Sexual and Reproductive Health and Rights of women living with HIV found that women living with HIV experience a wide range of violations in clinical settings, their homes and communities. The most common violation is forced and coerced sterlilisation.

The study titled violation of sexual and reproductive health and rights of women living with HIV in clinical and community setting in Uganda has many more examples. A couple of women narrate that they were told their fallopian tubes were going to be "tied" in local dialect so they thought they would be "untied" when they wanted to give birth again, the actual implication of the procedure was not explained then.

This study took place between 2014 and 2015, in nine districts of Uganda. It involved a field survey targeting 744 women living with HIV selected from rural areas, small towns and urban areas. Of these, 72 reported cases of sterilisation taking place at an average age of 29 years. Out of these, 20 women had been coerced or forced to undergo this irreversible operation. Most cases occurred in government hospitals during childbirth by caesarean section.

They were authorised by health workers and relatives of the women living with HIV. Even with initiatives like Elimination of Mother to Child Transmission, some health workers and members of society still believe that women living with HIV should not give birth.

The medical fraternity, government and the entire community should acknowledge that this vice is happening and take steps to end it. This should start with reaching out to women living with HIV, communities, health workers and men and educating them about women's rights and the fact that forced and coerced sterilisation is illegal.

Information on sexual reproductive health rights (SRHR) should also be integrated in the current HIV/Aids programmes and services. The tubal legation protocols need to be developed and should be communicated during antenatal clinic visits. Health workers need to be trained in offering professional care without violating women's rights, ensuring that informed consent processes are of high quality.

The current HIV and sexual reproductive health policies also need to be reviewed, taking into account SRHR violations. And for the women that have experienced these violations, counselling services at community level are necessary to offer psychosocial support.

And to use the example of the current cases, women who have experienced these violations should be offered legal support. We have seen this happening in Kenya where High Court is currently handling a case concerning the forced or coerced sterilisation of women living with HIV after a report titled "Robbed of Choice" was published.

And a win is possible because a court in Namibia in 2014 ruled that medical personnel at public hospitals violated the rights of three HIV-positive women when they sterilised them without their consent.

As these changes are being made, everyone needs to understand and know that Kalema and other women living with HIV like any other women who are not HIV-positive share similar sexual and reproductive health rights, including the right to get pregnant and determine how many children to have. These rights should be respected by everyone.

The writer is the communications officer, The International Community of Women Living with HIV Eastern Africa.

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