Five years after her rights were allegedly violated by a trusted custodian of her health, Harriet, an HIV-positive Ugandan who requested her real name not be used, still cannot bring herself to go anywhere near the hospital where the abuse took place. She tries not to think about the betrayal, and since finding out the shocking truth, has not come face-to-face with the doctor responsible for it. But the doctor’s image will be forever ingrained in Harriet’s memory.
The 33-year-old discovered that she had been sterilised six months after the fact – when she returned to the facility where she’d given birth by caesarean and sought treatment for bleeding. “The midwife told me briefly that I’d undergone tubal ligation after I’d given birth because I already had five kids and I was HIV-positive,” Harriet is quoted in a ThinkProgress report as saying. “She explained to me that I’d never be able to give birth again. Then she left. I really felt angry, because they did it without my consent.”
Sadly, Harriet’s story is not unique, the report says. A 2013 report by the National Forum of People Living with HIV/AIDS Networks in Uganda (NAFOPHANU) found that at least 11% of women living with HIV/Aids were coerced by a health care worker. A 2015 report focusing on such coercion from Uganda-based NGO International Community of Women Living with HIV Eastern Africa (ICWEA) revealed that forced sterilisation and coercion – which includes women being given money and misinformation or being intimidated by a health worker – continues in the country.
The report says the study, which looked at HIV-positive women between 15 and 49 years old in nine districts across the country, found that 72 of the total 744 women studied reported having undergone forced and coerced sterilisation, and 20 of them were pressured into sterilisation in clinical settings, like hospitals. The study also found that three young women were forced into abortions, often unsafe in the country, by their families.
“I think there might be a lot more,” Dorothy Namutamba, ICWEA’s programmes manager, is quoted as saying, of the number of women who are victims of forced sterilisation. “There’s a level of silence around this issue,” she said, explaining that many victims do not tell their families out of the belief among many Ugandans that HIV-positive women should not bear children, as well as the stigma against those who cannot have them.
Nearly all cases of forced sterilisations in the study (over 95%) occurred when women underwent caesareans, like Harriet, the report says.
The effects of the violations on the women range from psycho-social – husbands walking out on women and their children – to diminished desire for sex, and can also lead to financial implications when abandoned women are left as breadwinners or jobless due to sickness. Like Harriet, many women only discovered they had undergone sterilisation after failing to conceive years later.
“The fact that there’s no solution – it is so painful for them,” said Namutamba, explaining that alternate birth methods like in vitro fertilisation (IVF) are “damn expensive” in Uganda. “Some have personally asked me ‘how do I untie my tubes?'”
Once lauded as a model in tackling HIV/Aids for other African countries, HIV prevalence increased in Uganda from 6.4% in 2004 to 7.3% in 2012, according to the 2011 Uganda AIDS Indicator Survey. Women between 15 and 24 years old are more likely to be HIV-positive than men, with prevalence rates for them at 4.2%, compared to 2.4% for their male counterparts. That rise has likely exacerbated the issue of forced sterilisation.
In neighbouring Kenya, the report says four HIV-positive women who were forcibly sterilised have sued the government, as well as the NGOs Médecins Sans Frontières (MSF) and Marie Stopes International, who they claim referred them to state hospitals where the sterilisations occurred, between 2005 and 2010. Some women were allegedly told that if they did not consent to the operations, they would not qualify for food portions and milk formula for their children. The petition was in court last month and has been adjourned until June.
In Uganda, the “number one reason for the sterilisations is poor attitudes of health workers towards reproductive health choices of women living with HIV,” said Namutamba.
Many Ugandan health workers deny that this forced sterilisation is happening. “We don’t say ‘Don’t become pregnant,'” Ugandan Health Minister Elioda Tumwesigye is quoted in the report as saying. “If you become pregnant we give you treatment,” he said, adding the government’s policy was “clear” in there being no family planning discrimination against women living with HIV/Aids. But, says the report, perhaps the government policy isn’t clear enough — as seen with the case of Harriet.
Today, Harriet still hasn’t received an apology from the hospital. “Even if they’d said sorry it wouldn’t have changed anything,” she said. For now, the court victories by women who were forcibly sterilised in South Africa and Namibia in 2014 offer one glimmer of hope for Harriet and others like her that things will change.
Nyasha Chingore-Munazvo, a Johannesburg lawyer who worked on the Namibia court case, believes that victory set a “precedent” for other African countries, even though the judgment didn’t find that the women were sterilised because of their HIV status. In Uganda funding for legal action is a problem and may be some time off, but there’s one thing Harriet wants in the meantime. “I want other people to know this is going on,” she said.